A191 required to recoup the intervention cost sooner. In this study, we focused on persons at high risks for both hypertension and diabetes and assessed the costeffectiveness of lifestyle interventions from a health plan perspective. METHODS: We used a Markov-based discrete event model to simulate the health and economic outcomes associated with lifestyle interventions compared with normal care over persons' lifetime. The target population is U.S. adults with both prehypertension (a systolic blood pressure of 120-139 mm Hg or diastolic blood pressure of 80-89 mm Hg) and prediabetes. Data on the effect and costs of the intervention were obtained from published clinical trials. Outcomes included the incidences of diabetes and cardiovascular diseases, quality adjusted life years (QALY), and cost per QALY. Costs were expressed in 2012 US dollar. RESULTS: In persons aged 18-64, the intervention reduced the incidence of diabetes by 22% and major cardiovascular diseases by 7% over a lifetime. In persons aged 65-84, the corresponding reductions were 32% and 3% respectively. The intervention would save $3,500 and $1,500 per person among those aged 18-64 and 65-84 respectively. The intervention achieved cost-even in 10 years among those aged 18-64 and in 6 years among those aged 65-84 since initiation. CONCLUSIONS: Lifestyle intervention, targeting to persons at a high risk for both hypertension and diabetes, would lead to a greater lifetime saving and sooner recovery of the intervention costs, compared with targeting to those at risk for diabetes alone.
Pb) from a decomposed carotid pressure wave were obtained before discharge. Serum levels of NT-proBNP and the thoracic fluid content (TFC) were also determined before discharge. Patients were followed for up to 2 years.Results During a follow-up of 400 AE 256 days (range 16 to 730 days), 75patients experienced cardiovascular events including rehospitalization for heart failure, non-fatal myocardial infarction, non-fatal stroke, and mortality. The eventful patients were older, had lower estimated glomerular filtration rate (eGFR), and higher TFC, cf-PWV, SBP-c, PP-c, Pb, and levels of NT-proBNP. In multi-variate analysis, PP-c, and Pb but not cf-PWV were significant independent predictors of cardiovascular events, after accounting for age, eGFR, and NT-proBNP. Time series analysis demonstrated that Pb was the most significant hemodynamic predictor of cardiovascular events at 6 month (hazard ratio per SD, 1.5, 95% CI 1.2-2.0) and the significance declined with time. In contrast, cf-PWV was not significant predictor until 2 years after discharge (1.3, 95% CI 1.0-1.6).Conclusion Arterial wave reflection indexed by Pb may be the most important pulsatile hemodynamic factor associated with the outcomes of AHFS. The prognostic importance of arterial stiffness indexed by cf-PWV may not manifest until 2 years after discharge in patients with AHFS.
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