There were 16 cases of heart failure for every 1000 Filipino patients admitted due to a medical condition in 2014. Hypertension was possibly the most common aetiologic factor. Compared to western and Asia-Pacific countries, the local mortality rate was relatively higher.
Background Patients 65 years old and older largely represent (>50%) hospital-admitted patients with acute coronary syndrome (ACS). Data are conflicting comparing efficacy of early routine invasive (within 48-72 hours of initial evaluation) versus conservative management of ACS in this population. Objective We aimed to determine the effectiveness of routine early invasive strategy compared to conservative treatment in reducing major adverse cardiovascular events in patients 65 years old and older with non-ST elevation (NSTE) ACS. Data sources We conducted a systematic review of randomized controlled trials (RCTs) through PubMed, Cochrane, and Google Scholar database. Study selection The studies included were RCTs that evaluated the effectiveness of invasive strategy compared to conservative treatment among patients � 65 years old diagnosed with NSTEACS. Studies were included if they assessed any of the following outcomes of death, cardiovascular mortality, myocardial infarction (MI), stroke, recurrent angina, and need for revascularization. Six articles were subsequently included in the meta-analysis.
ObjectivesHospitalisation for congestive heart failure (CHF) was reported to be 1648 cases for every 100 000 patient claims in 2014 in the Philippines; however, there are no data regarding its economic impact. This study determined CHF hospitalisation cost and its total economic burden. It compared the healthcare-related hospitalisation cost from the societal perspective with the payer’s perspective, the Philippine Health Insurance Corporation (PhilHealth).MethodsThis is a cost analysis study. Data were obtained from representative government/private hospitals and a drugstore in all regions of the country. Healthcare costs included cost of diagnostics/treatment, professional fees and other CHF-related hospital charges, while non-healthcare costs included production losses, transportation and food expenses.ResultsThe overall mean healthcare-related cost for CHF hospitalisation (class III) in government hospitals in the Philippines in 2014 was PHP19 340–PHP28 220 (US$436–US$636). In private hospitals, it was PHP28 370–PHP41 800 (US$639–US$941). In comparison, PhilHealth’s coverage/CHF case rate payment is PHP15 700 (US$354). The mean non-healthcare cost was PHP10 700–PHP14 600 (US$241–US$329). Using PhilHealth’s case rate payment and the prevalence of CHF hospitalisation in 2014, the total economic burden was PHP691 522 200 (US$15 574 824). Using the study results on healthcare-related cost meant that the total economic burden for CHF hospitalisation would instead be PHP851 850 000–PHP1 841 563 000 (US$19 185 811–US$41 476 644).ConclusionsThe calculated healthcare-related hospitalisation cost for CHF in the Philippines in 2014 demonstrates the disparity between the actual cost and PhilHealth’s coverage. This implies a need for policymakers to review its coverage to make healthcare delivery affordable.
Introduction Heart failure (HF) is a major public health problem that affects 23 million people worldwide. The global incidence and prevalence rates of HF are approaching epidemiologic proportions, as evidenced by the relentless increase in the number of HF hospitalizations, the growing number of HF deaths, and the spiraling costs associated with the care of HF patients. Its diagnosis may be challenging because symptoms are nonspecific. Determination of left ventricular filling pressure (LVFP) is important to interpret equivocal symptoms so as to optimize therapy. Catheterization remains to be the gold standard; however, it is not practical to submit many patients with clinical suspicion of HF to invasive studies. Although echocardiographic indices are recommended by recent guidelines (Level IIIB), studies have shown conflicting results on its diagnostic performance. Purpose This study aims to identify the diagnostic performance of 2D-echocardiography compared with cardiac catheterization in assessing LV end-diastolic pressure (LVEDP) among adult patients with suspected HF using a meta-analysis of observational studies. Methods Eight studies with a total of 1,153 patients with suspected HF who underwent simultaneous evaluation of echocardiographic estimates of LVFP and invasive measurement of LVEDP by cardiac catheterization were included in the final analysis after extensive searching. Review Manager 5.3 was used to the assess the sensitivity and specificity of E/e' lateral, septal and average, and left atrial volume index (LAVI). Meta-Disc was applied to obtain pooled estimates, receiver operating characteristic curve (ROC) and area under curve (AUC) using a 95% confidence interval. Results Overall, pooled estimates for E/e' septal >15, E/e' lateral >12, E/e' average >13 and LAVI >34 have significant diagnostic values with pooled sensitivity of 62% (95% CI 0.54 to 0.69), 39% (95% CI 0.33 to 0.45), 81% (95% CI 0.73 to 0.87) and 53% (95% CI 0.46 to 0.61) respectively; pooled specificity of 59% (95% CI 0.53 to 0.65), 87% (95% CI 0.81 to 0.91), 72% (95% CI 0.65 to 0.78) and 69% (95% CI 0.57 to 0.79) respectively; and pooled AUC of 0.624, 0.8486, 0.8190 and 0.69 respectively. Conclusion 2D echocardiography have significant diagnostic performance compared with cardiac catheterization in assessing LVEDP among adults with suspected HF. Guidelines may be updated using this meta-analysis.
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