Approximately one half of the recent decline observed in age-adjusted coronary heart
disease (CHD) mortality rates can be attributed to the use of modern medical and surgical
interventions. In 2000, however, only about 30% to 60% of eligible patients actually
received the appropriate treatment. To examine the reduction in CHD mortality potentially
achievable by increasing the provision of specific medical and surgical treatment
to eligible patients with CHD in the United States, we integrated the data on CHD
patient numbers, medical and surgical treatment uptake levels, and treatment effectiveness
using a previously validated CHD policy model. We estimated the number of deaths prevented
or postponed for 2000 (baseline) and for an alternative scenario (60% of eligible
patients). In 2000, the treatment levels in the United States were generally poor;
only 30% to 60% of eligible patients received the appropriate therapy. These treatments
resulted in approximately 159,330 fewer deaths. By treating 60% of eligible patients,
297,470 fewer deaths would have been obtained (minimum 118,360; maximum 628,120),
representing 134,635 less than in 2000, with approximately 32% from heart failure
therapy, 30% from secondary prevention therapy, 19% from acute coronary syndrome treatment,
15% from primary prevention with statins, 0.5% from hypertension treatment, and 1%
from coronary bypass surgery for chronic angina. These findings remained stable in
the sensitivity analysis. In conclusion, increasing the proportion of eligible patients
with CHD who received the appropriate treatment could have achieved approximately
135,000 fewer deaths in 2000, almost doubling the benefit actually achieved. Future
strategies should maximize the delivery of appropriate therapies to all eligible patients
with CHD and prioritize medical therapies for secondary prevention and heart failure.
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References
- Explaining the decline in coronary mortality in the United States between 1980 and 2000.N Engl J Med. 2007; 356: 2388-2398
- A public health action plan to prevent heart disease and stroke.(Accessed on July 16, 2007)
- Explaining the decline in coronary heart disease mortality in England and Wales, 1981–2000.Circulation. 2004; 109: 1101-1107
- NCHS-CMS Linkage: Medicare Enrollment and Claims Files (2000).(Accessed November 15, 2007)
- Unstable angina: good long-term outcome after a complicated early course.J Am Coll Cardiol. 1998; 31: 1534-1539
- Detecting differences in quality of care: the sensitivity of measures of process and outcome in treating acute myocardial infarction.BMJ. 1995; 311: 793-796
- A critical evaluation of the methodology of the literature on medication compliance.Ann Pharmacother. 1999; 33: 531-540
- The decline in ischemic heart disease mortality rates: an analysis of the comparative effects of medical interventions and changes in lifestyle.Ann Intern Med. 1984; 101: 825-836
- Increasing the impact of cardiological treatments: how best to reduce deaths.Eur Heart J. 1999; 20: 1386-1392
- Optimal medical therapy with or without PCI for stable coronary disease.N Engl J Med. 2007; 356: 1503-1516
- Uncertainty in the economic evaluation of health care technologies: the role of sensitivity analysis.Health Econ. 1994; 3: 95-104
- International trends in coronary heart disease mortality, morbidity, and risk factors.Epidemiol Rev. 1990; 12: 1-15
- The decline in ischemic heart disease mortality rates: an analysis of the comparative effects of medical interventions and changes in lifestyle.Ann Intern Med. 1984; 101: 825-836
- Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries: principal results from EUROASPIRE II Euro Heart Survey Programme.Eur Heart J. 2001; 22: 554-572
- Over 20,000 avoidable coronary deaths in England and Wales in 2000: the failure to give effective treatments to many eligible patients.Heart. 2006; 92: 521-523
- The population mortality benefits of maximizing the number of eligible patients receiving appropriate cardiology treatments in Ireland.QJM. 2006; 99: 523-530
- Explaining the recent decrease in coronary heart disease mortality rates in Ireland, 1985–2000.J Epidemiol Commun Health. 2006; 60: 322-327
- The quality of health care delivered to adults in the United States.N Engl J Med. 2003; 348: 1866-1868
- Quality of care for coronary heart disease in two countries.Health Aff (Millwood). 2001; 20: 55-67
- Improving care for patients with acute coronary syndromes: initial results from the National Audit of Myocardial Infarction Project (MINAP).Heart. 2004; 90: 1004-1009
- In-hospital initiation of lipid-lowering therapy after coronary intervention as a predictor of long-term utilization: a propensity analysis.Arch Intern Med. 2003; 163: 2576-2582
- High and rising health care costs.Ann Intern Med. 2005; 143: 26-31
- Cardiovascular disease prevention and disease management: a critical role for nursing.J Cardiopulmonary Rehabil. 2006; 26: 197-206
- An intervention to improve secondary prevention of coronary heart disease.Arch Intern Med. 2007; 167: 586-590
- Effect of combinations of drugs on all cause mortality in patients with ischaemic heart disease: nested case-control analysis.BMJ. 2005; 330: 1059-1063
- Commentary: relative treatment effects are consistent across the spectrum of underlying risks, usually.Int J Epidemiol. 2002; 31: 76-77
- Missing, mediocre, or merely obsolete?.J Epidemiol Commun Health. 2003; 57: 530-535
- Economics notes: handling uncertainty in economic evaluation.BMJ. 1999; 319: 120
- Life-years gained from modern cardiological treatments and population risk factor changes in England and Wales, 1981–2000.Am J Pub Health. 2003; 95: 103-108
- The economic burden of coronary heart disease in the UK.Heart. 2002; 88: 597-603
Article info
Publication history
Published online: May 04, 2009
Accepted:
February 5,
2009
Received in revised form:
February 5,
2009
Received:
September 30,
2008
Footnotes
M. O'Flaherty was a Medical Research Council Research Fellow, and E. Ford was employed by the Centers for Disease Control; the funding sources have not been involved in any step of this research.
Identification
Copyright
© 2009 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
