Ethnic differences in the cost-effectiveness of targeted and mass screening for high cardiovascular risk in the UK: cross-sectional study

Baker, Jessica; Mitchell, Richard; Lawson, Kenny; Pell, Jill P.

doi:10.1136/heartjnl-2013-304625

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…The ability to reliably risk stratify populations at greater risk of adverse cardiac events is therefore of great importance. Recently, cardiovascular screening demonstrated the potential to reduce ethnic health inequalities [ 40 ]. In our study Indian Asians had a significantly greater prevalence of hypertension, diabetes mellitus, and hypercholesterolemia compared to Afro-Caribbeans and European whites.…”

Section: Discussionmentioning

confidence: 99%

The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients

O’Driscoll

Rossato

Gargallo-Fernandez

et al. 2015

Cardiovasc Ultrasound

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BackgroundThe incidence of cardiovascular disease is considerably disparate among different racial and ethnic populations. While dobutamine stress echocardiography (DSE) has been shown to be useful in Caucasian patients, its role among ethnic minority groups remains unclear. This study aimed to investigate the prognostic importance of DSE in three ethnic groups in the UK.MethodsDSE was performed on 6231 consecutive patients. After exclusions, 5329 patients formed the study (2676 [50.2 %] Indian Asian, 2219 [41.6 %] European white and 434 [8.1 %] Afro-Caribbean). Study outcome measures were non-fatal cardiac events (NFCE) and all-cause mortality.ResultsThere were 849 (15.9 %) NFCE and 1365 (25.6 %) deaths over a median follow-up period of 4.6 years. In total 1174 (22 %) patients had inducible myocardial ischaemia during DSE, 859 (16.1 %) had fixed wall motion abnormalities and 3645 (68.4 %) patients had a normal study. Ethnicity did not predict events. Among the three ethnic groups, ischaemia on DSE was associated with 2 to 2.5 times the risk of non-fatal cardiac events and 1.2 to 1.4 times the risk of all-cause mortality. Peak wall motion score index was the strongest independent predictor of non-fatal cardiac events and all-cause mortality in all groups. The C statistic for the prediction of NFCE and all-cause mortality were significantly higher when DSE parameters were added to the standard risk factors for all ethnic groups.ConclusionsDSE is a strong predictor of NFCE and all-cause mortality and provides predictive information beyond that provided by standard risk factors in three major racial and ethnic groups. No major differences among racial and ethnic groups in the predictive value of DSE was detected.Electronic supplementary materialThe online version of this article (doi:10.1186/s12947-015-0028-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients

O’Driscoll

Rossato

Gargallo-Fernandez

et al. 2015

Cardiovasc Ultrasound

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“…Current evidence indicates that screening for total cardiovascular risk, blood pressure measurement as well as blood glucose testing is more cost effective than screening the whole population for a single risk factor, and is cost effective in identifying individuals at high cardiovascular risk (39)(40)(41). In the setting of low and middle income countries, several barriers hinder accurate and affordable blood pressure measurement (42).…”

Section: P R E V E N T I O N a N D C O N T R O L M E A S U R E Smentioning

confidence: 99%

Review of Hypertension in sub-Saharan Africa

Nkyi

2017

Afri Jour Cur Med Res

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The prevalence of hypertension in sub-Saharan Africa is high and it is the main driver for cardiovascular diseases in the region. Cardiovascular diseases are associated with high morbidity and mortality worldwide. The high prevalence of hypertension in sub-Saharan Africa (SSA) can be attributed to rural-urban migration, high salt intake, smoking of tobacco and inadequate exercise. Awareness and control of hypertension is generally low with women having better control rates as compared to men. Untreated hypertension is associated with stroke, myocardial infarction and renal failure. The management of hypertension in the sub region is a major challenge due to financial constraints and inadequate resources. Hypertension is struggling to gain priority as a major health threat as infectious diseases like Human Immunodeficiency virus (HIV), tuberculosis (TB) and malaria are the main focus of most public health institutions. Hypertension is largely preventable and can be easily controlled using evidence based practices such as regular exercises, decreasing salt intake, cessation of smoking and alcohol intake and the usage of antihypertensives.Non-communicable diseases such as hypertension are rapidly overtaking communicable diseases in the sub-Saharan region and pose a major health threat. There is a need to prioritize cardiovascular diseases with a focus on pragmatic prevention and control of hypertension in order to decrease the burden of the disease in the region.

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“…Targeting certain ethnic groups may be more cost-effective and could reduce ethnic health inequities. 95 Some data suggest that variable willingness to pay may justify doing screenings, especially in high-risk groups. 96…”

Section: Summary Of Screening Recommendationsmentioning

confidence: 99%

Cardiovascular Ultrasound Combined With Non-invasive Screening for the Detection of Undiagnosed Cardiovascular Disease: A Literature Review

Bierig

Arnold

Einbinder³

et al. 2017

Journal of Diagnostic Medical Sonography

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Non-invasive screenings have been widely utilized in the United States and worldwide to provide early identification of cardiovascular disease, allowing for earlier diagnosis and treatment. Screening sonography detects valve disease, cardiac dysfunction, and carotid disease in 5% to 20% of the population. This review discusses the current data regarding cardiovascular screening, the methodologies, and the resources required for performance of screenings. Cardiac and carotid sonography is highly accurate and discovers cardiovascular diseases that impact quality of life and risk of future events. Screenings are performed in a variety of settings and accuracy depends on the quality of personnel performing the non-invasive testing, the equipment utilized, and the personnel interpreting the studies. Despite the potential benefit for disease detection, population screening to detect cardiovascular disease is not widely supported by national organizations due to the theoretical cost of further testing and lack of cost versus benefit data. Additional studies are necessary to compare costs and benefits of non-invasive cardiovascular screening in the community setting.

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Ethnic differences in the cost-effectiveness of targeted and mass screening for high cardiovascular risk in the UK: cross-sectional study

Abstract: Irrespective of whether cardiovascular screening is targeted or universal, it is more cost-effective in South Asian ethnic groups than in the general population. Therefore, cardiovascular screening has the potential to reduce ethnic health inequalities.

Cited by 11 publications

References 27 publications

The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients

The prognostic value of dobutamine stress echocardiography amongst British Indian Asian and Afro-Caribbean patients: a comparison with European white patients

Review of Hypertension in sub-Saharan Africa

Cardiovascular Ultrasound Combined With Non-invasive Screening for the Detection of Undiagnosed Cardiovascular Disease: A Literature Review

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