“…Prior reports have highlighted sex disparities in ICD and CRT implantation rates. 5 Whether or not there is a sex disparity of HF treatments in Moldova will require future analysis of our HF patient population. Figure 2 Distribution by sex.…”
“…Prior reports have highlighted sex disparities in ICD and CRT implantation rates. 5 Whether or not there is a sex disparity of HF treatments in Moldova will require future analysis of our HF patient population. Figure 2 Distribution by sex.…”
“…White patients with ICM are more likely to get admitted for invasive diagnostic testing compared to Black, Asian, and Indigenous patients in the United States (P < 0.01) [95] . Once diagnosed with ICM, the use of implantable cardioverterdefibrillator among women (3.5% vs. 10.2%; P < 0.001) and Black patients (5.4% vs. 8.1%; P < 0.001) is significantly lower compared to men and White patients, respectively [96,97] . In addition, while GDMT for heart failure is underprescribed for all racial and ethnic groups, Black patients with hFrEF are more likely to get discharged with optimal GDMT [98] , particularly β-blockers (OR 1.45, 95%CI: 1.10-1.90; P = 0.008) and angiotensin-converting enzyme inhibitors or angiotensin II receptor blocker (OR 1.57, 95%CI: 1.13-2.18; P = 0.008), compared to White patients due to higher rates of hypertension among Black patients [98,99] .…”
Section: Disparities In Management and Outcomes Of Cad With Reduced Lvefmentioning
Revascularization through percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) is used to manage left ventricular systolic dysfunction (LVSD) due to coronary artery disease (CAD). This review provides an overview of coronary revascularization for CAD with reduced left ventricular ejection fraction (LVEF), focusing on disparities in management. CABG provides more complete revascularization, and lower long-term all-cause mortality and reintervention and MI rates compared to PCI in patients with LVSD and CAD. Consequently, CABG is recommended as the primary revascularization therapy for CAD with reduced LVEF, with PCI being reserved for patients who are high-risk or have unfavorable coronary anatomy. Although LVSD increases revascularization risk, differential outcomes can be attributed to patients’ biological, behavioral, and socioeconomic factors as well as health system deficiencies. Women and racially and/or ethnically minoritized patients often present with progressive disease and greater comorbidity, experience delays in diagnosis and treatment, and have higher morbidity and mortality rates post-revascularization. These disparities may be explained by biological differences compounded by social determinants of health. Patients with CAD with LVSD pose unique medical challenges, which may be further complicated by disparities in care. Increased representation of minoritized patients in cardiovascular trials is needed to elucidate these differences and their long-term impact.
“…Furthermore, the included studies relied disproportionally on male participants, except for the Nordland study [26]. This may be explained by the significant sex disparity in ICD implantation rates, pointed out by Ingelaere et al [43]. Ingelaere et al [43] could not completely explain these differences by prevalence differences of cardiomyopathies and imply a possible undertreatment of women.…”
Section: Principal Findings and Comparison With Prior Workmentioning
Background
Telemonitoring patients with cardiac implantable electronic devices (CIEDs) can improve their care management. However, the results of cost-effectiveness studies are heterogeneous. Therefore, it is still a matter of debate whether telemonitoring is worth the investment.
Objective
This systematic review aims to investigate the cost-effectiveness of telemonitoring patients with CIEDs, focusing on its key drivers, and the impact of the varying perspectives.
Methods
A systematic review was performed in PubMed, Web of Science, Embase, and EconLit. The search was completed on July 7, 2022. Studies were included if they fulfilled the following criteria: patients had a CIED, comparison with standard care, and inclusion of health economic evaluations (eg, cost-effectiveness analyses and cost-utility analyses). Only complete and peer-reviewed studies were included, and no year limits were applied. The exclusion criteria included studies with partial economic evaluations, systematic reviews or reports, and studies without standard care as a control group. Besides general study characteristics, the following outcome measures were extracted: impact on total cost or income, cost or income drivers, cost or income drivers per patient, cost or income drivers as a percentage of the total cost impact, incremental cost-effectiveness ratios, or cost-utility ratios. Quality was assessed using the Consensus Health Economic Criteria checklist.
Results
Overall, 15 cost-effectiveness analyses were included. All studies were performed in Western countries, mainly Europe, and had primarily a male participant population. Of the 15 studies, 3 (20%) calculated the incremental cost-effectiveness ratio, 1 (7%) the cost-utility ratio, and 11 (73%) the health and cost impact of telemonitoring. In total, 73% (11/15) of the studies indicated that telemonitoring of patients with implantable cardioverter-defibrillators (ICDs) and cardiac resynchronization therapy ICDs was cost-effective and cost-saving, both from a health care and patient perspective. Cost-effectiveness results for telemonitoring of patients with pacemakers were inconclusive. The key drivers for cost reduction from a health care perspective were hospitalizations and scheduled in-office visits. Hospitalization costs were reduced by up to US $912 per patient per year. Scheduled in-office visits included up to 61% of the total cost reduction. Key drivers for cost reduction from a patient perspective were loss of income, cost for scheduled in-office visits and transport. Finally, of the 15 studies, 8 (52%) reported improved quality of life, with statistically significance in only 1 (13%) study (P=.03).
Conclusions
From a health care and patient perspective, telemonitoring of patients with an ICD or a cardiac resynchronization therapy ICD is a cost-effective and cost-saving alternative to standard care. Inconclusive results were found for patients with pacemakers. However, telemonitoring can lead to a decrease in providers’ income, mainly due to a lack of reimbursement. Introducing appropriate reimbursement could make telemonitoring sustainable for providers while still being cost-effective from a health care payer perspective.
Trial Registration
PROSPERO CRD42022322334; https://tinyurl.com/puunapdr
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
