Abstract:
BACKGROUND:Few telemedicine programs have undergone cost analyses, impeding their implementation into practice. We report on the economic analysis of a nurse-administered intervention designed to improve blood pressure control among hypertensive veterans. METHODS:We randomized hypertensive patients at the Durham Veterans Affairs Medical Center primary care clinic to behavioral (n = 294) or nonbehavioral (n = 294) interventions. Behavioral intervention patients received tailored information bimonthly for 2 years via telephone. To calculate intervention cost, we microcosted the nurse's labor cost and computer hardware and software costs, applied a direct-to-indirect cost ratio, and distributed the costs over an estimated cohort of patients. We analyzed data from the Veterans Affairs Decision Support System to assess whether the intervention impacted overall health care utilization and costs. We used life expectancy estimates from the literature to develop decision models to calculate cost per life-year saved. RESULTS:The mean annual intervention cost was $112 (range $61-$259). During 2 years of follow-up, patients in the intervention group incurred $7,800 in inpatient costs and $9,741 in outpatient costs; the nonintervention group incurred $6,866 in inpatient costs and $9,599 in outpatient costs. The total cost difference was not statistically significant (P = .56). Cost-effectiveness of the behavioral intervention ranged from $42,457 per life-year saved for normal-weight women to $87,300 per life-year saved for normal-weight men. CONCLUSIONS:The study results suggest that a nurse-administered, tailored behavioral intervention can be implemented at nominal cost and be cost-effective; however, there was no apparent lowering of health care utilization and costs during the 2 years of follow-up.
journal_name
Am Heart Jjournal_title
American heart journalauthors
Datta SK,Oddone EZ,Olsen MK,Orr M,McCant F,Gentry P,Bosworth HBdoi
10.1016/j.ahj.2010.05.024subject
Has Abstractpub_date
2010-08-01 00:00:00pages
257-63issue
2eissn
0002-8703issn
1097-6744pii
S0002-8703(10)00430-8journal_volume
160pub_type
杂志文章,随机对照试验abstract::We studied the prevalence and clinical significance of transient U wave inversion in 43 patients with variant angina. Twenty-four patients (group A) had ST segment elevation in the anterolateral and 19 patients (group B) had this finding in the inferoposterior leads of the ECG during spontaneous angina. In none of the...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90452-6
更新日期:1984-10-01 00:00:00
abstract::Transthoracic echocardiography has played a useful role in the screening of cardiac transplant donors. However, transthoracic echocardiograms may be suboptimal in many patients on ventilators. The role of transesophageal echocardiography in cardiac donor screening is unknown. Therefore we compared the potential benefi...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(93)90758-2
更新日期:1993-06-01 00:00:00
abstract:BACKGROUND:A shortcoming of the pediatric electrocardiogram (ECG) appears to be its inability to accurately detect left ventricular hypertrophy (LVH). This study prospectively assesses the usefulness of the pediatric ECG as a screening modality for LVH. METHODS:Concomitant echocardiograms and ECGs from a large cohort ...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1067/mhj.2003.15
更新日期:2003-04-01 00:00:00
abstract::To determine whether the first postpacing interval after entrainment was affected by recording and pacing sites, overdrive atrial pacing was undertaken in 13 episodes of atrial flutter with a mean flutter cycle length (FCL) of 140 +/- 8 msec induced in seven dogs. Atrial flutter was induced by means of an anatomic obs...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90259-7
更新日期:1989-09-01 00:00:00
abstract:BACKGROUND:The significance of troponin elevation and clinical utility of troponin testing in ambulatory patients with coronary artery disease (CAD) have not been examined. We sought to investigate the prevalence and prognostic value of cardiac troponin T (cTnT) elevation in a population with stable CAD. METHODS:We st...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2009.07.021
更新日期:2009-10-01 00:00:00
abstract:BACKGROUND:High-sensitivity C-reactive protein (hsCRP) is promoted as an independent predictor of atherosclerotic risk. In addition, cardiorespiratory fitness is inversely related to hsCRP in single-sex cross-sectional analyses. Our objective was to determine if modulating fitness with exercise training imposes changes...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2006.04.019
更新日期:2006-10-01 00:00:00
abstract::Myocardial reperfusion is associated with increased influx of activated neutrophils and intracellular accumulation of sodium in the ischemic zone. Lidocaine is a sodium channel blocker that also inhibits several neutrophil functions. We investigated the effect of lidocaine on infarct size in rabbits undergoing 30 minu...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(97)70226-6
更新日期:1997-03-01 00:00:00
abstract:BACKGROUND:Understanding pulmonary vein (PV) anatomy is important for the planning and execution of PV isolation for the treatment of atrial fibrillation, screening for PV stenosis after the procedure, and investigating the pathophysiology of atrial fibrillation. We hypothesized that significant changes in PV size occu...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2006.05.018
更新日期:2006-11-01 00:00:00
abstract::Fifty adult men with mild to moderate hypertension were recruited to participate in a double-blind crossover study. Each subject received 14 days of drug treatment and 14 days of placebo treatment (random order). Half the subjects were assigned to a metoprolol (150 mg/day) vs placebo treatment regimen and half to an a...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1016/0002-8703(88)90106-8
更新日期:1988-07-01 00:00:00
abstract:BACKGROUND:We sought to systematically evaluate whether percutaneous revascularization is associated with additional clinical benefit in patients with renal artery stenosis (RAS) as compared with medical management alone. METHODS:We included randomized controlled trials that compared percutaneous revascularization in ...
journal_title:American heart journal
pub_type: 杂志文章,meta分析
doi:10.1016/j.ahj.2010.12.006
更新日期:2011-03-01 00:00:00
abstract::Left ventricular (LV) thrombi are responsible for significant morbidity and mortality in our society. Twenty-five percent of cardiogenic emboli are associated with acute and chronic myocardial infarction. With the development of noninvasive imaging techniques LV thrombi have been increasingly recognized as an importan...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/0002-8703(92)91069-d
更新日期:1992-04-01 00:00:00
abstract::Oxygen has long been assumed beneficial for all ill and injured patients. However, hyperoxia may be harmful and aggravate myocardial injury such as that caused by myocardial infarction. We aimed to investigate if hyperoxia increases myocardial injury following direct current cardioversion compared with room air. METH...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2017.10.006
更新日期:2018-02-01 00:00:00
abstract:BACKGROUND:Stroke prevention in anticoagulation-naïve patients with atrial fibrillation undergoing cardioversion has not been systematically studied. OBJECTIVE:To determine outcomes in anticoagulation-naïve patients (defined as those receiving an anticoagulant for <48 hours during the index episode of atrial fibrillat...
journal_title:American heart journal
pub_type: 杂志文章,随机对照试验
doi:10.1016/j.ahj.2016.06.008
更新日期:2016-09-01 00:00:00
abstract::It is unclear how agents designed to promote angiogenesis in the human heart affect the arteriographic appearance of the collateral circulation. Possible changes in collateral vessels include new collateral vessels arising from epicardial arteries, new branches emanating from existing collateral vessels, wider or long...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/s0002-8703(99)70473-4
更新日期:1999-01-01 00:00:00
abstract::Cross-sectional echocardiography identified two abnormal patterns of mitral valve closure in 14 patients with mitral regurgitation due to papillary muscle dysfunction: (1) in three patients with an akinetic inferior-posterior wall but normal cavity size, papillary muscle fibrosis was associated with late systolic mitr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(79)90430-7
更新日期:1979-03-01 00:00:00
abstract::Hemodynamic and echocardiographic data from 33 consecutive patients undergoing cardiac transplantation were correlated with endomyocardial biopsy results to determine whether reversible restrictive hemodynamics accompany histologic evidence of transplant rejection. During the study period 251 biopsy specimens were obt...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(91)90475-w
更新日期:1991-10-01 00:00:00
abstract:BACKGROUND:Coronary artery disease (CAD) is the most common cause of left ventricular systolic dysfunction (LVSD). Patients with ischemia as the cause of LVSD may warrant revascularization. Angiography is the most accurate method of CAD diagnosis but is invasive, expensive, and associated with some risk. Noninvasive im...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/j.ahj.2010.03.026
更新日期:2010-06-01 00:00:00
abstract::Characteristics of color-coded Doppler imaging combined with two-dimensional and M-mode echocardiography in six patients with systolic-diastolic murmurs are reported. PDA, congenital absence of pulmonary valve leaflets, ventricular septal defect and aortic regurgitation, two ruptured aneurysms of sinus of Valsalva, an...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(87)90551-5
更新日期:1987-12-01 00:00:00
abstract:OBJECTIVES:We sought to determine the relationship of adverse diastolic remodeling (ie, worsening diastolic or persistent restrictive filling) with infarct scar characteristics, and to evaluate its prognostic value after ST-segment elevation myocardial infarction (STEMI). BACKGROUND:Severe diastolic dysfunction (restr...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/j.ahj.2016.05.020
更新日期:2016-10-01 00:00:00
abstract::The American Cancer Society's prospective study of 1 million Americans was analyzed to determine whether coronary heart disease (CHD) mortality rates by cigarette smoking in blacks differed from those in whites. More than 22,000 blacks were followed up for nearly 200,000 person-years in the 12-year study, 1960-1972. A...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(84)90675-6
更新日期:1984-09-01 00:00:00
abstract:BACKGROUND:Pacing leads with a small electrode surface for high-impedance stimulation have been shown to prolong pacemaker longevity, but no sufficient data is available on the safety and feasibility of a defibrillation lead with this novel design. METHODS:We evaluated the clinical performance of a tined, steroid-elut...
journal_title:American heart journal
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1016/S0002-8703(03)00411-3
更新日期:2003-12-01 00:00:00
abstract::The effect of the reperfusion on myocardial infarction has been studied in the rat in order to assess the possible reversibility of myocardial damage. The present study deals with reperfusion of experimental myocardial infarction in the rat. Two groups of animals were compared: one was subjected to permanent ischemia ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(77)80255-x
更新日期:1977-03-01 00:00:00
abstract:BACKGROUND:In patients with chronic heart failure, the use of carvedilol therapy induces clinical and hemodynamic improvement. However, although the benefits of this beta-blocker have been established in patients with chronic heart failure, the mechanisms underlying them and the changes in left ventricular systolic fun...
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/s0002-8703(00)90036-x
更新日期:2000-04-01 00:00:00
abstract::Baroreflex modulation of forearm vascular resistance (FVR) has been reported to be abnormal in patients with congestive heart failure (CHF). However, the neurohumoral mechanisms for this impairment are not defined. We assessed the responses of arterial pressure, FVR, plasma norepinephrine, and plasma renin activity to...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/0002-8703(89)90075-6
更新日期:1989-07-01 00:00:00
abstract::Currently, automated systems for quantitative analysis by intracoronary ultrasound (ICUS) are restricted to the detection of the lumen. The aim of this study was to determine the accuracy and reproducibility of a new semiautomated contour detection method, providing off-line identification of the intimal leading edge ...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90233-1
更新日期:1996-09-01 00:00:00
abstract:BACKGROUND:Despite the common practice of clopidogrel loading for coronary stenting, the time dependence and degree of platelet inhibition after this therapy are not well defined. We sought to establish an optimal clopidogrel dosing regimen for sustained platelet inhibition in stented patients. METHODS AND RESULTS:Pla...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1067/mhj.2003.109
更新日期:2003-02-01 00:00:00
abstract:BACKGROUND:Glycoprotein (GP) IIb/IIIa inhibitors can improve outcomes in patients with non-ST-segment elevation acute coronary syndromes but raise the risk of bleeding, particularly if dosed in excess. The impact of GP IIb/IIIa dosing feedback on safety and major bleeding is unknown. METHODS:Glycoprotein IIb/IIIa dosi...
journal_title:American heart journal
pub_type: 杂志文章,多中心研究
doi:10.1016/j.ahj.2010.08.008
更新日期:2010-12-01 00:00:00
abstract::The efficacy and safety of sotalol therapy for ventricular arrhythmias was evaluated in 133 patients with drug-refractory ventricular arrhythmias. All patients had baseline electrophysiologic studies before and after oral sotalol therapy. Sixty-six patients were discharged home, treated with sotalol (52 patients witho...
journal_title:American heart journal
pub_type: 杂志文章
doi:10.1016/s0002-8703(96)90008-3
更新日期:1996-11-01 00:00:00
abstract::The novel oral anticoagulants (NOACs) have rapidly emerged as an alternative therapy to warfarin. Several recent phase 3 randomized control trials have demonstrated the efficacy and safety of the NOACs in the treatment for patients with nonvalvular atrial fibrillation. As the NOACs are incorporated in clinical practic...
journal_title:American heart journal
pub_type: 杂志文章,评审
doi:10.1016/j.ahj.2014.12.008
更新日期:2015-03-01 00:00:00
abstract::To test alterations in plasma potassium and magnesium levels with maximal exercise, 15 sedentary, healthy men (mean age 29 years) participated in a double-blind crossover study for 11 weeks with propranolol, atenolol, and placebo. Maximal exercise tests were done at baseline and after placebo and beta-blockade phases....
journal_title:American heart journal
pub_type: 临床试验,杂志文章
doi:10.1016/0002-8703(91)90962-h
更新日期:1991-01-01 00:00:00