Increasing evidence-based treatments to reduce coronary heart disease mortality in Sweden: quantifying the potential
L Björck1, S Capewell, K Bennett
1Department of Emergency and Cardiovascular Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. lena.bjorck@gu.se
Insights
Increasing evidence-based treatments for coronary heart disease (CHD) could significantly reduce mortality. Aggressively treating eligible patients may nearly double the reduction in CHD deaths, highlighting the importance of timely interventions.
Area of Science:
- Cardiovascular Medicine
- Public Health
- Health Economics
Background:
- Coronary heart disease (CHD) mortality in Sweden decreased by over 50% between 1986 and 2002.
- Treatments and primary prevention medications accounted for approximately one-third of this decline.
- Suboptimal uptake of evidence-based therapies in eligible patients was observed.
Purpose of the Study:
- To evaluate the potential reduction in CHD mortality by increasing the utilization of specific treatments in eligible patient populations in Sweden.
Main Methods:
- Utilized the validated IMPACT CHD model.
- Combined data on CHD patient numbers, medical/surgical intervention uptake, and treatment efficacy.
- Modeled a scenario where at least 60% of eligible patients received treatment.
Main Results:
- Increasing treatment coverage to 60% could have prevented or postponed approximately 8900 deaths in 2002.
- This represents a potential reduction of about 4100 more deaths than actually occurred.
- Primary prevention with statins (45%) and acute coronary syndrome treatments (23%) were major contributors to the potential gain.
Conclusions:
- Enhancing the uptake of evidence-based CHD treatments could nearly double the observed mortality reduction.
- Aggressively identifying and treating CHD patients and high-risk individuals is crucial for public health.
- Further improvements in treatment adherence can significantly impact cardiovascular mortality rates.
Objectives:
Between 1986 and 2002, coronary heart disease (CHD) mortality in Sweden fell by more than 50%. Approximately one-third (4800 fewer deaths) of this decline in age-adjusted CHD mortality could be attributed to treatments in patients with CHD and primary prevention medications. High treatment levels were achieved in some cases, but in others, only 50-80% of eligible patients received appropriate therapy. We therefore examined to what extent increasing the use of specific treatments in eligible patients might have reduced CHD mortality rates in Sweden.
Design And Methods:
We used the previously validated IMPACT CHD model to combine data on CHD patient numbers, medical and surgical uptake levels and treatment effectiveness. We estimated the number of deaths prevented or postponed for 2002 (baseline scenario) and for an alternative scenario (if at least 60% of eligible patients were treated).
Results:
If treatments were increased to consistently cover at least 60% of eligible patients, approximately 8900 deaths could have been postponed or prevented, representing a potential gain of approximately 4100 fewer deaths than actually occurred in 2002. Approximately 45% of the 4100 gain would have come from primary prevention with statins, 23% from acute coronary syndrome treatments, 15% from secondary prevention therapies and 15% from treatments for heart failure.
Conclusion:
Increasing the proportion of eligible patients with CHD who receive evidence-based treatment could have resulted in approximately 4100 fewer deaths in 2002, almost doubling the actual mortality reduction. These findings further emphasize the importance of aggressively identifying and treating patients with CHD and high-risk individuals.
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