WHO data on Cardiovascular Disease and Nuclear Cardiology Utilization Worldwide
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1 WHO data on Cardiovascular Disease and Nuclear Cardiology Utilization Worldwide João V. Vitola, MD, PhD Cardiologist and Nuclear Medicine Physician Quanta Diagnostico Nuclear Curitiba - Brazil DISCLOSURES Honorarium Research / Advisor, Expert Services and Conferences in Nuclear Cardiology BMS, CVT, Astellas, Lantheus, PPGx, IAEA Royalties Publications in Nuclear Cardiology Springer-Verlag Verlag-Nuclear Cardiology and Correlative Imaging: a teaching file, NY, 2004 Lippincott Williams & Wilkins, - Nuclear Medicine teaching File,, 2009
2 General Overview Leader Cause of Mortality in Adults Men and Women 80% of 17.5 mi Deaths Due to CVD are in Low to Mid Income Countries Significant Economic Burden
3 Ischemic Heart Disease Downloaded from in Jan 2010
4 Cerebrovascular Disease Downloaded from in Jan 2010
5 Death from CAD - variation by country and gender cause of mortality age > 60 yo
6
7 OLD AND NEW CHALLENGES TO FACE IN CARDIAC CARE Rising health care cost of chronic disease (obesity/lack of exercise/smoking) OBESITY SPECIALLY WOMEN DM IMPACTING THE YOUNG AGING WORLDWIDE
8 OBESITY Downloaded from in Jan 2010
9 Downloaded from in Jan 2010
10 DIABETES Downloaded from in Jan 2010
11 Downloaded from in Jan 2010
12 World Scenario Estimation for 2025 Diabetes International Federation Diabetes Atlas: 2006; DIF
13 DM, Age and SPECT Abnormalities (n=10594) Resultado anormal: idade x DM % A B N O R M A L Não diabético Diabético 33% 33% 44% 50% 62% 73% Até a a a a ou mais Vitola JV et al, Quanta Database Curitiba - Brazil
14 Diabetes is Increasing Mostly in Developing Countries (middle age) Source WHO
15 Projected Percentage of Deaths from Cardiovascular Disease Among Those yrs Health Affairs Jan/Feb 2007
16 Clinical Case 36 yo, Man DM, Obese (IMC: 30.1), HTN, High Cholesterol Denies Chest Pain TMT Rest ECG LAHB Bruce : 10 min HR: (85% = 156 bpm) BP: 130/ /90 mmhg No ST segment changes At peak exercise right should pain, Not Limiting Duke Score Duke: exer min 5x ST 4x angina Duke = (+10) (5x0) (4x1) = + 6
17 Cortes Tomográficos-Referencia Eje Corto Eje Largo Vertical Eje Largo Horizontal ESV: 70 ml, LVEF: 45% High Risk Findings Revascularization + Optimized Medical Therapy
18 Projected Increase Deaths due to CVD from 1990 to Increase Deaths (%) Women Men 0 Developing Nations Developed Nations Yusuf S et al, Circulation 2001; 104: Leeder, S et al. A Race against time: the challenges of cardiovascular disease in developing countries. New York: Trustees of Columbia University; 2004
19 Life Expectancy at Birth Country Men Women Russia India Brazil China BRIC Emerging Economies Developing Countries Argentina Cuba USA Population is aging Canada Italy Australia Japan Implications for NC RATIONAL INVESTMENTS Life tables for WHO member states, Geneva, Word Health Organization,
20 The Elderly Population is Increasing Source: WHO
21 Age as a Predictor of SPECT Abnormality Vitola JV et al. Quanta Database Curitiba, Brazil (n=10594) Resultado anormal: idade x sexo Feminino Masculino 68% 46% 41% 55% 52% 10% 14% 23% 19% 21% 33% 30% Até a a a a ou mais P<0.048 P<0.611 P<0.001 P<0.036 P<0.001 RR 1,5 (CI 1,0-2,2) RR 1,1 (CI 0,9 1,3) RR 1,4 (CI 1,2-1,7) RR 1,2 (CI 1,0 1,5) RR 1,9 (1,3 2,7)
22 PREVALENCIA DE EAC - EUA Percent of Population Males Females 10,4 5,54,60 4,20 17,4 13,60 34,2 28,90 51,0 48,10 65,2 65,20 70, Ages 79,00 American Heart Association Heart and Stroke Statistical Update. 2001
23 Prevalence of Heart Failure by Gender and Age in the Framingham Study 10 9,7 9,8 patients per 100 persons ,1 0,1 0,5 0,7 1,8 1,3 6,2 3,4 6,6 6,8 Women Men $ Age Ho, Pinsky, Kannel, Levy. J Am Coll Cardiol 1993; 22:6A
24 Chronic Heart Failure in the United States. A Manifestation of Coronary Artery Disease Mihai Gheorghiade, MD; Robert O. Bonow, MD Circulation 1998;97: non-cad 32% CAD 68% CAD non-cad $
25 NEW CHALLENGES TO FACE IN CARDIAC CARE OBESITY SPECIALLY WOMEN DM IMPACTING THE YOUNG AGING WORLDWIDE LIMITED / RATIONAL USE OF RESOURCES: PREVENTION (Long Term Investment: exercise/quit smoking/diet) INVESTIGATION (Mostly Non Invasive Nuclear/IAEA) MANAGEMENT (Guided by APPROPRIATE Investigation)
26
27 Cost Effectiveness treating CVD U$ per DALY = Disability Adjusted Life Year averted
28 WHAT ARE THE ECONOMIC COSTS OF CARDIOVASCULAR DISEASES? 1. CVDs affect many people in middle age, very often severely limiting the income and savings of affected individuals and their families. 2. Lost earnings and out of pocket health care payments undermine the socioeconomic development of communities and nations. 3. CVDs place a heavy burden on the economies of countries. 4. Lower socioeconomic groups in high income countries generally have a greater prevalence of risks factors, diseases and mortality, a similar pattern is emerging as the CVD epidemic evolves in low and middle income countries. Rationale for a investments in meetings involving Nuclear Cardiology at the IAEA...
29 IAEA, Vienna, Austria, 2008 Organized by Maurizio Dondi Adel Allam Egypt Amalia Peix Cuba Annare Ellmann South Africa Bon Nang Lee Malaysia C. Siritara - Thailand Felix Keng Singapore Fernando Mut- (Co-chairman) - Uruguay Gianmario Sambucetti Italy Gregory Thomas USA João V. Vitola (Chairman) - Brazil Kevin Allman Australia Leslee Shaw USA Maurizio Dondi - IAEA - Austria Marla Kiess Canada Pilar Orellana Chile Raffaele Giubbini Switzerland Salaheddine Bouyoucef Algeria Zuo Xiang He China
30
31 Worldwide Utilization of Nuclear Cardiology Underutilized in Many Nations High Moderate High Moderate Moderate Low Low Inexistente Vitola JV, Shaw L, Allam A et al JNC, 2009
32 Influenced by: - Economy GDP Healthcare Policies -Information Organized scientific groups Local Scientific Production Training -Neighboring coutries Comunication Training Scientific meetings Vitola JV, Shaw L, Allam A et al. JNC 2009
33
34 USA budget for health care 2 trillion US $ 16% of GDP Beller G, JNC 2008
35 Leppo J, JNC, 2009
36 What investment is ideal (Prevention + Investigation + Management)? AMERICA LATINA Porter ME, Teisberg EO: Redefining Health Care Harvard Business School Press, 2006
37 Leppo J, JNC, 2009
38 What information should we be looking for to change management and result in better patient outcome in a cost effective way?
39 ECONOMIC IMPLICATIONS OF REVASCULARISATION WITHOUT SELECTING BASED ON ISCHEMIA Leslee Shaw et al. JACC 1999;33:
40 Shaw JACC 1999;33:
41
42 What is the utilization of Nuclear Cardiology in India? Only about 20 thousand SPECT / year / entire India 100 MPI/mo
43 Confronting the Epidemics of CVD Worldwide: Time to Stop and Think About Cardiac Care Imaging Utilization in 2010 Obesity and DM will contribute to increased CVD mortality worldwide Prevention of CAD is essential Imaging can be used to assess risk and guide management cost effectivelly Wide variation under and over utilization of technology regional differences - GDP but also Information Considering increasing costs - essential to rationalize investigation and management
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