Optimal Design of Multiple Medication Guidelines for Type 2 Diabetes Patients
|
|
- Frederick Cameron
- 5 years ago
- Views:
Transcription
1 Optimal Design of Multiple Medication Guidelines for Type 2 Diabetes Patients Jennifer E. Mason PhD Student Edward P. Fitts Department of Industrial and Systems Engineering NC State University, Raleigh, NC INFORMS Annual Meeting, Austin, TX November 7,
2 Collaborators Brian Denton, PhD, NC State University Nilay Shah, PhD, Mayo Clinic Steve Smith, MD, Mayo Clinic Supported by the Agency for Health Care Research and Quality (R21HS017628) and the National Science Foundation (CMMI ) 2
3 Diabetes The American Diabetes Association estimates 23.6 million people have diabetes in the U.S. 8% of the population 90-95% have type 2 diabetes Two out of three people with diabetes will die from either stroke or coronary heart disease (CHD) 3
4 Treatment Managing a patient s cholesterol and blood pressure are important for preventing stroke and CHD events Numerous cholesterol medications (e.g., statins) and blood pressure medications (e.g., beta blockers) 4
5 Cost Projections Source: Huang et al., Projecting the Future Diabetes Population Size and Related Costs for the U.S., Diabetes Care, 32: ,
6 When and in what order should medications be initiated? 6
7 US Guidelines ATP III 1 : Diabetes patients now considered CHD risk equivalents. Treatment Goal: LDL < 100 mg/dl JNC 7 2 : Treatment Goal: SBP/DBP < 130/80 mmhg 1 Third report on the National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III), NIH Publication No , The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, NIH Publication No ,
8 Optimal Treatment Guidelines 8
9 Markov Decision Process Model Stages Ages 40 to 100 Decision Horizon: 40 to 80 States Actions Annual Decision Epochs TC, HDL, and SBP (each L, M, H, or V), HbA1c, smoking status, history of CHD event or stroke, medication status At each epoch, each medication is either initiated or delayed 9
10 MDP Model Actions A (l,mi ) = *I, W+ if m i = 0 *W+ if m i = 1 Rewards r l, m = R(l, m) C O C m C S l + C CHD l CF S l + CF CHD l where R l, m = R 0 1 d S l 1 d CHD l 1 d Med m 10
11 Optimality Equations Optimality Equations v t l, m = max α a (l,m) r l, m + λ p t α l, m l, m v t+1 (l, m ) (l,m ) for t, l, m 11
12 MDP Model 12
13 MDP Model 13
14 Complexity Total number of states: Health States Event States = 655,360 Medication States Yearly Decisions Solved MDP model using backwards recursion Model instances solved in less than 18 minutes on a 2.83GHz PC with 8GB of RAM 14
15 Data Model Input Source R 0 = $100,000 Rascati (2006) Probabilities among health states Probability of death from other causes Probability of stroke and CHD events Mayo EMR and DEMS 1 CDC Mortality Tables 2 UKPDS Models 3 1 Gorman et al National Vital Statistics Reports, National Center for Health Statistics, Stevens et al. 2001, Kothari et al
16 Results 16
17 Meet Jack Age 55 Diabetes TC: 270 (V) HDL: 34 (L) SBP: 148 (H) 17
18 Jack s Treatment Plan US Guidelines Age 55 Age 56 Age 57 Age 71 statins + thiazides fibrates + ACE/ARBs beta blockers calcium channel blockers expected QALYs and $32,592 expected treatment Optimal Treatment Age 55 Age 56 Age 57 Age 65 statins thiazides beta blockers ACE/ARBs expected QALYs and $23,485 expected treatment 18
19 Meet Jill Age 40 Diabetes TC: 217 (H) HDL: 33 (L) SBP: 161 (V) 19
20 Jill s Treatment Plan US Guidelines Age 40 Age 41 Age 42 Age 43 statins + thiazides ACE/ARBs fibrates + beta blockers calcium channel blockers expected QALYs and $30,875 expected treatment Optimal Treatment Age 40 statins Age 62 thiazides expected QALYs and $15,051 expected treatment 20
21 Overall Tradeoff: Males 21
22 Overall Tradeoff: Males 22
23 Overall Tradeoff: Females 23
24 Overall Tradeoff: Females 24
25 Primary Prevention Results Objective: Maximize rewards for time until first event minus medication costs r l, m = R 0 C(m) if no events 0 if event or death 25
26 Males 26
27 Females 27
28 Limitations The patient cohort is from one health system Sparse clinical data to model other races or ethnicities Only stroke and CHD events are modeled 28
29 Conclusions Personalized treatment plans result in lower costs and greater expected QALYs Guidelines should manage cholesterol and blood pressure with coordinated treatment Use of optimal guidelines could result in large savings at the population level 29
30 Future Work Expand the model to include more medications (including glucose control medications) Prove threshold properties for initiation of treatment Provide sufficient conditions for the sequencing of treatment 30
31 Jennifer Mason THANK YOU 31
Evaluating the Impact of Different Perspectives on the Optimal Start Time for Statins
Evaluating the Impact of Different Perspectives on the Optimal Start Time for Statins Jennifer E. Mason Edward P. Fitts Department of Industrial and Systems Engineering, NC State University, Raleigh, NC
More informationMarkov Decision Processes for Chronic Diseases Lessons learned from modeling type 2 diabetes
Markov Decision Processes for Chronic Diseases Lessons learned from modeling type 2 diabetes Brian Denton Department of Industrial and Operations Engineering University of Michigan Agenda Models for study
More informationUsing Longitudinal Data to Build Natural History Models
Using Longitudinal Data to Build Natural History Models Lessons learned from modeling type 2 diabetes and prostate cancer INFORMS Healthcare Conference, Rotterdam, 2017 Brian Denton Department of Industrial
More informationABSTRACT. MASON, JENNIFER E. Optimal Timing of Statin Initiation for Patients with Type 2 Diabetes. (Under the direction of Dr. Brian Denton).
ABSTRACT MASON, JENNIFER E. Optimal Timing of Statin Initiation for Patients with Type 2 Diabetes. (Under the direction of Dr. Brian Denton). HMG Co-A reductase inhibitors (statins) are an important part
More informationMarkov Decision Processes for Screening and Treatment of Chronic Diseases
Markov Decision Processes for Screening and Treatment of Chronic Diseases Lauren N. Steimle and Brian T. Denton Abstract In recent years, Markov decision processes (MDPs) and partially obserable Markov
More informationComparative Effectiveness of Guidelines for the Management of Hyperlipidemia and Hypertension for Type 2 Diabetes Patients
Comparative Effectiveness of Guidelines for the Management of Hyperlipidemia and Hypertension for Type 2 Diabetes Patients Nilay D. Shah 1,2 *, Jennifer Mason 4, Murat Kurt 3, Brian T. Denton 1,4, Andrew
More informationKnow Your Number Aggregate Report Single Analysis Compared to National Averages
Know Your Number Aggregate Report Single Analysis Compared to National s Client: Study Population: 2242 Population: 3,000 Date Range: 04/20/07-08/08/07 Version of Report: V6.2 Page 2 Study Population Demographics
More informationCONTRIBUTING FACTORS FOR STROKE:
CONTRIBUTING FACTORS FOR STROKE: HYPERTENSION AND HYPERCHOLESTEROLEMIA Melissa R. Stephens, MD, FAAFP Associate Professor of Clinical Sciences William Carey University College of Osteopathic Medicine LEARNING
More informationManagement of Lipid Disorders and Hypertension: Implications of the New Guidelines
Management of Lipid Disorders and Hypertension Management of Lipid Disorders and Hypertension: Implications of the New Guidelines Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine
More informationHow would you manage Ms. Gold
How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56
More informationUpdate on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines
Update on Lipid Management in Cardiovascular Disease: How to Understand and Implement the New ACC/AHA Guidelines Paul Mahoney, MD Sentara Cardiology Specialists Lipid Management in Cardiovascular Disease
More informationOptimal Design of Biomarker-Based Screening Strategies for Early Detection of Prostate Cancer
Optimal Design of Biomarker-Based Screening Strategies for Early Detection of Prostate Cancer Brian Denton Department of Industrial and Operations Engineering University of Michigan, Ann Arbor, MI October
More informationHypertension. Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute
Hypertension Does it Matter What Medications We Use? Nishant K. Sekaran, M.D. M.Sc. Intermountain Heart Institute Hypertension 2017 Classification BP Category Systolic Diastolic Normal 120 and 80 Elevated
More informationALLHAT. Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic
1 U.S. Department of Health and Human Services National Institutes of Health Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker
More informationJennifer E. Mason (803)
Jennifer E. Mason http://people.engr.ncsu.edu/jemason2/ jemason2@ncsu.edu, (803) 608-0727 Research Interests Stochastic dynamic programming and stochastic models Applications in health care delivery and
More informationMacrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?
Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists
More informationThe Latest Generation of Clinical
The Latest Generation of Clinical Guidelines: HTN and HLD Dave Brackett Clinical Guideline Purpose Uniform approach Awareness of key details Diagnosis Treatment Monitoring Evidence based approach Inform
More informationNew Lipid Guidelines. PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids.
PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN: Implications of the New Guidelines for Hypertension and Lipids Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant
More informationShould we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway
Should we prescribe aspirin and statins to all subjects over 65? (Or even all over 55?) Terje R.Pedersen Oslo University Hospital Oslo, Norway The Polypill A strategy to reduce cardiovascular disease by
More informationPractical Diabetes. Nic Crook. (and don t use so many charts) Kuirau Specialists 1239 Ranolf Street Rotorua. Rotorua Hospital Private Bag 3023 Rotorua
Practical Diabetes (and don t use so many charts) Nic Crook Rotorua Hospital Private Bag 3023 Rotorua Kuirau Specialists 1239 Ranolf Street Rotorua Worldwide rates of diabetes mellitus: predictions 80
More informationPlacebo-Controlled Statin Trials MANAGEMENT OF HIGH BLOOD CHOLESTEROL MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES
MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest
More information2/10/2016. Perspectives on the 2013 ACC/AHA Cholesterol Guidelines. Disclosures. ATP-III Update 2004
Perspectives on the 2013 ACC/AHA Cholesterol Guidelines Donald M. Lloyd-Jones, MD ScM Senior Associate Dean Chair and Professor of Preventive Medicine Northwestern Feinberg School of Medicine Disclosures
More informationEstablished Risk Factors for Coronary Heart Disease (CHD)
Getting Patients to Make Small Lifestyle Changes That Result in SIGNIFICANT Improvements in Health - Prevention of Diabetes and Obesity for Better Health Maureen E. Mays, MD, MS, FACC Director ~ Portland
More informationCalculating Risk for Primary Prevention of Cardiovascular Disease (CVD)
Calculating Risk for Primary Prevention of Cardiovascular Disease (CVD) 2. Welcome by Stacey Sheridan, MD, MPH Hello. My name is Stacey Sheridan, and I m here as your partner in Heart Health Now. The North
More informationIs there a mechanism of interaction between hypertension and dyslipidaemia?
Is there a mechanism of interaction between hypertension and dyslipidaemia? Neil R Poulter International Centre for Circulatory Health NHLI, Imperial College London Daegu, Korea April 2005 Observational
More informationAndrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION
2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL
More information2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD
2013 ACC AHA LIPID GUIDELINE JAY S. FONTE, MD How do you interpret my blood test results? What are our targets for these tests? Before the ACC/AHA Lipid Guidelines A1c:
More informationThe Clinical Unmet need in the patient with Diabetes and ACS
The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge
More informationDisclosure. No relevant financial relationships. Placebo-Controlled Statin Trials
PREVENTING CARDIOVASCULAR DISEASE IN WOMEN: Current Guidelines for Hypertension, Lipids and Aspirin Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial
More informationClinical Recommendations: Patients with Periodontitis
The American Journal of Cardiology and Journal of Periodontology Editors' Consensus: Periodontitis and Atherosclerotic Cardiovascular Disease. Friedewald VE, Kornman KS, Beck JD, et al. J Periodontol 2009;
More informationNo relevant financial relationships
MANAGEMENT OF LIPID DISORDERS: WHERE DO WE STAND WITH THE NEW PRACTICE GUIDELINES? Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Disclosure No relevant financial relationships
More informationOptimization in Medicine
Optimization in Medicine INFORMS Healthcare Conference, Rotterdam, 2017 Brian Denton Department of Industrial and Operations Engineering University of Michigan Optimization in Medicine OR in Medicine Cancer
More informationReduced 10-year Risk of CHD in Patients who Participated in Communitybased DPP: The DEPLOY Pilot Study
Diabetes Care Publish Ahead of Print, published online December 23, 2008 Reduced 10-year CHD Risk: DEPLOY Pilot Study Reduced 10-year Risk of CHD in Patients who Participated in Communitybased DPP: The
More informationACC/AHA GUIDELINES ON LIPIDS AND PCSK9 INHIBITORS
ACC/AHA GUIDELINES ON LIPIDS AND PCSK9 INHIBITORS Ziyad Ghazzal MD, FACC, FSCAI Professor of Medicine Deputy Vice President/Dean Associate Dean for Clinical Affairs American University of Beirut Adjunct
More informationNo relevant financial relationships
MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu
More informationLipid Panel Management Refresher Course for the Family Physician
Lipid Panel Management Refresher Course for the Family Physician Objectives Understand the evidence that was evaluated to develop the 2013 ACC/AHA guidelines Discuss the utility and accuracy of the new
More informationAntihypertensive Trial Design ALLHAT
1 U.S. Department of Health and Human Services Major Outcomes in High Risk Hypertensive Patients Randomized to Angiotensin-Converting Enzyme Inhibitor or Calcium Channel Blocker vs Diuretic National Institutes
More informationThe Metabolic Syndrome: Is It A Valid Concept? YES
The Metabolic Syndrome: Is It A Valid Concept? YES Congress on Diabetes and Cardiometabolic Health Boston, MA April 23, 2013 Edward S Horton, MD Joslin Diabetes Center Harvard Medical School Boston, MA
More informationHighlights of the new blood pressure and cholesterol guidelines: A whole new philosophy. Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM
Highlights of the new blood pressure and cholesterol guidelines: A whole new philosophy Jeremy L. Johnson, PharmD, BCACP, CDE, BC-ADM OSHP 2014 Annual Meeting Oklahoma City, OK April 4, 2014 1 Objectives
More informationPlacebo-Controlled Statin Trials Prevention Of CVD in Women"
MANAGEMENT OF HIGH BLOOD CHOLESTEROL: IMPLICATIONS OF THE NEW GUIDELINES Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest
More informationShould we base treatment decisions on short-term or lifetime CVD risk? Rod Jackson University of Auckland New Zealand
Should we base treatment decisions on short-term or lifetime CVD risk? Rod Jackson University of Auckland New Zealand Presentation outline Strengths & weaknesses of short-term risk approach Strengths &
More information2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary
2013 ACC/AHA Guidelines on the Assessment of Atherosclerotic Cardiovascular Risk: Overview and Commentary The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease Becky McKibben, MPH; Seth
More informationUpdate on Current Trends in Hypertension Management
Friday General Session Update on Current Trends in Hypertension Management Shawna Nesbitt, MD Associate Dean, Minority Student Affairs Associate Professor, Department of Internal Medicine Office of Student
More informationUsing Cardiovascular Risk to Guide Antihypertensive Treatment Implications For The Pre-elderly and Elderly
Using Cardiovascular Risk to Guide Antihypertensive Treatment Implications For The Pre-elderly and Elderly Paul Muntner, PhD MHS Professor and Vice Chair Department of Epidemiology University of Alabama
More informationAmerican Diabetes Association 2018 Guidelines Important Notable Points
American Diabetes Association 2018 Guidelines Important Notable Points The Standards of Medical Care in Diabetes-2018 by ADA include the most current evidencebased recommendations for diagnosing and treating
More informationSecondary prevention and systems approaches: Lessons from EUROASPIRE and EUROACTION
Secondary prevention and systems approaches: Lessons from EUROASPIRE and EUROACTION Dr Kornelia Kotseva National Heart & Lung Insitute Imperial College London, UK on behalf of all investigators participating
More informationIdentification of subjects at high risk for cardiovascular disease
Master Class in Preventive Cardiology Focus on Diabetes and Cardiovascular Disease Geneva April 14 2011 Identification of subjects at high risk for cardiovascular disease Lars Rydén Karolinska Institutet
More informationMetformin should be considered in all patients with type 2 diabetes unless contra-indicated
November 2001 N P S National Prescribing Service Limited PPR fifteen Prescribing Practice Review PPR Managing type 2 diabetes For General Practice Key messages Metformin should be considered in all patients
More information9/18/2017 DISCLOSURES. Consultant: RubiconMD. Research: Amgen, NHLBI OUTLINE OBJECTIVES. Review current CV risk assessment tools.
UW MEDICINE UW MEDICINE UCSF ASIAN TITLE HEALTH OR EVENT SYMPOSIUM 2017 DISCLOSURES Consultant: RubiconMD ESTIMATING CV RISK IN ASIAN AMERICANS AND PREVENTION OF CVD Research: Amgen, NHLBI EUGENE YANG,
More informationAnalyzing Coronary Heart Disease Risk Factors and Proper Clinical Prescription of Statins. Peter Thorne
Abstract Analyzing Coronary Heart Disease Risk Factors and Proper Clinical Prescription of Statins Peter Thorne A sample of adults participating in the first 7 months of visit 5 of the Atherosclerosis
More informationTreatment of Cardiovascular Risk Factors. Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center
Treatment of Cardiovascular Risk Factors Kevin M Hayes D.O. F.A.C.C. First Coast Heart and Vascular Center Disclosures: None Objectives What do risk factors tell us What to check and when Does treatment
More informationKnow Your Number Aggregate Report Comparison Analysis Between Baseline & Follow-up
Know Your Number Aggregate Report Comparison Analysis Between Baseline & Follow-up... Study Population: 340... Total Population: 500... Time Window of Baseline: 09/01/13 to 12/20/13... Time Window of Follow-up:
More informationCost-effectiveness of pravastatin for primary prevention of coronary artery disease in Japan Nagata-Kobayashi S, Shimbo T, Matsui K, Fukui T
Cost-effectiveness of pravastatin for primary prevention of coronary artery disease in Japan Nagata-Kobayashi S, Shimbo T, Matsui K, Fukui T Record Status This is a critical abstract of an economic evaluation
More information4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for
+ Update on Lipid Management Stacey Gardiner, MD Assistant Professor Division of Cardiovascular Medicine Medical College of Wisconsin + The stats on heart disease Over the past 10 years for which statistics
More informationSupplementary Table 1. Baseline Characteristics by Quintiles of Systolic and Diastolic Blood Pressures
Supplementary Data Supplementary Table 1. Baseline Characteristics by Quintiles of Systolic and Diastolic Blood Pressures Quintiles of Systolic Blood Pressure Quintiles of Diastolic Blood Pressure Q1 Q2
More informationHYPERTENSION MANAGEMENT IN ELDERLY POPULATIONS
HYPERTENSION MANAGEMENT IN ELDERLY POPULATIONS Michael J. Scalese, PharmD, BCPS, CACP Assistant Clinical Professor Auburn University Harrison School of Pharmacy July 14, 2018 DISCLOSURE/CONFLICT OF INTEREST
More informationComplications of Diabetes mellitus. Dr Bill Young 16 March 2015
Complications of Diabetes mellitus Dr Bill Young 16 March 2015 Complications of diabetes Multi-organ involvement 2 The extent of diabetes complications At diagnosis as many as 50% of patients may have
More informationEuroPrevent 2010 Fatal versus total events in risk assessment models
EuroPrevent 2010 Fatal versus total events in risk assessment models Pekka Jousilahti, MD, PhD,Research Professor National Institute for Health and Welfare, Finland Risk assessment models Estimates the
More informationOptimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden
Optimizing risk assessment of total cardiovascular risk What are the tools? Lars Rydén Professor Karolinska Institutet Stockholm, Sweden Cardiovascular Disease Prevention (CVD) Three Strategies for CVD
More informationDisclosure. No relevant financial relationships. Placebo-Controlled Statin Trials
MANAGEMENT OF HYPERLIPIDEMIA AND CARDIOVASCULAR RISK IN WOMEN: Balancing Benefits and Harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial
More informationUsing the New Hypertension Guidelines
Using the New Hypertension Guidelines Kamal Henderson, MD Department of Cardiology, Preventive Medicine, University of North Carolina School of Medicine Kotchen TA. Historical trends and milestones in
More informationTreatment to reduce cardiovascular risk: multifactorial management
Treatment to reduce cardiovascular risk: multifactorial management Matteo Anselmino, MD PhD Assistant Professor San Giovanni Battista Hospital Division of Cardiology, Department of Internal Medicine University
More informationDISCLOSURE PHARMACIST OBJECTIVES 9/30/2014 JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES. I have nothing to disclose.
JNC 8: A REVIEW OF THE LONG-AWAITED/MUCH-ANTICIPATED HYPERTENSION GUIDELINES Tiffany Dickey, PharmD Assistant Professor, UAMS COP Clinical Pharmacy Specialist, Mercy Hospital Northwest AR DISCLOSURE I
More informationAmerican Osteopathic College of Occupational and Preventive Medicine 2012 Mid-Year Educational Conference St. Petersburg, Florida
The 21 st Century Paradigm Shift: Prevention Rather Than Intervention for the Treatment of Stable CHD The Economic Burden of Cardiovascular Diseases Basil Margolis MD, FACC, FRCP Director, Preventive Cardiology
More informationBest Practices in Cardiac Care: Getting with the Guidelines
Best Practices in Cardiac Care: Getting with the Guidelines December 9, 2014 Agenda Cardiovascular Disease: How do the guidelines fit into an implementation scheme? What the guidelines set out to accomplish
More informationModelling Reduction of Coronary Heart Disease Risk among people with Diabetes
Modelling Reduction of Coronary Heart Disease Risk among people with Diabetes Katherine Baldock Catherine Chittleborough Patrick Phillips Anne Taylor August 2007 Acknowledgements This project was made
More informationHypertension in 2015: SPRINT-ing ahead of JNC-8. MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic
Hypertension in 2015: SPRINT-ing ahead of JNC-8 MAJ Charles Magee, MD MPH FACP Director, WRNMMC Hypertension Clinic Conflits of interest? None Disclaimer The opinions contained herein are not to be considered
More informationDiabetes Mellitus: A Cardiovascular Disease
Diabetes Mellitus: A Cardiovascular Disease Nestoras Mathioudakis, M.D. Assistant Professor of Medicine Division of Endocrinology, Diabetes, & Metabolism September 30, 2013 1 The ABCs of cardiovascular
More informationMetabolic Syndrome Is A Key Determinant Of Coronary Microvascular Function In Patients With Stable Coronary Disease Undergoing PCI
Metabolic Syndrome Is A Key Determinant Of Coronary Microvascular Function In Patients With Stable Coronary Disease Undergoing PCI Narbeh Melikian*, Ajay M Shah*, Martyn R Thomas, Roy Sherwood, Mark T
More informationPrevention of Heart Disease: The New Guidelines
Prevention of Heart Disease: The New Guidelines Nisha I. Parikh MD MPH Assistant Professor of Medicine Division of Cardiology Department of Medicine University of California San Francisco May 18 th 2015
More informationReview of guidelines for management of dyslipidemia in diabetic patients
2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University
More informationALLHAT. ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status
ALLHAT Antihypertensive Trial Results by Baseline Diabetic & Fasting Glucose Status 1 Introduction and Background Clinical trials have reported reduction in CV events with diuretics, CCBs, ACE inhibitors,
More informationOptimal medical decision making is challenged
ARTICLE Data-Driven Markov Decision Process Approximations for Personalized Hypertension Treatment Planning Greggory J. Schell, PhD, Wesley J. Marrero, BS, Mariel S. Lavieri, PhD, Jeremy B. Sussman, MD,
More informationJNC Evidence-Based Guidelines for the Management of High Blood Pressure in Adults
JNC 8 2014 Evidence-Based Guidelines for the Management of High Blood Pressure in Adults Table of Contents Why Do We Treat Hypertension? Blood Pressure Treatment Goals Initial Therapy Strength of Recommendation
More informationCVD Risk Assessment. Michal Vrablík Charles University, Prague Czech Republic
CVD Risk Assessment Michal Vrablík Charles University, Prague Czech Republic What is Risk? A cumulative probability of an event, usually expressed as percentage e.g.: 5 CV events in 00 pts = 5% risk This
More informationUpdate in Cardiology Pharmacologic Management of Cardiovascular Risk. Christopher C. Roe, MSN, ACNP
Update in Cardiology Pharmacologic Management of Cardiovascular Risk Christopher C. Roe, MSN, ACNP Objectives 1. Verbalize understanding of new pharmacologic guidelines in the treatment of hypertension
More informationLong-Term Care Updates
Long-Term Care Updates August 2015 By Darren Hein, PharmD Hypertension is a clinical condition in which the force of blood pushing on the arteries is higher than normal. This increases the risk for heart
More informationHDL-C. J Jpn Coll Angiol, 2008, 48: NIPPON DATA80, MEGA study, JELIS, dyslipidemia, risk assessment chart
Online publication March 25, 2009 48 6 2007 2007 HDL-C LDL-C HDL-C J Jpn Coll Angiol, 2008, 48: 463 470 NIPPON DATA80, MEGA study, JELIS, dyslipidemia, risk assessment chart 1987 NIPPON DATA80 Iso 10 MRFIT
More informationCardio-Protective Medication Bundle. Louis H. Carter II, PharmD.
Cardio-Protective Medication Bundle Louis H. Carter II, PharmD. 1 Objectives 1. Discuss cardio-protective medication bundle and the reason it is needed 2. Review medications consisted within the bundle
More informationNew Hypertension Guidelines. Kofi Osei, MD
New Hypertension Guidelines Kofi Osei, MD None Disclosures Objectives The new blood pressure definitions and cardiovascular risk The role to time and location in the diagnosis of hypertension Apply evidence-based
More informationUnderstanding new international guidelines to tackle CV Risk: A practical model John Deanfield, MD UCL, London United Kingdom s
Understanding new international guidelines to tackle CV Risk: A practical model John Deanfield, MD UCL, London United Kingdom s Ho Chi Minh City, Vietnam August 7, 2014 JBS 2 Risk Guidelines (2005) Based
More informationType of intervention Primary prevention; secondary prevention. Economic study type Cost-effectiveness analysis and cost utility analysis.
A predictive model of the health benefits and cost effectiveness of celiprolol and atenolol in primary prevention of cardiovascular disease in hypertensive patients Milne R J, Hoorn S V, Jackson R T Record
More informationPractical and Detail Oriented Quality Improvement Intervention Model for Cardiovascular Disease
Practical and Detail Oriented Quality Improvement Intervention Model for Cardiovascular Disease Brian Forrest, MD ABFM Specialist In Clinical Hypertension (ASH) Founder- Access Hypertension and Cardiovascular
More informationSupplementary Appendix
Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Wanner C, Inzucchi SE, Lachin JM, et al. Empagliflozin and
More informationTotal risk management of Cardiovascular diseases Nobuhiro Yamada
Nobuhiro Yamada The worldwide burden of cardiovascular diseases (WHO) To prevent cardiovascular diseases Beyond LDL Multiple risk factors With common molecular basis The Current Burden of CVD CVD is responsible
More informationwell-targeted primary prevention of cardiovascular disease: an underused high-value intervention?
well-targeted primary prevention of cardiovascular disease: an underused high-value intervention? Rod Jackson University of Auckland, New Zealand October 2015 Lancet 1999; 353: 1547-57 Findings: Contribution
More informationThe Heart of a Woman. Karen E. Friday, M.D. Associate Professor of Medicine Section of Endocrinology Louisiana State University School of Medicine
The Heart of a Woman Karen E. Friday, M.D. Associate Professor of Medicine Section of Endocrinology Louisiana State University School of Medicine American Heart Association Women, Heart Disease and Stroke
More informationAtherosclerotic Disease Risk Score
Atherosclerotic Disease Risk Score Kavita Sharma, MD, FACC Diplomate, American Board of Clinical Lipidology Director of Prevention, Cardiac Rehabilitation and the Lipid Management Clinics September 16,
More informationStatistical Fact Sheet Populations
Statistical Fact Sheet Populations At-a-Glance Summary Tables Men and Cardiovascular Diseases Mexican- American Males Diseases and Risk Factors Total Population Total Males White Males Black Males Total
More informationSupplement materials:
Supplement materials: Table S1: ICD-9 codes used to define prevalent comorbid conditions and incident conditions Comorbid condition ICD-9 code Hypertension 401-405 Diabetes mellitus 250.x Myocardial infarction
More informationImproved control for confounding using propensity scores and instrumental variables?
Improved control for confounding using propensity scores and instrumental variables? Dr. Olaf H.Klungel Dept. of Pharmacoepidemiology & Clinical Pharmacology, Utrecht Institute of Pharmaceutical Sciences
More informationMOLINA HEALTHCARE OF CALIFORNIA
MOLINA HEALTHCARE OF CALIFORNIA HIGH BLOOD CHOLESTEROL IN ADULTS GUIDELINE Molina Healthcare of California has adopted the Third Report of the National Cholesterol Education Program (NCEP) Expert Panel
More informationNew Hypertension Guideline Recommendations for Adults July 7, :45-9:30am
Advances in Cardiovascular Disease 30 th Annual Convention and Reunion UERM-CMAA, Inc. Annual Convention and Scientific Meeting July 5-8, 2018 New Hypertension Guideline Recommendations for Adults July
More informationIschemic Heart and Cerebrovascular Disease. Harold E. Lebovitz, MD, FACE Kathmandu November 2010
Ischemic Heart and Cerebrovascular Disease Harold E. Lebovitz, MD, FACE Kathmandu November 2010 Relationships Between Diabetes and Ischemic Heart Disease Risk of Cardiovascular Disease in Different Categories
More informationPreventing Cardiovascular Disease Stroke Primary Prevention Guidelines. John Potter Professor Ageing & Stroke Medicine University of East Anglia
Preventing Cardiovascular Disease Stroke Primary Prevention Guidelines John Potter Professor Ageing & Stroke Medicine University of East Anglia Preventing Cardiovascular Disease Stroke Primary Prevention
More informationCardiovascular Health Practice Guideline Outpatient Management of Coronary Artery Disease 2003
Authorized By: Medical Management Guideline Committee Approval Date: 12/13/01 Revision Date: 12/11/03 Beta-Blockers Nitrates Calcium Channel Blockers MEDICATIONS Indicated in post-mi, unstable angina,
More informationNew Guidelines in Dyslipidemia Management
The Fourth IAS-OSLA Course on Lipid Metabolism and Cardiovascular Risk Muscat, Oman, February 2018 New Guidelines in Dyslipidemia Management Dr. Khalid Al-Waili, MD, FRCPC, DABCL Senior Consultant Medical
More informationRandomized Design of ALLHAT BP Trial
Outcomes in Hypertensive Black and Nonblack Patients Treated with Chlorthalidone, Amlodipine, and Lisinopril* *Wright JT, Dunn JK, Cutler JA et al. JAMA 2005:293:1595-1608. 42,418 High-risk hypertensive
More informationLipid Management C. Samuel Ledford, MD Interventional Cardiology Chattanooga Heart Institute
Lipid Management 2018 C. Samuel Ledford, MD Interventional Cardiology Chattanooga Heart Institute Disclosures No Financial Disclosures Disclosures I am an Interventional Cardiologist I put STENTS in for
More informationCedars Sinai Diabetes. Michael A. Weber
Cedars Sinai Diabetes Michael A. Weber Speaker Disclosures I disclose that I am a Consultant for: Ablative Solutions, Boston Scientific, Boehringer Ingelheim, Eli Lilly, Forest, Medtronics, Novartis, ReCor
More information