The population mortality benefits of maximizing the number of eligible patients receiving appropriate cardiology treatments in Ireland.
BACKGROUND
Coronary heart disease (CHD) mortality rates have been decreasing in many industrialized countries since the 1980s. Up to half this decrease can be attributed to evidence-based medical and surgical cardiology interventions. However, recent studies suggest that modern cardiology treatment uptake levels remain disappointingly low in many patient categories.


OBJECTIVE
To determine the potential for further reductions in CHD mortality in Ireland from increasing the number of eligible patients receiving cardiology treatments.


METHODS
A previously validated, cell-based IMPACT CHD mortality model was used to integrate large amounts of data describing CHD patient numbers, and the effectiveness and uptake levels of specific medical and surgical treatments. The CHD mortality reductions potentially achievable through the increased use of specific treatments were then calculated, stratified by age and gender and tested using sensitivity analyses.


RESULTS
In 2000, medical and surgical coronary disease treatments together prevented or postponed approximately 1950 CHD deaths in the adult population aged 25-84. However, increasing treatment levels to reach 80% of eligible patients might have prevented or postponed a further 2280 CHD deaths in 2000 (minimum estimate 860, maximum estimate 4000). The biggest gain was from maximizing the treatment uptake of eligible heart failure patients, followed by those receiving statins and secondary prevention therapies.


CONCLUSIONS
Many eligible patients are currently not receiving appropriate evidence-based treatments that would reduce CHD mortality and morbidity. Our results suggest that increasing cardiology treatment uptake in Ireland could at least double the current therapeutic reduction in CHD mortality.
Kabir
Z
Z
Department of Pharmacology & Therapeutics, Trinity Centre for Health Sciences, St James's Hospital, Dublin 8, Ireland. kabirzin@yahoo.com
Bennett
K
K
Shelley
E
E
Unal
B
B
Critchley
J
J
Feely
J
J
Capewell
S
S
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000401:mortality* / Q000601:surgery / Q000628:therapy*; D004363:Drug Utilization / Q000706:statistics & numerical data; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000628:therapy; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use; D007494:Ireland / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010349:Patient Compliance / Q000706:statistics & numerical data; D012680:Sensitivity and Specificity
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors