[Cardiac sudden death in Italy. Dimensions, perceptions, policies and economic/financial impact].
This study is based on the consideration that sudden cardiac death (SCD) incidence is increasing in today's society and, despite the efforts of clinicians, there is great lack of awareness and focus for its prevention on behalf of society and institutions. During 2006 a research project on SCD was initiated in Italy by the CUSAS (Centro Universitario di Studi in Amministrazione Sanitaria) and the Institute for Internal Medicine and Cardiology of the University of Florence with the intention to: estimate the dimension(s) of the SCD phenomenon in the general population; underline the economical consequences of SCD; identify the causes for the lack of interest in SCD; evaluate the degree of use of biomedical technologies for SCD prevention, and compare the actual scenario with the ideal one (driven by treatment guidelines implementation); the last part of the study analyzes economical sustainability of the implementation of the 2006 European Society of Cardiology new guidelines. We estimated an occurrence of SCD in young subjects (between 35 and 65 years of age) of roughly 9300 cases per year (approximately 17% of total): nearly one case of SCD in 5 afflicts young and still active individuals. Causes of the phenomenon vary greatly: in older subjects the pathology that most frequently causes SCD is ischemic heart disease, whereas in younger subjects it is more often related to heart failure. The most optimistic hypothesis is that each year SCD causes the loss of nearly 600 000 life years. We came up with a first estimate of the socio-economic impact due to life years lost each year to SCD, using net individual work salary for the basis of the calculation. Results are extremely variable (between 6.482 and 12.216 millions of euros each year). Considering that half of the events occur in patients in whom SCD can be accurately predicted, due to their high risk factor, it is possible to estimate the financial investment necessary to prevent SCD in at least these individuals. The DRG tariff is used as a proxy for the economic calculation of the procedure costs. An additional investment of 310 million euros would have been necessary, which represents only 0.33% of the national health budget for that same year. We strongly believe that preventing SCD is not only financially feasible but very beneficial from the societal perspective.
Facoltà di Medicina e Chirurgia, Università degli Studi, Firenze. mario.delvecchio@unifi.it
Mario
M
Del Vecchio
Luigi
L
Padeletti
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017281:Cost of Illness; D016757:Death, Sudden, Cardiac / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy; D008297:Male; D008875:Middle Aged; D018570:Risk Assessment