Hanna Zowall

N-Terminal Pro–B-Type Natriuretic Peptide Testing Improves the Management of Patients With Suspected Acute Heart Failure Primary Results of the Canadian Prospective Randomized Multicenter IMPROVE-CHF Study

Background— The diagnostic utility of N-terminal pro-B-type natriuretic peptide (NT-proBNP) in heart failure has been documented. However, most of the data were derived from countries with high healthcare resource use, and randomized evidence for utility of NT-proBNP was lacking. Methods and Results— We tested the hypothesis that NT-proBNP testing improves the management of patients presenting with dyspnea to emergency departments in Canada by prospectively comparing the clinical and economic impact of a randomized management strategy either guided by NT-proBNP results or without knowledge of NT-proBNP concentrations. Five hundred patients presenting with dyspnea to 7 emergency departments were studied. The median NT-proBNP level among the 230 subjects with a final diagnosis of heart failure was 3697 compared with 212 pg/mL in those without heart failure (P<0.00001). Knowledge of NT-proBNP results reduced the duration of ED visit by 21% (6.3 to 5.6 hours; P=0.031), the number of patients rehospitalized over 60 days by 35% (51 to 33; P=0.046), and direct medical costs of all ED visits, hospitalizations, and subsequent outpatient services (US

The cost-effectiveness of exercise training for the primary and secondary prevention of cardiovascular disease.

6129 to US

Cost-Effectiveness of Treating Hyperlipidemia in the Presence of Diabetes Who Should Be Treated?

5180 per patient; P=0.023) over 60 days from enrollment. Adding NT-proBNP to clinical judgment enhanced the accuracy of a diagnosis; the area under the receiver-operating characteristic curve increased from 0.83 to 0.90 (P<0.00001). Conclusions— In a universal health coverage system mandating judicious use of healthcare resources, inclusion of NT-proBNP testing improves the management of patients presenting to emergency departments with dyspnea through improved diagnosis, cost savings, and improvement in selected outcomes.

Treating Osteoarthritis With Cyclooxygenase-2-Specific Inhibitors What Are the Benefits of Avoiding Blood Pressure Destabilization?

BACKGROUND Although exercise training improves cardiovascular disease (CVD) risk factors, few studies have evaluated its potential long-term cost-effectiveness. METHODS Using the Cardiovascular Disease Life Expectancy Model, a validated disease simulation model, we calculated the life expectancy of average 35- to 74-year-old Canadians found in the 1992 Canadian Heart Health Survey. The impacts of exercise training on cardiovascular risk factors were estimated as a 4% decrease in low-density lipoprotein (LDL) cholesterol, a 5% increase in high-density lipoprotein (HDL) cholesterol, and a 6 mm Hg decrease in both systolic and diastolic blood pressure. Exercise adherence was estimated at 50% for the first year and 30% for all additional years. Costs for a supervised exercise program determined from Canadian sources and converted to US dollars were estimated at

Costs of dyslipidemia

605 for the first year (medical evaluation, stress test, exercise prescription, and program costs) and

Response to Letter Regarding Article, “N-Terminal Pro–B-Type Natriuretic Peptide Testing Improves the Management of Patients With Suspected Acute Heart Failure: Primary Results of the Canadian Prospective Randomized Multicenter IMPROVE-CHF Study”

367 for all additional years (program costs). For an unsupervised program, the costs were estimated at

Estimating the Benefits of Modifying Risk Factors of Cardiovascular Disease A Comparison of Primary vs Secondary Prevention

311 for the first year and

The Cost-effectiveness of HMG-CoA Reductase Inhibitors to Prevent Coronary Heart Disease: Estimating the Benefits of Increasing HDL-C

73 for all additional years. RESULTS The cost-effectiveness (CE) of an unsupervised exercise program (1996 U.S. dollars) was less than

How Cost-Effective Is the Treatment of Dyslipidemia in Patients With Diabetes but Without Cardiovascular Disease?

12,000 per year of life saved (YOLS) for all individuals. The CE of a supervised exercise program was less than

Cost-effectiveness of 3-Hydroxy-3-Methylglutaryl- Coenzyme A Reductase Inhibitors in the Secondary Prevention of Cardiovascular Disease Forecasting the Incremental Benefits of Preventing Coronary and Cerebrovascular Events

15,000/YOLS for men with CVD, and between