WHO data on Cardiovascular Disease and Nuclear Cardiology...
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WHO data on Cardiovascular Disease and Nuclear Cardiology Utilization Worldwide DISCLOSURES DISCLOSURES Honorarium Honorarium – – Research / Advisor, Expert Services and Conferences in Nuclear Research / Advisor, Expert Services and Conferences in Nuclear Cardiology Cardiology BMS, CVT, Astellas, Lantheus, PPGx, IAEA BMS, CVT, Astellas, Lantheus, PPGx, IAEA Royalties Royalties – – Publications in Nuclear Cardiology Publications in Nuclear Cardiology Springer Springer - - Verlag Verlag - - Nuclear Cardiology and Correlative Imaging: a teaching file, Nuclear Cardiology and Correlative Imaging: a teaching file, NY, 2004 NY, 2004 Lippincott Williams & Wilkins, Lippincott Williams & Wilkins, - - Nuclear Medicine teaching File Nuclear Medicine teaching File , 2009 , 2009 João V. Vitola, MD, PhD João V. Vitola, MD, PhD Cardiologist and Nuclear Medicine Physician Cardiologist and Nuclear Medicine Physician Quanta Diagnostico Nuclear Quanta Diagnostico Nuclear Curitiba Curitiba - - Brazil Brazil
Transcript of WHO data on Cardiovascular Disease and Nuclear Cardiology...
WHO data on Cardiovascular Diseaseand
Nuclear Cardiology Utilization Worldwide
DISCLOSURESDISCLOSURESHonorarium Honorarium –– Research / Advisor, Expert Services and Conferences in NuclearResearch / Advisor, Expert Services and Conferences in Nuclear CardiologyCardiology
BMS, CVT, Astellas, Lantheus, PPGx, IAEABMS, CVT, Astellas, Lantheus, PPGx, IAEARoyalties Royalties –– Publications in Nuclear CardiologyPublications in Nuclear CardiologySpringerSpringer--VerlagVerlag--Nuclear Cardiology and Correlative Imaging: a teaching file,Nuclear Cardiology and Correlative Imaging: a teaching file, NY, 2004NY, 2004Lippincott Williams & Wilkins, Lippincott Williams & Wilkins, -- Nuclear Medicine teaching FileNuclear Medicine teaching File, 2009, 2009
João V. Vitola, MD, PhDJoão V. Vitola, MD, PhD
Cardiologist and Nuclear Medicine Physician Cardiologist and Nuclear Medicine Physician Quanta Diagnostico NuclearQuanta Diagnostico Nuclear
Curitiba Curitiba -- BrazilBrazil
http://www.who.int/cardiovascular_diseases/en/
Leader Cause of Mortality in Adults Men and Women80% of 17.5 mi Deaths Due to CVD are in Low to Mid Income Countries
Significant Economic Burden
General Overview
Downloaded from www.who.int in Jan 2010
Ischemic Heart Disease
Downloaded from www.who.int in Jan 2010
Cerebrovascular Disease
Death from CAD - variation by country and gendercause of mortality age > 60 yo
OLD AND NEW CHALLENGES TO FACE IN CARDIAC CAREOLD AND NEW CHALLENGES TO FACE IN CARDIAC CARE
Rising health care cost of chronic disease Rising health care cost of chronic disease (obesity/lack of exercise/smoking)(obesity/lack of exercise/smoking)
OBESITY OBESITY –– SPECIALLY WOMENSPECIALLY WOMENDM DM –– IMPACTING THE YOUNGIMPACTING THE YOUNGAGING AGING –– WORLDWIDEWORLDWIDE
Downloaded from www.who.int in Jan 2010
OBESITY
Downloaded from www.who.int in Jan 2010
Downloaded from www.who.int in Jan 2010
DIABETES
Downloaded from www.who.int in Jan 2010
World Scenario – Estimation for 2025Diabetes International Federation
Diabetes Atlas: 2006; DIFDiabetes Atlas: 2006; DIF
Resultado anormal: idade x DM
33% 33%
44%50%
62%
73%
Até 39 40 a 49 50 a 59 60 a 69 70 a 79 80 ou mais
Não diabéticoDiabético
DM, Age and SPECT Abnormalities
%ABNORMAL
(n=10594)(n=10594)
Vitola JV et al , Quanta Database – Curitiba - Brazil
Diabetes is Increasing Mostly in Developing Countries (middle age)
Source WHO
Projected Percentage of Deaths from Cardiovascular Projected Percentage of Deaths from Cardiovascular Disease Among Those 35 Disease Among Those 35 -- 64 yrs64 yrs
Health Affairs Jan/Feb 2007
36 yo, ManDM, Obese (IMC: 30.1), HTN, High CholesterolDenies Chest Pain
TMTRest ECG – LAHBBruce : 10 minHR: 84 .... 159 (85% = 156 bpm)BP: 130/80 ....180/90 mmHgNo ST segment changes At peak exercise right should pain, Not LimitingDuke ScoreDuke: exer min – 5x ST – 4x anginaDuke = (+10) – (5x0) – (4x1) = + 6
Clinical Case
Eje Corto
Eje Largo Vertical
Eje Largo Horizontal
Cortes Tomográficos-Referencia
ESV: 70 ml, LVEF: 45%High Risk Findings
Revascularization + Optimized Medical Therapy
IncreaseDeaths (%)
02040
6080
100120
140
Developing Nations Developed Nations
WomenMen
Projected Increase Deaths due to CVD from 1990 to 2020
Yusuf S et al, Circulation 2001; 104:2746-2753Leeder, S et al. A Race against time: the challenges of cardiovascular disease in developing countries. New York: Trustees of Columbia University; 2004
Life tables for WHO member states, Geneva, Word Health Organization , 2006http://www.who.int/whosis/database/life_tables.cfm
Country Men WomenRussia 59 72India 62 64Brazil 68 75China 71 74Argentina 72 78Cuba 75 79USA 75 80Canada 78 83Italy 78 84Australia 79 84Japan 79 86
Population is aging
BRIC Emerging Economies Developing Countries
Life Expectancy at Birth
Implications for NCRATIONAL INVESTMENTS
The Elderly Population is Increasing
Source: WHO
Resultado anormal: idade x sexo
10%
19% 21%
30%
41%
52%
14%
23%
33%
46%
55%
68%
Até 39 40 a 49 50 a 59 60 a 69 70 a 79 80 ou mais
FemininoMasculino
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)
P<0.048P<0.611P<0.001P<0.036P<0.001
Age as a Predictor of SPECT AbnormalityAge as a Predictor of SPECT AbnormalityVitola JV et al. Quanta Database – Curitiba, Brazil (n=10594)
PREVALENCIA DE EAC PREVALENCIA DE EAC -- EUAEUA
5,510,4
17,4
34,2
51,0
65,270,7
4,60 4,20
13,60
28,90
79,00
48,10
65,20
0102030405060708090
20-24 25-34 35-44 45-54 55-64 65-74 75+Ages
Perc
ent o
f Pop
ulatio
n
MalesFemales
American Heart Association. 2002 Heart and Stroke Statistical Update. 2001
Prevalence of Heart Failure by Gender Prevalence of Heart Failure by Gender and Age in the Framingham Studyand Age in the Framingham Study
0,1 0,51,3
3,4
6,6
9,7
0,10,7
1,8
6,26,8
9,8
0
2
4
6
8
10
20-34 35-44 45-54 55-64 65-74 75+Age
patie
nts pe
r 100
perso
ns
WomenMen
Ho, Pinsky, Kannel, Levy. J Am Coll Cardiol 1993; 22:6A
$
Chronic Heart Failure in the United States. A Manifestation of Coronary Artery Disease
Mihai Gheorghiade, MD; Robert O. Bonow, MD Circulation 1998;97:282-289
CAD68%
non-CAD32%
CAD non-CAD $
NEW CHALLENGES TO FACE IN CARDIAC CARENEW CHALLENGES TO FACE IN CARDIAC CAREOBESITY OBESITY –– SPECIALLY WOMENSPECIALLY WOMENDM DM –– IMPACTING THE YOUNGIMPACTING THE YOUNGAGING AGING –– WORLDWIDEWORLDWIDE
LIMITED / RATIONAL USE OF RESOURCES:LIMITED / RATIONAL USE OF RESOURCES:PREVENTIONPREVENTION
(Long Term Investment: exercise/quit smoking/diet)(Long Term Investment: exercise/quit smoking/diet)INVESTIGATIONINVESTIGATION
(Mostly Non Invasive (Mostly Non Invasive –– Nuclear/IAEA)Nuclear/IAEA)MANAGEMENT MANAGEMENT
(Guided by APPROPRIATE Investigation)(Guided by APPROPRIATE Investigation)
Cost Effectiveness treating CVD U$ per DALY = Disability Adjusted Life – Year averted
WHAT ARE THE ECONOMIC COSTS OF CARDIOVASCULAR DISEASES ?
1. CVDs affect many people in middle age, very often severely limiting the incomeand 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 .....
Adel Allam – EgyptAmalia Peix – Cuba
Annare Ellmann – South AfricaBon Nang Lee – Malaysia
C. Siritara - ThailandFelix Keng – Singapore
Fernando Mut- (Co-chairman) - UruguayGianmario Sambucetti – Italy
Gregory Thomas – USAJoão V. Vitola (Chairman) - Brazil
Kevin Allman – AustraliaLeslee Shaw – USA
Maurizio Dondi - IAEA - AustriaMarla Kiess – CanadaPilar Orellana – Chile
Raffaele Giubbini – SwitzerlandSalaheddine Bouyoucef – Algeria
Zuo – Xiang He – China
IAEA, Vienna, Austria, 2008IAEA, Vienna, Austria, 2008Organized by Maurizio DondiOrganized by Maurizio Dondi
Vitola JV, Shaw L, Allam A et al JNC, 2009
Worldwide Utilization of Nuclear Cardiology – Underutilized in Many Nations
HighModerate – HighModerateModerate – LowLowInexistente
Influenced by:- Economy
GDPHealthcare Policies
-InformationOrganized scientific groupsLocal Scientific Production
Training-Neighboring coutries
ComunicationTraining
Scientific meetings
Vitola JV, Shaw L, Allam A et al. JNC 2009
USA budget for health care – 2 trillion US $16% of GDPBeller G, JNC 2008
Leppo J, JNC, 2009
Porter ME, Teisberg EO: Redefining Health Care Harvard Business School Press, 2006
What investment is ideal (Prevention + Investigation + Management) ?
AMERICA LATINA
Leppo J, JNC, 2009
What information should we be looking for to change What information should we be looking for to change management and result in better patient outcome in a management and result in better patient outcome in a
cost effective way ?cost effective way ?
Leslee Shaw et al. JACC 1999;33:661-669
ECONOMIC IMPLICATIONS OF REVASCULARISATIONWITHOUT SELECTING BASED ON ISCHEMIA
Shaw JACC 1999;33:661-669
What is the utilization of Nuclear Cardiology in India ?Only about 20 thousand SPECT / year / entire India 100 MPI/mo
•• Obesity and DM will contribute to Obesity and DM will contribute to increased CVD mortality worldwideincreased CVD mortality worldwide
•• Prevention of CAD is essentialPrevention of CAD is essential
•• Imaging can be used to assess risk Imaging can be used to assess risk and guide management cost and guide management cost effectivellyeffectivelly
•• Wide variation under and over Wide variation under and over utilization of technology utilization of technology –– regional regional differences differences -- GDP but also GDP but also InformationInformation
•• Considering increasing costs Considering increasing costs --essential to rationalize investigation essential to rationalize investigation and managementand management
Confronting the Epidemics of CVD Worldwide:Time to Stop and Think About Cardiac Care
Imaging Utilization in 2010
