Heart Asia最新文献

{"title":"MiR-93-5p is a novel predictor of coronary in-stent restenosis.","authors":"John F O'Sullivan,&nbsp;Antoinette Neylon,&nbsp;Eoin F Fahy,&nbsp;Pengyi Yang,&nbsp;Catherine McGorrian,&nbsp;Gavin J Blake","doi":"10.1136/heartasia-2018-011134","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011134","url":null,"abstract":"<p><strong>Aims: </strong>MicroRNAs (miRNAs), small non-coding RNAs, have been implicated as regulators of multiple phases of atherothrombosis, and some reports have suggested altered levels in coronary artery in-stent restenosis (ISR). We recently demonstrated that miR-93-5 p was able to discriminate between patients with stable coronary artery disease (CAD) and those with no CAD, after adjusting for traditional risk factors (RFs). Thus, we wanted to determine if circulating miRNAs could predict coronary ISR.</p><p><strong>Objective: </strong>To determine if circulating miRNAs have diagnostic capability for determining ISR in a cohort of matched patients with and without ISR.</p><p><strong>Approach and results: </strong>To determine if miRNA plasma levels are elevated in coronary ISR, we conducted a study comprising 78 patients (39 with no ISR and 39 with ISR) and measured plasma miRNAs in each. We then determined the predictive ability of differential miRNAs, adjusting for Framingham Heart Study (FHS) RFs, and stent length and diameter, to discriminate between ISR and no ISR. After correction for multiple testing, two miRNAs-miR425-5p and miR-93-5 p-were differential between patients with ISR and patients without ISR. Only miR-93-5 p remained a strong independent predictor of ISR after correction for FHS RFs (OR 6.30, p=0.008) and FHS RFs plus stent length and diameter (OR 4.80, p=0.02) and improved discriminatory power for ISR over FHS RFs alone in receiver operator characteristic curve analysis.</p><p><strong>Conclusion: </strong>This novel finding that miR-93-5 p independently predicts ISR extends our recent observation that miR-93-5 p predicted CAD after adjustment for traditional CAD RFs. These data suggest further potential diagnostic utility.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011134"},"PeriodicalIF":0.0,"publicationDate":"2019-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011134","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"37190107","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Primary prevention ICD generator at end of life: to replace or not to replace?","authors":"S. Padala, K. Ellenbogen","doi":"10.1136/HEARTASIA-2018-011167","DOIUrl":"https://doi.org/10.1136/HEARTASIA-2018-011167","url":null,"abstract":"Implantable cardioverter-defibrillators (ICDs) are the cornerstone of therapy for primary prevention of sudden cardiac death in patients with severely depressed left ventricular ejection fraction (EF) ≤35%, irrespective of the aetiology.1–3 Current device guidelines and appropriate use criteria lay profound emphasis on the baseline left ventricular EF and New York Heart Association functional class in selecting appropriate candidates for primary prevention ICD implantation.4 5 However, these society guidelines do not provide guidance regarding a decision about replacing ICD generators, especially in patients who have not had any appropriate ICD therapies during the lifespan of the device and/or in whom the left ventricular EF improves to >35% at the time of reimplantation. Prior studies have shown that among primary prevention ICD recipients, about 75% do not experience any appropriate ICD therapies during the lifetime of their first ICD generator6 7 and about 25%–40% have improvements in their left ventricular EF >35% after ICD implantation.7–12 Furthermore, patients requiring generator replacements are older and have significantly greater comorbidities compared with the initial recipients.6 13 14 A significant proportion of ICD-related procedures in the USA, approximately 40%, involve ICD generator replacement based on the National Cardiovascular Data Registry data.6 Device replacements are associated with substantial healthcare costs and greater risk of major complications compared with initial implant.15 16 This raises a critical question as to whether the risk of sudden cardiac death warrants ICD generator replacement in patients who have not had any prior appropriate ICD therapies. Does improvement in left ventricular EF >35% lower the risk of sudden cardiac death negating the potential benefits of ICD?\u0000\u0000In this issue of the Journal , Looi et al 17 report their single-centre outcomes in patients with heart failure after primary prevention ICD generator replacement. …","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/HEARTASIA-2018-011167","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43763686","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Global cardiac surgery: lessons learnt from the global neurosurgery movement.","authors":"Dominique Vervoort,&nbsp;Kee B Park,&nbsp;JaBaris D Swain","doi":"10.1136/heartasia-2018-011125","DOIUrl":"10.1136/heartasia-2018-011125","url":null,"abstract":"Surgical care is increasingly considered as a crucial pillar of robust health systems. Five billion people worldwide lack access to safe surgical care, responsible for 16.9 million deaths every year and one-third of the global burden of disease.1 Contrary to previous belief, investing in surgical care is cost-effective on an individual and macroeconomic level, preventing a loss of 12.3 trillion dollars in economic growth by low-income and middle-income countries (LMICs) by 2030.1 \u0000\u0000In the past decade, the field of global surgery has gradually evolved, with its zenith paralleling the 2015 launch of the Lancet Commission on Global Surgery and the WHO Resolution WHA68.15. Since this release, several surgical subspecialties have gained important ground to create awareness surrounding the importance of their respective fields within the wider discussions. For example, the World Federation of Societies of Anaesthesiologists established a global platform for anaesthesiologists focused on capacity-building and promoting safety and quality of care, particularly in resource-constrained settings. Paediatric surgery has developed a global consensus group within the Global Initiative for Children’s Surgery, addressing its global disparities. Neurosurgery, once discarded as too complex for LMICs, has evolved to become a mainstay of global health discussions. Strategic efforts to heighten visibility and awareness about the need for expansion of neurosurgical services have led neurosurgery to become a major priority of the WHO’s Emergency and Essential Surgical Care Programme.\u0000\u0000Cardiac surgery, however, can be considered the unborn child of global surgery , with limited unified efforts to address the >4.5 billion people without access to cardiac surgery.2 To illustrate, the third edition of the Disease Control Priorities, examining the global burden of disease and cost-effective interventions, does not include any cardiac intervention …","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011125"},"PeriodicalIF":0.0,"publicationDate":"2019-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011125","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36988806","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Secondary prevention therapies in acute coronary syndrome and relation to outcomes: observational study.","authors":"Clara K Chow,&nbsp;David Brieger,&nbsp;Mark Ryan,&nbsp;Nadarajah Kangaharan,&nbsp;Karice K Hyun,&nbsp;Tom Briffa","doi":"10.1136/heartasia-2018-011122","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011122","url":null,"abstract":"<p><strong>Objective: </strong>To ascertain the use of secondary prevention medications and cardiac rehabilitation after an acute coronary syndrome (ACS) and the impact on 2-year outcomes.</p><p><strong>Methods: </strong>CONCORDANCE (Cooperative National Registry of Acute Coronary care, Guideline Adherence and Clinical Events) is a prospective, observational registry of 41 Australian hospitals. A representative sample of 6859 patients with an ACS and 6 months' follow-up on 31 May 2016 were included. The main outcome measure was use of ≥75% of indicated medications (≥4/5 (or ≥3/4 if contraindicated) of angiotensin-converting enzyme (ACE) inhibitor/angiotensin receptor blocker, beta-blocker, lipid-lowering therapy, aspirin and other antiplatelet). Major adverse cardiovascular events (MACE) included myocardial infarction, stroke or cardiovascular death.</p><p><strong>Results: </strong>The mean age was 65±13 years, 29% were women, and the mean Global Registry of Acute Coronary Events (GRACE) score was 106±30. At discharge, 92% were on aspirin, 93% lipid-lowering therapy, 78% beta-blocker, 74% ACE/angiotensin receptor blocker and 73% a second antiplatelet; 89% were taking ≥75% of medications at discharge, 78% at 6 months and 66% at 2 years. At 6 months, 38% attended cardiac rehabilitation, 58% received dietary advice and 32% of smokers reported quitting. Among 1896 patients followed to 2 years, death/MACE was less frequent among patients on ≥75% vs <75% of medications (8.3% vs 13.9%; adjusted OR 0.75, 95 % CI 0.56 to 0.99), and was less frequent in patients who attended versus who did not attend cardiac rehabilitation (4.6% vs 13.4%; adjusted OR 0.44, 95% CI 0.31 to 0.62).</p><p><strong>Conclusions: </strong>Use of secondary prevention therapies diminishes over time following an ACS. Patients receiving secondary prevention had decreased rates of death and MACE at 2 years.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011122"},"PeriodicalIF":0.0,"publicationDate":"2019-01-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011122","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36926753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Low levels of ideal cardiovascular health in a semi-urban population of Western Nepal: a population-based, cross-sectional study.","authors":"Bishal Gyawali,&nbsp;Shiva Raj Mishra,&nbsp;Salim S Virani,&nbsp;Per Kallestrup","doi":"10.1136/heartasia-2018-011131","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011131","url":null,"abstract":"<p><strong>Background: </strong>The aim of this study was to assess the status of cardiovascular health among a semi-urban population of Nepal, and determine factors associated with ideal cardiovascular health.</p><p><strong>Methods: </strong>A population-based, cross-sectional study using a systematic random sample was conducted among 2310 adults aged ≥ 25 years in a semi-urban area of the Pokhara Metropolitan City previously named Lekthnath in Nepal. The ideal, intermediate and poor cardiovascular health were defined as the presence of 6-7, 4-5 or 1-3 health metrics, among a list of 7 health behaviours and healthfactors, namely smoking, body mass index, physical activity, fruits and vegetables intakes, harmful alcohol consumption, blood pressure, and fasting blood glucose. We used univariate and multivariate Poisson regression models adjusting for sex, age groups, ethnicity, educational level and socioeconomic status, and calculated the prevalence ratios with 95% CIs.</p><p><strong>Results: </strong>Only 14.3 % of the participants had ideal cardiovascular health, whereas 67.0% and 18.7% of the participants had intermediate and poor cardiovascular health, respectively. Age groups 45-54 years (prevalence ratio 0.88, 95% CI: 0.83 to 0.94, p<0.001) and 55-64 years (prevalence ratio 0.84, 95% CI: 0.79 to 0.90, p<0.001) were significantly associated with low prevalence of ideal cardiovascular health compared with the age group 35-44 years. Ethnic groups, including Janajati (prevalence ratio 0.89, 95% CI: 0.85 to 0.93, p<0.001) and Dalit (prevalence ratio 0.9, 95% CI: 0.84 to 0.95, p=0.001), were significantly associated with low prevalence of ideal cardiovascular health.</p><p><strong>Conclusions: </strong>Prevalence of ideal cardiovascular health is low in the semi-urban population in Nepal. Concerted efforts are needed to develop a population-based intervention to improve cardiovascular health in Nepal.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011131"},"PeriodicalIF":0.0,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011131","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36926754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in LMICs.","authors":"Fatima Ali,&nbsp;Mohammad Qasim Mehdi,&nbsp;Saleem Akhtar,&nbsp;Nadeem Aslam,&nbsp;Rashid Abbas,&nbsp;Izat Shah,&nbsp;Jabbir Abidi,&nbsp;Sajid Arthur,&nbsp;Zeenat Nizar,&nbsp;Andrea Goodmann,&nbsp;Lisa Bergersen,&nbsp;Babar Hasan","doi":"10.1136/heartasia-2018-011105","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011105","url":null,"abstract":"<p><strong>Background: </strong>The importance of registries for collaborative quality improvement has been overlooked in low/middle-income countries (LMIC). Aga Khan University Hospital (AKUH) in Pakistan joined the Congenital Cardiac Catheterization Project on Outcomes-Quality Improvement (C3PO-QI) in March 2017 with the goal of leveraging international collaboration to improve patient care and institutional standards.</p><p><strong>Methods: </strong>The C3PO-QI key driver-based approach was used, with certain modifications, for process re-engineering in AKUH's congenital cardiac catheterisation laboratory (CCL) to reduce radiation exposure during cardiac catheterisation procedures (the primary outcome of C3PO- QI). Educating staff and standardising procedural documentation were the principal goals of the process re-engineering. Data survey was used to assess staff knowledge, attitude and practice before and after the initiative. Additionally, case demographics and outcomes were compared between AKUH and C3PO-QI centres.</p><p><strong>Results: </strong>There was an increase in appropriate recording of radiation surrogates (0%-100%, p=0.00) and in the percentage of cases that met the established benchmark of 'Ideal documentation' (35% vs 95%, p=0.001). There was also an increase in self-reported staff interest during the case (25% vs 75%, p=0.001). AKUH versus C3PO-QI data showed similar demographic characteristics. There was a slight over-representation of diagnostic cases (42% vs 32%) as compared with interventional (58% vs 68%) at AKUH. Furthermore, interventional procedures were predominately PDA and ASD device closures (n=19 and 15, respectively). The frequency of adverse events were the same between AKUH and collaborative sites.</p><p><strong>Conclusion: </strong>Collaborative efforts between developed and LMIC CCL are significant in advancing system-level processes.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011105"},"PeriodicalIF":0.0,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011105","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36937301","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Novel technique to manage pacemaker exposure with buried flap reconstruction: case series.","authors":"Raja Tiwari,&nbsp;Shruti Marwah,&nbsp;Ambuj Roy,&nbsp;Maneesh Singhal","doi":"10.1136/heartasia-2018-011086","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011086","url":null,"abstract":"<p><strong>Objective: </strong>Exposure of implantable electrical devices may increase morbidity and mortality significantly. Usually superficial infections are conservatively managed whereas invasive infections necessitate complete capsulectomy, sub-pectoral placement or implant exchange. Most commonly inadequate soft tissue coverage, soft tissue thinning and scar dehiscence over the edge of the pacemaker are the primary predisposing event. Multiple local surgical options have been described, however, with all these designs, the final scar still remains over the edge of the pacemaker and continue to have a tendency of thinning out with time. We have described a local skin flap which can be de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge, thereby preventing further recurrence.</p><p><strong>Methods: </strong>Three patients admitted in the Cardiology Department presented with impending exposure (n=2)and exposed implant (n=1) over the edge of pacemaker with superficial infection. Local modified rotation skin flap which was de-epithelialized and partially buried under the skin to increase the thickness over the pacemaker edge was performed under local anaesthesia in all the cases.</p><p><strong>Results: </strong>Flaps settled well in all patients with no evidence of infection, scar dehiscence and recurrence over a follow-up period of 2 years.</p><p><strong>Conclusions: </strong>This flap technique is recommended for cases of impending pacemaker exposure resulting due to scar dehiscence over the edge and helps by addressing the predisposing factors at an initial stage. In our experience, this technique also helped to salvage exposed pacemaker with superficial infection. To our bestof knowledge this technique has not been described before in the literature.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"11 1","pages":"e011086"},"PeriodicalIF":0.0,"publicationDate":"2019-01-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011086","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36937299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electrophysiological properties of the South Asian heart.","authors":"James O Neill,&nbsp;Muzahir Hassan Tayebjee","doi":"10.1136/heartasia-2018-011079","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011079","url":null,"abstract":"<p><strong>Objective: </strong>The South Asian population has a lower burden of arrhythmia compared with Caucasians despite a higher prevalence of traditional cardiovascular risk factors. We aimed to determine whether this was due to differences in the electrophysiological properties of the South Asian heart.</p><p><strong>Methods: </strong>We performed a retrospective cohort study of South Asian and Caucasian patients who underwent an electrophysiology study for supraventricular tachycardia between 2005 and 2017. Surface ECG, intracardiac ECG and intracardiac conduction intervals were measured and a comparison between the two ethnic cohorts was performed.</p><p><strong>Results: </strong>A total of 5908 patients underwent an electrophysiology study at the Yorkshire Heart Centre, UK, during the study period. Of these 262 were South Asian and 113 met the eligibility criteria. South Asians had a significantly higher resting heart rate (p=0.024), shorter QRS duration (p=0.012) and a shorter atrioventricular (AV; p=0.001)) and ventriculoatrial (VA; p=0.013) effective refractory period (ERP). There was no difference in atrial or ventricular ERP. On linear regression analysis, South Asian ethnicity was independently predictive of a higher resting heart rate, narrower QRS and shorter AV-ERP and VA-ERP.</p><p><strong>Conclusions: </strong>South Asians have significant differences in their resting heart rate, QRS duration and AV nodal function compared with Caucasians. These differences may reflect variations in autonomic function and may also be influenced by genetic factors. Electrophysiological differences such as these may help to explain why South Asians have a lower burden of arrhythmia.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011079"},"PeriodicalIF":0.0,"publicationDate":"2018-11-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267330/pdf/heartasia-2018-011079.pdf","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36787357","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimal duration and predictors of diagnostic utility of patient-activated ambulatory ECG monitoring.","authors":"Eugene S J Tan,&nbsp;Swee-Chong Seow,&nbsp;Pipin Kojodjojo,&nbsp;Devinder Singh,&nbsp;Wee Tiong Yeo,&nbsp;Toon Wei Lim","doi":"10.1136/heartasia-2018-011061","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011061","url":null,"abstract":"<p><strong>Objective: </strong>We studied the optimal duration of ambulatory event monitors for symptomatic patients and the predictors of detected events.</p><p><strong>Methods: </strong>Patients with palpitations or dizziness received a patient-activated handheld event monitor which records 30 s single-lead ECG strips. Patients were monitored in an ambulatory setting for a range of 1-4 weeks and ECG strips interpreted by five independent electrophysiologists. Event pick-up rates and clinical covariates were analysed.</p><p><strong>Results: </strong>Of 335 consecutive adults (age 50±16 years, 58% female) with palpitations (94%) and dizziness (25%) monitored, 286 patients (85%) reported events, and clinically significant events were detected in 86 (26%) patients. Of these 86 patients, 26% had ≥2 significant events, and 73% had events detected in the first 3 days. No significant events were detected after 12 days. The most common ECG abnormalities detected were premature ventricular ectopy (38%), premature atrial ectopy (37%) and atrial fibrillation (AF)/atrial flutter (34%). A history of AF (adjusted OR (AOR) 4.2, 95% CI 1.1 to 15.8), previous arrhythmia (AOR 2.8, 95% CI 2.3 to 5.9) and previous abnormal ambulatory monitoring (AOR 3.4, 95% CI 1.0 to 9.4) were associated with detection of clinically significant events. Patients older than 50 years were 82% more likely to have a clinically significant event (OR 1.8, 95% CI 1.3 to 3.6).</p><p><strong>Conclusion: </strong>Patient-activated ambulatory event monitoring for 7 days may be sufficient in the diagnosis of symptomatic patients as significant events first detected beyond 10 days were rare. Patients with a history of AF, arrhythmia or previous abnormal ambulatory monitoring may require even shorter monitoring periods.</p>","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011061"},"PeriodicalIF":0.0,"publicationDate":"2018-11-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36787356","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Single-use medical devices: economic issues.","authors":"Philip Jacobs,&nbsp;Ilke Akpinar","doi":"10.1136/heartasia-2018-011034","DOIUrl":"https://doi.org/10.1136/heartasia-2018-011034","url":null,"abstract":"Evaluate MedTech estimated that worldwide sales of medical devices in 2017 were US$386.8 billion. Cardiology was among the largest groups, with $44.6 billion in sales.1 The Emergo Group estimated US sales to be $147.7 billion and sales in India to be $3.5 billion.2 The average annual growth of the device market since 2009 has been about 16%.3 \u0000\u0000Although many devices have been labelled as ‘single-use’ by the original manufacturers, some of these have nonetheless been reprocessed and used again. Some device manufacturers have warned against this practice,4 5 ostensibly because of the potential risks of infection or breakdown. For some time, hospitals have been reprocessing SUDs in-house. Also, since about the year 2000 a thriving third-party reprocessing industry has emerged in North America and Europe. Only about 2%–3% of all devices can be safely reprocessed.6 By 2016, global revenue of independent SUD reprocessors was estimated to be $1.054 billion.7 Estimated sales of third-party reprocessors in the USA was $848.5 million.8 In-house hospital activities are generally not included when considering the size of the reprocessing marketplace. In India, there is considerable in-house activity in device reprocessing in hospitals,9 10 but there is no large-scale SUD third-party market.\u0000\u0000We compare the difference in cost with the difference in harm between new and reused SUDs. The variables included in this comparison are shown in table 1. These variables are defined differently between countries because the markets and regulatory systems are so different.\u0000\u0000View this table:\u0000\u0000Table 1 \u0000Variables used for economic analysis of reuse in the USA and India\u0000\u0000\u0000\u0000The risk of harm is the major clinical outcome for reprocessing activity. To help regulate the safety of brand new and reprocessed devices, The US Food and Drug Administration (US FDA) developed a three-class licensing system.11 Devices in the …","PeriodicalId":12858,"journal":{"name":"Heart Asia","volume":"10 2","pages":"e011034"},"PeriodicalIF":0.0,"publicationDate":"2018-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1136/heartasia-2018-011034","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"36789266","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}