Download or read book The Relative Cost effectiveness of Five Non invasive Cardiac Imaging Technologies for Diagnosing Coronary Artery Disease in Ontario written by and published by . This book was released on 2010 with total page 54 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Cardiac radionuclide imaging and cost effectiveness written by and published by DIANE Publishing. This book was released on with total page 68 pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Non invasive Cardiac Imaging Technologies for the Diagnosis of Coronary Artery Disease written by and published by . This book was released on 2010 with total page 40 pages. Available in PDF, EPUB and Kindle. Book excerpt: Of aggregate results: Safety: Radiation -- Limitations of the analysis and GRADE quality of the evidence.

Download or read book Integrated Non Invasive Cardiovascular Imaging A Guide for the Practitioner written by IAEA and published by International Atomic Energy Agency. This book was released on 2021-06-14 with total page 258 pages. Available in PDF, EPUB and Kindle. Book excerpt: Integrated cardiovascular imaging is the optimal use of multiple imaging modalities to obtain complementary information about cardiac diseases, to aid in diagnosis, determine aetiology and prognosis, with the ultimate objective of effectively guiding clinical decision making. Over the past few decades, advances in technology have contributed to the development of new imaging modalities and refinement of existing ones, leading to major improvements in the accuracy of diagnosing cardiovascular disease. While modality-centric expertise has been the primary driver of improvements in each modality, this has also contributed to imagers working in silos resulting with limited inter-modality coordination and collation of information relevant for patient care. This publication provides comprehensive guidance on the rationale and implementation of integrated cardiovascular imaging for practitioners.

Download or read book Patient and Physician Preferences for Non invasive Diagnostic Cardiac Imaging Technologies written by Thomas Bertrand and published by . This book was released on 2018 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: "BACKGROUND: The use of non-invasive cardiovascular imaging tests for diagnosing coronary artery disease (CAD) has risen dramatically over the last decade. However, guidelines for the diagnosis and management of patients with stable ischemic heart disease reported a lack of attention devoted to users' satisfaction, and repeatedly documented the importance of patient-oriented research to guide clinical decision-making. In this context, this study aims to contribute to the understanding of patient and physician preference in relation to the choice of cardiovascular imaging tests. METHODS: A discrete choice experiment (DCE) questionnaire on a convenience sample from the Royal Victoria cardiology clinic was used to systematically elicit patient and physician preference toward diagnostic imaging tests. Tests were differentiated using 6 attributes (patient out-of-pocket cost, risks and side effects, type of procedures, diagnostic accuracy, type of scanner and test duration). A choice-based conjoint analysis with hierarchical Bayes estimation was performed with Sawtooth Software. RESULTS: One hundred and forty-eight cardiac patients and 63 physicians completed the DCE. Risks and side effects had the highest impact on patients' preference (30%). Patients assigned notably high utility to tests with milder side effects (+97.7), while avoiding exposure to ionizing radiation (-36.7) and risks associated with exercise and the use of pharmacological agents inducing direct coronary arteriolar vasodilation (-61.0). Physicians attributed more importance to costs for patients (29%). CONCLUSIONS: Patients' preference was most determined by the risks and side effects associated with cardiovascular imaging tests, while physicians preferred less costly alternatives. When engaging in shared decision-making with patients, physicians should discuss the risks and side effects associated with cardiovascular imaging tests. In aiming for the best possible care, the clinical implementation of safer, more accurate and cost-effective imaging tests for diagnosing CAD may improve users' satisfaction and health outcomes." --

Download or read book Noninvasive Imaging for the Assessment of Coronary Artery Disease written by Punitha Arasaratnam and published by . This book was released on 2015 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Noninvasive cardiac imaging is a cornerstone of the diagnostic work-up in patients with suspected coronary artery disease (CAD), cardiomyopathy, heart failure, and congenital heart disease. It is essential for the assessment of CAD from functional and anatomical perspectives, and is considered the gate-keeper to invasive coronary angiography. Cardiac tests include exercise electrocardiography, single photon emission computed tomography myocardial perfusion imaging, positron emission tomography myocardial perfusion imaging, stress echocardiography, coronary computed tomography angiography, and stress cardiac magnetic resonance. The wide range of imaging techniques is advantageous for the detection and management of cardiac diseases, and the implementation of preventive measures that can affect the long-term prognosis of these diseases. However, clinicians face a challenge when deciding which test is most appropriate for a given patient. Basic knowledge of each modality will facilitate the decision-making process in CAD assessment.

Download or read book Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women Future Research Needs written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-08-19 with total page 54 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiovascular disease is the leading cause of mortality for women in the U.S. According to the American Heart Association (AHA), approx. one in three female adults have some form of cardiovascular disease. AHA suggests there is evidence showing that women at risk for coronary artery disease (CAD) are less often referred for the appropriate diagnostic test than are men. Coronary anatomy and pathology have traditionally been defined and identified by coronary angiography, a procedure that is indicated in patients who have chest pain and are at high risk for CAD. For intermediate-risk patients, clinicians have a wide range of noninvasive technologies (NITs) to choose from that can assess functional status (i.e., ischemia or no ischemia) or visualize anatomic abnormalities. Functional modalities include stress electrocardiography (ECG); stress echocardiography (ECHO); and stress radionuclide myocardial perfusion imaging, including single-proton emission computed tomography (SPECT) and positron emission tomography (PET). Anatomic modalities include stress myocardial perfusion and wall-motion cardiac magnetic resonance (CMR) imaging and coronary computed tomography angiography (coronary CTA). The comparative safety and accuracy of these NITs in women was uncertain, although substantial data exists for populations combining men and women, and for mixed populations of known and no known CAD. In 2012, a Comparative Effectiveness Review, “Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women,” evaluated the diagnostic accuracy and risks of NITs in women with symptoms suspicious for CAD, including assessing predictors affecting test accuracy, and the ability of NITs to provide risk stratification and prognostic information, inform decisionmaking about treatment options, and affect clinical outcomes. For women with no known CAD, the summary of accuracy for each NIT modality compared with coronary angiography was ECG: sensitivity 62%, specificity 68%; ECHO: sensitivity 79%, specificity 83%; SPECT: sensitivity 81%, specificity 78%; CMR: sensitivity 72%, specificity 84%; and CTA: sensitivity 94%, specificity 87%. Compared with men evaluated in the same studies, in women ECG and coronary CTA modalities were both less sensitive and less specific. The ECHO and SPECT modalities appeared to be more specific in women. The lower specificity of the ECG modality in women was the only statistically significant difference. Strength of evidence was high for ECG, ECHO, and SPECT, and was low for CMR and coronary CTA compared with coronary angiography in women. Eleven comparative studies examined predictors of diagnostic accuracy in women such as postmenopausal status, race/ethnicity, heart size, beta blocker use, and pretest probability; insufficient evidence was available to draw conclusions about predictors that affect accuracy. Eight studies assessed risk stratification and prognostic factors, two studies assessed treatment decisionmaking, and four studies provided comparative clinical outcomes but provided insufficient evidence on the comparative effectiveness of NITs to provide risk stratification, prognostic information, treatment decisionmaking, or impact on clinical outcomes in women. Thirteen comparative studies reported risks. Of these, four studies of coronary CTA showed a higher mean effective radiation dose and attributable risk of cancer incidence in women compared with men; however, radiation safety issues were not discussed in other NIT modalities with radiation exposure. Thus, there was insufficient evidence regarding the comparative risks of various NIT modalities in women. Given the clinical and economic importance of noninvasive testing for CAD in women, the ongoing investment in NIT research, and the remaining areas of uncertainty, we sought to create a prioritized research agenda that would represent the interests of diverse stakeholders and allow the remaining areas of uncertainty to be addressed.

Download or read book Non invasive Cardiac Diagnostic Tests in Ontario written by Idan Roifman and published by . This book was released on 2016 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:

Download or read book Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women written by U. S. Department of Health and Human Services and published by CreateSpace. This book was released on 2013-04-11 with total page 344 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiovascular disease is the leading cause of mortality for women in the U.S. Coronary heart disease—which includes coronary artery (or atherosclerotic) disease (CAD), myocardial infarction (MI), acute coronary syndromes, and angina—is the largest subset of this mortality. According to the American Heart Association (AHA), approximately one in three female adults has some form of cardiovascular disease. It is estimated that 8.1 million women alive today have a history of heart attack, angina pectoris (chest pain or discomfort caused by reduced blood supply to the heart muscle), or both, and experts predict that in 2010 alone an estimated 370,000 women will have a new or recurrent MI. Overall, women who have had an acute MI—particularly those older than 55 years of age—have a worse prognosis than men, with a greater recurrence of MI and higher mortality. More women (5.5 million) than men (4.3 million) have angina in total numbers. However, the prevalence of CAD in women with chest pain is about 50%, compared with 80% in men, which complicates diagnosis in women. The AHA suggests there is evidence showing that women at risk for CAD are less often referred for the appropriate diagnostic test than are men. Coronary anatomy and pathology have traditionally been defined and identified by invasive, catheter-based x-ray angiography, also referred to as coronary angiography. The major benefits of invasive coronary angiography over noninvasive techniques are that the use of a catheter makes it possible to see the coronary arteries with greater anatomic precision and resolution and to combine diagnosis and treatment in a single procedure. The limitations of the procedure include the invasive nature of the test and the limited data on the functional impact of a luminal obstruction. These limitations are generally considered to be minor when compared with the benefits of the procedure, and coronary angiography is now the reference (gold) standard for clinical care of patients who have chest pain suggestive of CAD. Coronary angiography, however, is not risk-free. Coronary angiography is generally indicated in patients who have chest pain and are at high risk for CAD. The goal of this comparative effectiveness report was to conduct a systematic review of the peer-reviewed medical literature assessing (1) the accuracy of different NITs for diagnosing CAD in women with symptoms suspicious of CAD, (2) the predictors affecting test accuracy, (3) the ability to provide risk stratification and prognostic information, inform decisionmaking about treatment options, and affect clinical outcomes, and (4) the safety concerns and risks to women undergoing these tests. The following Key Questions (KQs) were considered in this review: KQ1. What is the accuracy of one NIT in diagnosing obstructive and nonobstructive CAD when compared with another NIT or with coronary angiography in women with symptoms suspicious for CAD? KQ2. What are the predictors of diagnostic accuracy (e.g., age, race/ethnicity, body size, heart size, menopausal status, functional status, stress modality) of different NITs in women? KQ3. Is there evidence that the use of NITs (when compared with other NITs or with coronary angiography) in women improves: KQ3a. Risk stratification/prognostic information? KQ3b. Decisionmaking regarding treatment options (e.g., revascularization, optimal medical therapy)? KQ3c. Clinical outcomes (e.g., death, myocardial infarction, unstable angina, hospitalization, revascularization, angina relief, quality of life)? KQ4. Are there significant safety concerns/risks (i.e., radiation exposure, access site complications, contrast agent-induced nephropathy, nephrogenic systemic fibrosis, anaphylaxis, arrhythmias) associated with the use of different NITs to diagnose CAD in women with symptoms suspicious for CAD?

Download or read book Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women written by Gillian D. Sanders and published by . This book was released on 2013 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiovascular disease is the leading cause of mortality for women in the United States. According to the American Heart Association (AHA), approximately one in three female adults have some form of cardiovascular disease. AHA suggests there is evidence showing that women at risk for coronary artery disease (CAD) are less often referred for the appropriate diagnostic test than are men. Coronary anatomy and pathology have traditionally been defined and identified by coronary angiography, a procedure that is indicated in patients who have chest pain and are at high risk for CAD. For intermediate-risk patients, clinicians have a wide range of noninvasive technologies (NITs) to choose from that can assess functional status (i.e., ischemia or no ischemia) or visualize anatomic abnormalities (i.e., no CAD, nonobstructive CAD, or obstructive CAD). Functional modalities include stress electrocardiography (ECG); stress echocardiography (ECHO); and stress radionuclide myocardial perfusion imaging, including single-proton emission computed tomography (SPECT) and positron emission tomography (PET). Anatomic modalities include stress myocardial perfusion and wall-motion cardiac magnetic resonance (CMR) imaging and coronary computed tomography angiography (coronary CTA). The comparative safety and accuracy of these NITs in women was uncertain, although substantial data exists for populations combining men and women, and for mixed populations of known and no known CAD. In 2012, a Comparative Effectiveness Review (CER), "Noninvasive Technologies for the Diagnosis of Coronary Artery Disease in Women," evaluated the diagnostic accuracy and risks of NITs in women with symptoms suspicious for CAD, including assessing predictors affecting test accuracy, and the ability of NITs to provide risk stratification and prognostic information, inform decisionmaking about treatment options, and affect clinical outcomes. A total of 104 comparative studies (110 articles) were included. For women with no known CAD, the summary of accuracy for each NIT modality compared with coronary angiography was ECG (29 studies): sensitivity 62 percent, specificity 68 percent; ECHO (14 studies): sensitivity 79 percent, specificity 83 percent; SPECT (14 studies): sensitivity 81 percent, specificity 78 percent; CMR (5 studies): sensitivity 72 percent, specificity 84 percent; and CTA (5 studies): sensitivity 94 percent, specificity 87 percent. Compared with men evaluated in the same studies, in women ECG and coronary CTA modalities were both less sensitive and less specific. The ECHO and SPECT modalities, although less sensitive, appeared to be more specific in women. The lower specificity of the ECG modality in women was the only statistically significant difference. Strength of evidence was high for ECG, ECHO, and SPECT, and was low for CMR and coronary CTA compared with coronary angiography in women. Eleven comparative studies examined predictors of diagnostic accuracy in women such as postmenopausal status, race/ethnicity, heart size, beta blocker use, and pretest probability; insufficient evidence was available to draw conclusions about predictors that affect accuracy. Eight studies assessed risk stratification and prognostic factors, two studies assessed treatment decisionmaking, and four studies provided comparative clinical outcomes but provided insufficient evidence on the comparative effectiveness of NITs to provide risk stratification, prognostic information, treatment decisionmaking, or impact on clinical outcomes in women. Thirteen comparative studies reported risks. Of these, four studies of coronary CTA showed a higher mean effective radiation dose and attributable risk of cancer incidence in women compared with men; however, radiation safety issues were not discussed in other NIT modalities with radiation exposure. Thus, there was insufficient evidence regarding the comparative risks of various NIT modalities in women. Given the clinical and economic importance of noninvasive testing for CAD in women, the ongoing investment in NIT research, and the remaining areas of uncertainty, we sought to create a prioritized research agenda that would represent the interests of diverse stakeholders and allow the remaining areas of uncertainty to be addressed.

Download or read book Disease Control Priorities Third Edition Volume 5 written by Dorairaj Prabhakaran and published by World Bank Publications. This book was released on 2017-11-17 with total page 948 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiovascular, respiratory, and related conditions cause more than 40 percent of all deaths globally, and their substantial burden is rising, particularly in low- and middle-income countries (LMICs). Their burden extends well beyond health effects to include significant economic and societal consequences. Most of these conditions are related, share risk factors, and have common control measures at the clinical, population, and policy levels. Lives can be extended and improved when these diseases are prevented, detected, and managed. This volume summarizes current knowledge and presents evidence-based interventions that are effective, cost-effective, and scalable in LMICs.

Download or read book Multimodality Imaging written by Qifa Zhou and published by . This book was released on 2020 with total page 273 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book provides a state-of-the-art overview of the combined use of imaging modalities to obtain important functional and morphological information on intravascular disease and enhance disease detection. It discusses the integration of intravascular ultrasound (IVUS, intravascular optical coherence tomography (OCT), intravascular photoacoustic imaging (IVPA) and acoustic radiation force optical coherence elastography (ARF-OCE), and introduces the integration of multimodality imaging systems, such as IR and florescence. It includes the latest research advances and numerous imaging photos to offer readers insights into current intravascular applications. It is a valuable resource for students, scientists and physicians wanting to gain a deeper understanding of multimodality imaging tools.

Download or read book Cardiovascular Magnetic Resonance written by Warren J. Manning and published by Elsevier Health Sciences. This book was released on 2018-04-26 with total page 672 pages. Available in PDF, EPUB and Kindle. Book excerpt: Provides state-of-the-art coverage of CMR technologies and guidelines, including basic principles, imaging techniques, ischemic heart disease, right ventricular and congenital heart disease, vascular and pericardium conditions, and functional cardiovascular disease. Includes new chapters on non-cardiac pathology, pacemaker safety, economics of CMR, and guidelines as well as new coverage of myocarditis and its diagnosis and assessment of prognosis by cardiovascular magnetic resonance, and the use of PET/CMR imaging of the heart, especially in sarcoidosis. Features more than 1,100 high-quality images representing today’s CMR imaging. Covers T1, T2 and ECV mapping, as well as T2* imaging in iron overload, which has been shown to save lives in patients with thalassaemia major Discusses the cost-effectiveness of CMR.

Download or read book Strengthening Forensic Science in the United States written by National Research Council and published by National Academies Press. This book was released on 2009-07-29 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: Scores of talented and dedicated people serve the forensic science community, performing vitally important work. However, they are often constrained by lack of adequate resources, sound policies, and national support. It is clear that change and advancements, both systematic and scientific, are needed in a number of forensic science disciplines to ensure the reliability of work, establish enforceable standards, and promote best practices with consistent application. Strengthening Forensic Science in the United States: A Path Forward provides a detailed plan for addressing these needs and suggests the creation of a new government entity, the National Institute of Forensic Science, to establish and enforce standards within the forensic science community. The benefits of improving and regulating the forensic science disciplines are clear: assisting law enforcement officials, enhancing homeland security, and reducing the risk of wrongful conviction and exoneration. Strengthening Forensic Science in the United States gives a full account of what is needed to advance the forensic science disciplines, including upgrading of systems and organizational structures, better training, widespread adoption of uniform and enforceable best practices, and mandatory certification and accreditation programs. While this book provides an essential call-to-action for congress and policy makers, it also serves as a vital tool for law enforcement agencies, criminal prosecutors and attorneys, and forensic science educators.

Download or read book Coronary Pressure written by N.H. Pijls and published by Springer Science & Business Media. This book was released on 2013-06-29 with total page 348 pages. Available in PDF, EPUB and Kindle. Book excerpt: Cardiologists must answer three important questions when evaluating and treating patients with a coronary artery stenosis. As a physiologist: "What is the effect of this stenosis on coronary blood flow and myocardial function?"; as a clinician: " Is this lesion responsible for the patient's symptoms?"; and finally as an interventionalist: "Will revascularization of this artery improve the patient?" Fundamentally, the answer to these questions can be given to a large extent by measuring coronary pressure. That is the rationale of writing this book. 1. 1 Historical overview. Andreas Gruentzig and most interventional cardiologists in the early days of PTCA, had the intuitive feeling that pressure measurements could help to establish the severity of a coronary stenosis and to monitor the progress and result of a coronary intervention. At that time, measuring coronary pressure by the balloon catheter was part of a standard procedure. A residual transstenotic gradient of less than 15 mmHg was generally considered as a good result. Later, however, it turned out that measuring these (resting) gradients with balloon catheters was inaccurate an only had a limited prognostic value. Moreover, because there was no consistent theory to correlate pressure measurements to blood flow, the interest in measuring coronary pressures faded and disappeared almost completely with the introduction of new balloon catheters not intended for pressure measurement.

Download or read book Ventricular Arrhythmias written by John M. Miller and published by . This book was released on 2008 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: Ventricular arrhythmias cause most cases of sudden cardiac death, which is the leading cause of death in the US. This issue reviews the causes of arrhythmias and the promising new drugs and devices to treat arrhythmias.

Download or read book Registries for Evaluating Patient Outcomes written by Agency for Healthcare Research and Quality/AHRQ and published by Government Printing Office. This book was released on 2014-04-01 with total page 396 pages. Available in PDF, EPUB and Kindle. Book excerpt: This User’s Guide is intended to support the design, implementation, analysis, interpretation, and quality evaluation of registries created to increase understanding of patient outcomes. For the purposes of this guide, a patient registry is an organized system that uses observational study methods to collect uniform data (clinical and other) to evaluate specified outcomes for a population defined by a particular disease, condition, or exposure, and that serves one or more predetermined scientific, clinical, or policy purposes. A registry database is a file (or files) derived from the registry. Although registries can serve many purposes, this guide focuses on registries created for one or more of the following purposes: to describe the natural history of disease, to determine clinical effectiveness or cost-effectiveness of health care products and services, to measure or monitor safety and harm, and/or to measure quality of care. Registries are classified according to how their populations are defined. For example, product registries include patients who have been exposed to biopharmaceutical products or medical devices. Health services registries consist of patients who have had a common procedure, clinical encounter, or hospitalization. Disease or condition registries are defined by patients having the same diagnosis, such as cystic fibrosis or heart failure. The User’s Guide was created by researchers affiliated with AHRQ’s Effective Health Care Program, particularly those who participated in AHRQ’s DEcIDE (Developing Evidence to Inform Decisions About Effectiveness) program. Chapters were subject to multiple internal and external independent reviews.