Healthcare Costs for Acute Hospitalized and Chronic Heart Failure in South Korea: A Multi-Center Retrospective Cohort Study

PURPOSE: Although heart failure (HF) is recognized as a leading contributor to healthcare costs and a significant economic burden worldwide, studies of HF-related costs in South Korea are limited. This study aimed to estimate HF-related costs per Korean patient per year and per visit. MATERIALS AND METHODS: This retrospective cohort study analyzed data obtained from six hospitals in South Korea. Patients with HF who experienced ≥one hospitalization or ≥two outpatient visits between January 1, 2013 and December 31, 2013 were included. Patients were followed up for 1 year [in Korean won (KRW)]. RESULTS: Among a total of 500 patients (mean age, 66.1 years; male sex, 54.4%), the mean 1-year HF-related cost per patient was KRW 2,607,173, which included both, outpatient care (KRW 952,863) and inpatient care (KRW 1,654,309). During the post-index period, 22.2% of patients had at least one hospitalization, and their 1-year costs per patient (KRW 8,530,290) were higher than those of patients who had only visited a hospital over a 12-month period (77.8%; KRW 917,029). Among 111 hospitalized patients, the 1-year costs were 1.7-fold greater in patients (n=52) who were admitted to the hospital via the emergency department (ED) than in those (n=59) who were not (KRW 11,040,453 vs. KRW 6,317,942; p<0.001). CONCLUSION: The majority of healthcare costs for HF patients in South Korea was related to hospitalization, especially admissions via the ED. Appropriate treatment strategies including modification of risk factors to prevent or decrease hospitalization are needed to reduce the economic burden on HF patients.

Clinical profiles of peripartum cardiomyopathy / 대한산부인과학회지

OBJECTIVE: To analyze the clinical characteristic of peripartum cardiomyopathy. METHODS: A retrospective review was undertaken on records of women who were diagnosed with peripartum cardiomyopathy at Yonsei University, Wonju College of Medicine, Wonju Christian Hospital between January 1994 and December 2004. We made criteria for its diagnosis, namely: (1) developement of heart failure in the last month of pregnancy or within 5 months after delivery, (2) absence of a determinable etiology for the cardiac failure, and (3) absence of demonstrable heart disease prior to the last month of pregnancy. (4) ejection fraction less than 45%. RESULTS: During the research period, 8 pregnant women were documented as peripartum cardiomyopathy. All of the women undertook echocardiography. Three women were complicated with pregnancy induced hypertension. One woman was in cardiogenic shock. CONCLUSION: Early diagnosis of the peripartum cardiomyopathy is extremely important. The echocardiography can provide helpful information on disease progression.

A Diagnostic Value of Ischemia Modified Albumin in Patients with Suspected Acute Coronary Syndrome with Normal EKG and Cardiac Markers

BACKGROUND AND OBJECTIVES: In the early phase of acute chest pain, the diagnosis of acute coronary syndrome (ACS) is often difficult to achieve in an emergency department (ED) due to the non-diagnostic ECG and cardiac markers. Ischemia modified albumin (IMA) has recently been shown to be a sensitive early biochemical marker of ischemia. The aim of this study was to evaluate the diagnostic value of IMA for the patients with suspected ACS and who have normal ECG/cardiac markers. SUBJECTS AND METHODS: We enrolled 142 consecutive patients who presented to the ED due to suspected ACS, and they had a normal EKG and troponin-I/CK-MB within 5 hours after the onset of their chest pain. The diagnosis of ACS was based upon the clinical findings, the results of serial ECG/troponin and the coronary angiography. The ideal cutoff value of IMA for ACS was calculated by the receiver operator characteristic (ROC) curve analysis. RESULTS: The ACS was diagnosed in 80/142 (56%). The ROC curve area for the IMA test was 0.77 (CI; 0.70-0.85, p<0.01). At a cutoff value of 98.5 U/mL, the sensitivity, specificity and negative predictive values for ACS were 73%, 75% and 75%, respectively. At a cutoff value of 85 U/mL, the sensitivity and specificity and negative predictive values for ACS were 92%, 35% and 95%, respectively. CONCLUSION: IMA might be a useful diagnostic marker of ACS for those patients with normal ECG/cardiac markers and who present within 5 hours after the onset of chest pain.

Comparison of the Cobalt Alloy and Stainless Steel Core(r) Stent in a Porcine Coronary Restenosis Model

BACKGROUND AND OBJECTIVES: The stent material and thickness may influence the rate of restenosis following coronary artery stenting. A thin strut cobalt-alloy stent has been developed in an attempt to reduce the restenosis rate, while maintaining the radiopacity and radial strength. The purpose of this study was to compare a stainless steel Core(r) stent (thickness: 90 micrometer/HUMED Co. Ltd, Korea) with that of a cobalt alloy Core(r) stent (thickness: 60 micrometer/HUMED Co. Ltd, Korea) in a porcine coronary stent restenosis model. MATERIALS AND METHODS: The cobalt alloy (Co-alloy) and stainless steel (SS) stents were implanted in 24 porcine coronary arteries. Four weeks after stenting, the pigs were sacrificed after quantitative coronary angiography (QCA). The coronary arteries were perfusion-fixed and stained, and a pathological examination performed by computer-aided histomorphometry. RESULTS: The minimal luminal diameter at 4 weeks was larger in the Co-alloy than the SS group according to the QCA (1.8+/-0.8 mm vs. 2.7+/-0.8 mm, p=0.019). The neointimal area was significantly smaller in the Co-alloy than the SS group (1.96+/-0.68 mm2 vs. 0.89+/-0.27 mm2, p<0.001). The intima/media area ratio was significant lower in the Co-alloy than the SS group (1.33+/-0.46 vs. 0.69+/-0.21, p=0.003). CONCLUSION: The thin strut cobalt alloy Core(r) stent significantly reduces the neointimal formation compared to the stainless steel Core(r) stent in a porcine coronary stent injury model.

Ascertainment of Clinical Usefulness of Neurosurgery Simulator(R) in Stereotactic & Functional Neurosurgery

OBJECTIVE: An usefulness and an accuracy of Neurosurgery Simulator(R)(NSS(R)) is evaluated for the clinical applications. The NSS(R) is a surgical planning tool for stereotactic and functional neurosurgery, recently developed in Korea. METHODS: Thirty-four surgical cases, performed with the NSS(R) from October 1999 to April 2002, were analyzed. The accuracy was examined by comparing the actual lesion with the planned target. The usefulness was discussed with time consuming factor and convenience for surgical steps. Results of surgical outcome were also reviewed. RESULTS: The precise coordinates of surgical target is directly acquired by designating an anatomical lesion on the magnetic resonance image with NSS(R) due to auto recognition algorithm of the fiducials on the MRI image. The correctness is confirmed again by examining the anatomical lesion with superimposing the Schaltenbrand-Wahren atlas on the image directly. Among eleven cases of the thalamotomy for tremors, five cases resulted in complete resolution, the remaining five patients showed significant reduction of tremors. Improvement of ADL and UPDRS was recorded in all 6 Parkinson's disease patients who had undergone pallidotomy. Seventy five percent of patient in pain and psychosurgery resulted in improvements. The NSS(R) achieved 100% accuracy in calculating stereotactic biopsy coordinates. There was no deviation in guiding surgical trajectory. There was no significant surgical complication. CONCLUSION: Stereotactic and functional neurosurgery performed with the assistance of the NSS(R) is relatively safe and accurate.

The Effect of Local Delivery of IBMX on the Neointimal Proliferation in Rat Carotid Balloon Injury Model

BACKGROUND: Hyperplastic neointima is one of the major mechanisms of restenosis following balloon angioplasty in selected patients with symptomatic angina pectoris. Elevation of cellular cyclic nucleotide levels such as cAMP and cGMP are known to inhibit the proliferation of vascular smooth muscle cells. 3-isobutyl-1-methylxanthine (IBMX) increases intracellular cAMP and cGMP by nonselective inhibition of phosphodiesterases (PDEs). We conducted this study under the hypothesis that local delivery of IBMX could inhibit neointimal hyperplasia after balloon injury of the rat carotid artery. METHODS: Left common carotid artery of 10 week old male Sprague-Dawley rats were subjected to arterial injury by 2F Fogarty balloon catheter. After injury, animals were allocated to the control groups (control 1: injury control and control 2: pluronic gel plus DMSO control) and IBMX group, which received pluronic polymer gel, DMSO and IBMX mixture periadventitially. After 3 weeks, the rats were killed by overdose of ketamine, and the injured left arteries were pressure-fixed with 10% formalin and subjected to histomorphological analysis. RESULTS: Mean body weight of rats was not statistically different among study groups. The mean area of neointima (control group 1:0.28+/-0.05 mm2,Control group 2:0.27+/-0.08 mm2 , IBMX group:0.18+/-0.08 mm2 : p<0.05) and the mean ratio of neointima to medial area[versus (control group 1:1.89+/-0.37, control group 2:1.95+/-0.41, IBMX group: 1.41+/-0.47: p<0.05)] were significantly less in IBMX group. The mean area of external elastic lamina was significantly larger in control group 1 than IBMX group (0.57+/-0.07 mm2 versus 0.47+/-0.10 mm2 ) and mean luminal area showed no significant difference among groups (control group1:0.14+/-0.07 mm2 , control group 2: 0.10+/-0.05 mm2 , control group 3: 0.16+/-0.06 mm2). CONCLUSION: Peri-adventitial single administration of IBMX showed its effectiveness in reducing the neointimal proliferation in rat carotid balloon injury model. Furthermore we observed the positive correlation between intimal area and EELA suggesting vascular remodeling depending on the intima volume.

The Effect of Local Delivery of IBMX on the Neointimal Proliferation in Rat Carotid Balloon Injury Model

BACKGROUND: Hyperplastic neointima is one of the major mechanisms of restenosis following balloon angioplasty in selected patients with symptomatic angina pectoris. Elevation of cellular cyclic nucleotide levels such as cAMP and cGMP are known to inhibit the proliferation of vascular smooth muscle cells. 3-isobutyl-1-methylxanthine (IBMX) increases intracellular cAMP and cGMP by nonselective inhibition of phosphodiesterases (PDEs). We conducted this study under the hypothesis that local delivery of IBMX could inhibit neointimal hyperplasia after balloon injury of the rat carotid artery. METHODS: Left common carotid artery of 10 week old male Sprague-Dawley rats were subjected to arterial injury by 2F Fogarty balloon catheter. After injury, animals were allocated to the control groups (control 1: injury control and control 2: pluronic gel plus DMSO control) and IBMX group, which received pluronic polymer gel, DMSO and IBMX mixture periadventitially. After 3 weeks, the rats were killed by overdose of ketamine, and the injured left arteries were pressure-fixed with 10% formalin and subjected to histomorphological analysis. RESULTS: Mean body weight of rats was not statistically different among study groups. The mean area of neointima (control group 1:0.28+/-0.05 mm2,Control group 2:0.27+/-0.08 mm2 , IBMX group:0.18+/-0.08 mm2 : p<0.05) and the mean ratio of neointima to medial area[versus (control group 1:1.89+/-0.37, control group 2:1.95+/-0.41, IBMX group: 1.41+/-0.47: p<0.05)] were significantly less in IBMX group. The mean area of external elastic lamina was significantly larger in control group 1 than IBMX group (0.57+/-0.07 mm2 versus 0.47+/-0.10 mm2 ) and mean luminal area showed no significant difference among groups (control group1:0.14+/-0.07 mm2 , control group 2: 0.10+/-0.05 mm2 , control group 3: 0.16+/-0.06 mm2). CONCLUSION: Peri-adventitial single administration of IBMX showed its effectiveness in reducing the neointimal proliferation in rat carotid balloon injury model. Furthermore we observed the positive correlation between intimal area and EELA suggesting vascular remodeling depending on the intima volume.

A Case Report of Mediastinal Leiomyosarcoma / 결핵

The leiomyosarcoma is uncommom tumor that consists of 10% of all sarcoma incidence and commonly arise from retroperitomeum or mesentery. But leiomyosarcoma arose from mediastinum is very rare and only incidental case report is present. Mediastial leiomyosarcoma may originate from superior vene cava, pulmonary artery, small vessels of alveoli, esophagus and cardiac muscle. Common symptoms that are related with leimoyosarcoma of mediastinum are cough and dydpnea but dysphagia, chest pain and hemoptysis can be produced. Although long term survival after complete resection of tumor was reported in localized disease, there wes no effective therapy that prolong the survival in patients who had disseminated disease of huge tumor mass. We report the case of posterior mediastinal leiomyosarcoma confirmed by aspiration cytology and immunohistochemical staining, along with a review of literature.

Coronary Artery Calcification Its Incidence and Significance in Patients Detected by Cineangiography

BACKGROUND: The clacification of the wall and narrowing of the lumen of the coronary artery is closely related to the process of atherosclerosis and its severity. Thus, the present study of calcified coronary artery lesions by analysis of cineangiography is attempt to define the incidence and factors to affect the coronary artery calcification. METHODS: Our report concerns a consecutive series of 513 patients who underwent coronary angiography between January 1, 1991 and September 30, 1993. We determined the relationship between the coronary artery calcification and sex, age, risk factors, serum calcium, BUN, creatinine, lesional lumen stenosis and severity of coronary artery disease. RESULTS: Among patients with significant coronary artery disease, 22%(62/282 cases) had the coronary artery calcification by cineangiography. Patients with calcification were older(62+/-8 years) than those without calcification(56+/-10 years)(p=0.0001). The distribution of calcified coronary artery was 35 lesions in LAD, 17 in LCX, 16 in RCA and 4 in LM. The calcification rate was 38%(40/104 cases) for patients with multi-vessel disease, compared to 12%(22/178 case) for those with single vessel disease(p=0.0001). Patients with calcification significantly had the long lesion(22.4+/-13.4mm), compared to those without calcification(18.0+/-11.3mm)(=0.012). Coronary artery calcification was correlated with smoking habits. CONCLUSION: Coronary artery calcification was seen in 22 percent and strongly correlated with age, smoking habits, the severity of disease and length of lesion.