[Cost-effectiveness of clopidogrel vs. aspirin treatment in high-risk acute coronary syndrome patients in Denmark]. / Omkostningseffektivitet ved clopidogrel- versus acetylsalicylsyrebehandling af højrisikopatienter med akut koronarsyndrom i Danmark.

INTRODUCTION: The aim of this study was to estimate the cost-effectiveness of clopidogrel versus aspirin (ASA) in Denmark in the secondary prevention of cardiovascular events in three high-risk CAPRIE populations: (1) patients with a history of coronary artery bypass grafting, (2) patients with a history of ischemic events and (3) patients with multiple vascular territory involvement. Additionally, the cost-effectiveness of clopidogrel versus no treatment in ASA-intolerant patients was estimated. MATERIALS AND METHODS: Clinical, epidemiological and cost data (Danish estimates) were combined in a Markov model. Estimates of transition probabilities were derived from post hoc analyses of the CAPRIE database. RESULTS: Cost-effectiveness (CE) ratios ranged from 25,445 Danish kroner per LYG (life year gained) in patients with a history of CABG to 55,503 Danish kroner per LYG in patients with multiple vascular territory involvement. The estimated cost-effectiveness ratio of clopidogrel in ASA-intolerant patients was significantly lower (3,093 Danish kroner per LYG). Sensitivity analyses showed that the order of magnitude of these CE ratios is unaffected by changes in model assumptions. CONCLUSION: In a Danish setting, clopidogrel may be considered a cost-effective treatment alternative to ASA for the secondary prevention of cardiovascular events in high-risk populations. Clopidogrel is also an effective and cost-effective treatment for ASA-intolerant patients.

[Chronic left heart failure. A focus on the pathogenetic basis of medical treatment]. / Kronisk venstresidigt hjertesvigt. Fokus på det patogenetiske grundlag for medicinsk behandling.

Chronic left heart failure is the result of the activation of pathophysiological mechanisms which over time lead to progressive deterioration of the cardiac function. As pharmacotherapy aims at these mechanisms and as treatment possibilities are increasing, we find it relevant to provide a survey. Treatment evidence is based mainly on systolic dysfunction. It consists of angiotensin-converting enzyme inhibitor, aldosterone antagonist, beta-blocker, digoxin and diuretics. Incorporation of evidence-based medicine and treatment of diastolic dysfunction should be focussed on in the future.

[Prevalence and significance of anaemia in patients with chronic congestive heart failure]. / Forekomst og betydning af anaemi hos patienter med kronisk hjertesvigt.

INTRODUCTION: This study aimed to investigate the prevalence and significance of anaemia in patients with congestive heart failure (CHF), as well as the prevalence of impaired renal function. MATERIALS AND METHODS: We did a retrospective study of 50 women and 113 men with systolic CHF. Data were collected by reviewing clinical records. Age at inclusion was 70 +/- 8 years. The follow-up period was 30 +/- 7.5 months. Patients in NYHA class IV were not included in this study. Anaemia was defined as a haemoglobin (Hb) count of < or = 8 mmol/l for both sexes. RESULTS: At inclusion 23% and at follow-up 35% were anemic. Forty-nine patients' Hb was measured at both inclusion and follow-up; their Hb was 8.8 +/- 1.1 mmol/l at inclusion and 8.3 +/- 1.1 mmol/l at follow-up (p < 0.001). Of these 49 patients, 10 were anemic at both inclusion and follow-up (group A), 10 developed anemia in the follow-up period (group B), 26 did not have anemia at either inclusion or follow-up (group C) and 3 had anemia at inclusion but not at follow-up (group D). A decrease in Hb in group A, B and C and an elevation in S-creatinine in all four groups was observed. In group B and C the decrease in Hb and S-creatinine was significant. Ninety-six patients' S-creatinine was measured at both inclusion and follow-up, and a significant decrease was observed. 18% of the patients died in the intervening period, and 7% were lost to follow-up. CONCLUSION: This study showed that both anaemia and impaired renal function are found in CHF patients (23-32% and 20-27%, respectively) and that these may influence patients' quality of life and functional level. In the future, there should be a greater focus on both anaemia and impaired renal function in CHF patients.

[The cardio-renal anemia syndrome: what is it? With a focus on congestive heart failure]. / Det kardiorenale anaemisyndrom, hvad er det? Med fokus på kronisk hjertesvigt.

The cardio-renal anemia syndrome describes how the three conditions congestive heart failure, chronic kidney insufficiency and anemia form a vicious circle in which each condition is capable of causing or being caused by another. As the prevalence of congestive heart failure is steadily rising, it must be expected that more patients will develop this syndrome. The optimal treatment for patients with the cardio-renal anemia syndrome is yet to be determined, but new trials, in which patients were treated with erythropoietin and intravenous iron, promise a better outcome for these patients in the future.

[Ambulance transportation and prehospital treatment in connection with admission for suspected acute myocardial infarction]. / Ambulancetransport og praehospital behandling ved indlaeggelse for formodet akut myokardieinfarkt.

INTRODUCTION: The aim was to describe ambulance transportation and pre-hospital treatment in connection with admission for suspected acute myocardial infarction. MATERIAL AND METHODS: For all patients with suspected acute coronary syndrome who were urgently admitted to the Cardiological Department, Odense University Hospital between 3 August 1998 and 6 December 1998, information about ambulance transportation and pre-hospital treatment was collected through interviews with the patients and study of ambulance records, admission notes, and hospital medical records. In addition, details of the regarding response times were obtained from Falck's emergency service and from nurses' papers. RESULTS: Altogether 279 patients (83%) were transported by ambulance. Half the ambulances arrived at the hospital after 34 minutes (range 11-140 minutes), but every third ambulance took more than 40 minutes to reach the hospital. The pre-hospital treatment of all the patients was: oxygen 69%, nitroglycerin sublingually 46%, nitrous oxide 2%, defibrillation 1.4%, acetylsalicylic acid 9%, morphine injection 8%, and ECG monitoring 57%. CONCLUSION: The study showed that there were quality problems, as every third ambulance took more than 40 minutes to reach the hospital. It also showed that acetylsalicylic acid and morphine were used only to a limited extent in a pre-hospital situation.