Abstract
Diagnosing and treating acute coronary syndromes consumes a significant fraction of the healthcare budget worldwide. The pressure on resources is expected to increase with the continuing rise of cardiovascular disease, other chronic diseases and extended life expectancy, while expenditure is constrained. The objective of this review is to assess if home-based solutions for measuring chemical cardiac biomarkers can mitigate or reduce the continued rise in the costs of ACS treatment. A systematic review was performed considering published literature in several relevant public databases (i.e., PUBMED, Cochrane, Embase and Scopus) focusing on current biomarker practices in high-risk patients, their cost-effectiveness and the clinical evidence and feasibility of implementation. Out of 26,000 references screened, 86 met the inclusion criteria after independent full-text review. Current clinical evidence highlights that home-based solutions implemented in primary and secondary prevention reduce health care costs by earlier diagnosis, improved patient outcomes and quality of life, as well as by avoidance of unnecessary use of resources. Economical evidence suggests their potential to reduce health care costs if the incremental cost-effectiveness ratio or the willingness-to-pay does not surpass £20,000/QALY or €50,000 limit per 20,000 patients, respectively. The cost-effectiveness of these solutions increases when applied to high-risk patients.
Highlights
Over the past few decades, cardiovascular diseases (CVD) are in a continuous rise and currently accounting for 17.64 million deaths worldwide in the general population [1]
The damage or injury is generated by the lack of blood and oxygen supply to the downstream myocardium and it can be largely irreversible in the absence of essential repair mechanisms, inherent to the myocardium
The objective of this review is to explore these opportunities by assessing the available evidence in key enabling fields: sensing technologies currently available for home-based telemonitoring systems; relevance of personal data for diagnosis and prognosis of acute coronary syndromes (ACS) including NSTEMI and STEMI; anticipated clinical benefits from implementation of telemonitoring in this context; and features that make an ambulatory troponin-based strategy potentially cost-effective
Summary
Over the past few decades, cardiovascular diseases (CVD) are in a continuous rise and currently accounting for 17.64 million deaths worldwide in the general population [1]. CVD is the leading cause of death in patients with chronic kidney disease (CKD) and other comorbidities. In adult diabetic patients the probability of dying from heart disease is 2–4 times higher compared to their healthy peers [1]. One of the most common acute coronary syndromes (ACS) triggered by CVD are heart attacks, known as acute myocardial infarction (AMI). These can be symptomatic or asymptomatic and are caused by a complete (ST-segment elevation MI, or STEMI) or partial blockage of coronary arteries (non-STEMI or unstable angina).
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