MEDICAL ECONOMIC EFFECTIVENESS OF SINGLE-STAGE REVASCULARIZATION OF VARIOUS ARTERIAL POOLS IN PATIENTS WITH COMORBIDITY OF CHRONIC ISCHEMIC CARDIOVASCULAR DISEASES

Highlights

The comorbid course of ischemic cardiovascular diseases with indications for surgical revascularization and untimely surgical correction of blood circulation in chronic ischemic heart disease and lower limb ischemia, asymptomatic stenosis of the common/internal carotid artery ≥ 70% cause high risks of developing adverse cardiovascular outcomes – acute coronary syndrome, acute cerebrovascular accident, critical ischemia of the lower extremities and death. The improvement of the surgical stage of treatment for comorbidity of ischemic cardiovascular diseases based on the tactics of single-stage revascularization of various arterial basins using X-ray endovascular technology contributes to the timely availability of surgical care and the medical and economic efficiency of the healthcare organization.

Abstract

Aim. To evaluate the medical economic effectiveness of single-stage revascularization of various arterial pools (RVAP) in patients with comorbidity of chronic ischemic cardiovascular diseases (CICVD) and indications for surgical revascularization.

Methods. A multicenter research (n = 6) was in 2004–2024. The research subjects were patients (n = 854) with comorbidity of chronic ischemic heart disease (CIHD) and limb ischemia (CLI) 2B-4 st., asymptomatic stenosis ≥ 70% of the common/internal carotid artery (CCA/ICA), with indications for RVAP in accordance with the clinical guidelines of the Russian Federation. The average age of patients was 74.1 ± 7.4 years. Patients of the main group A (n = 106) underwent single-stage RVAP, and patients of the control group B (n = 748) underwent two-stage RVAP, a stage interval – 3.2 ± 8.25 days. Endovascular technology was used for RVAP. To evaluate the safety, clinical, angiographic, social, financial and economic effectiveness of medical care with RVAP. The follow-up period for evaluate of results was 1 and 3 years. The methods of content analysis, statistical, mathematical, comparative analysis were applied. For statistical analysis the program Statistica 6.0 (StatSoft Inc., USA) was applied.

Results. Patients in groups A and B were comparable in terms of age and sex, prevalence of CICVD with indications for RVAP and risk factors of cardiovascular complications (CVC). Indications for revascularization in 2 and 3 arterial pools were established in 94.6% (n = 808) and 5.4% (n = 46) of patients, respectively. The structure of 2-pool revascularization: for CLI 3–4 st. and CIHD (n = 539, 63.1%) – single-stage (n = 84, 15.6%) and two-stage (n = 455, 84.4%); for CLI 2B st. and CIHD (16.2%, n = 138) – single-stage (n = 5, 3.6%) and two-stage (n = 133, 96.4%); with CLI 3–4 st. and unilateral stenosis ≥ 70% of CCA/ICA (8.4%, n = 72) – single-stage (n = 8, 11.1%) and two-stage (n = 64, 88.9%); with CIHD and unilateral CCA/ICA stenosis ≥ 70% (4.1%, n = 35) – single-stage (n = 7, 20%) and two-stage (n = 28, 80%); with CLI 2B st. and unilateral stenosis ≥ 70% of CCA/ICA (1.76%, n = 15) – single-stage (n = 2, 13.3%) and two-stage (n = 15, 86.7%); with bilateral stenosis ≥ 70% of CCA/ICA (1.05%, n = 9) a two-stage endovascular procedures was performed. Three-pool revascularization tactic was performed in patients with CLI 3–4 st, CIHD and unilateral stenosis ≥ 70% of CCA/ICA (5.4%, n = 46). One-year results were assessed in all patients in group A and 89.7% (n = 670) in group B. Three-year results were assessed in all patients in group A and 81.3% (n = 608) patients in group B. In all cases, clinical and angiographic effectiveness of RVAP was achieved, there were no complications. The period of hospital treatment in patients of group A was 1.2 ± 2.6 days, group B 2.9 ± 4.15 days. In 1st year of follow-up the indications for repeated revascularization arose due to the progression of CLI in 1 patient of group A and 3 patients of group B and the return of angina pectoris to 2–3 FC in 2 patients of group B. During 3 years of follow-up the remaining patients did not have repeated revascularizations and CVC, which was facilitated by continuous controlled dispensary care according to the developed algorithm. The average bill and direct costs for one-stage RVAP were 487.4 ± 15.1 rubles and 158.6 ± 12.8 rubles, for two-stage – 634.8 ± 18.7 rubles and 196.9 ± 16.2 rubles, for three-stage – 816.8 ± 18.1 rubles and 276.1 ± 24.9 rubles, respectively. Three-year survival in both groups is 98.7%.

Conclusion. The scientific practical novelty and theoretical significance of the findings on the safety, medical, social, economic and financial effectiveness of complex medical care in patients with comorbidity of CICVD with indications for surgical care and using single-stage RVAP, can become the basis for improving clinical recommendations in patients with cardiovascular diseases, with the accumulation of analytical data.

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