Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young.
Diagnostic yield and financial implications of a nationwide electrocardiographic screening programme to detect cardiac disease in the young.
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DOI：
10.1093/europace/euab021
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发表时间：
2021-08-06
期刊：
影响因子：
--
通讯作者：
Sharma S
中科院分区：
文献类型：
--
作者：
Dhutia H;Malhotra A;Finocchiaro G;Parpia S;Bhatia R;D'Silva A;Gati S;Mellor G;Narain R;Chandra N;Behr E;Tome M;Papadakis M;Sharma S
关于心电图（ECG）筛查在一般人群中非选择性青少年和年轻成人组中识别心血管疾病与心源性猝死（SCD）相关的作用的信息有限。在2012年至2014年期间，对26900名年轻人（年龄在14-35岁之间）进行了健康问卷和ECG前瞻性评估。结果异常的个人接受二次检查，其费用基于英国国民保健服务收费标准。675名（2.5%）个体需要进一步调查异常健康问卷，2175名（8.1%）需要进一步调查异常ECG，114名（0.5%）需要进一步调查两者。在88名（0.3%）个体中确定了与年轻SCD相关的疾病，其中15名（17%）通过健康问卷检测到，72名（81%）通过ECG检测到，2名（2%）通过两者检测到。在24个月的随访期内，这些人中有49人（56%）接受了生活方式改变建议以外的医疗干预。评估过程的总成本为每人97欧元，检测到的心血管疾病为17 834欧元，检测到的SCD相关心血管疾病为29 588欧元。与单独的健康问卷调查相比，纳入ECG与SCD相关疾病的每次诊断成本降低36%相关。将ECG纳入健康问卷与年轻个体中检测SCD相关疾病的能力增加5倍相关，并且与单独使用健康问卷进行筛查相比，检测严重疾病更具成本效益。
There is limited information on the role of screening with electrocardiography (ECG) for identifying cardiovascular diseases associated with sudden cardiac death (SCD) in a non-select group of adolescents and young adults in the general population. Between 2012 and 2014, 26 900 young individuals (aged 14–35 years) were prospectively evaluated with a health questionnaire and ECG. Individuals with abnormal results underwent secondary investigations, the costs of which were being based on the UK National Health Service tariffs. Six hundred and seventy-five (2.5%) individuals required further investigation for an abnormal health questionnaire, 2175 (8.1%) for an abnormal ECG, and 114 (0.5%) for both. Diseases associated with young SCD were identified in 88 (0.3%) individuals of which 15 (17%) were detected with the health questionnaire, 72 (81%) with ECG and 2 (2%) with both. Forty-nine (56%) of these individuals received medical intervention beyond lifestyle modification advice in the follow-up period of 24 months. The overall cost of the evaluation process was €97 per person screened, €17 834 per cardiovascular disease detected, and €29 588 per cardiovascular disease associated with SCD detected. Inclusion of ECG was associated with a 36% cost reduction per diagnosis of diseases associated with SCD compared with the health questionnaire alone. The inclusion of an ECG to a health questionnaire is associated with a five-fold increase in the ability to detect disease associated with SCD in young individuals and is more cost effective for detecting serious disease compared with screening with a health questionnaire alone.
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