Coronary heart disease is currently the leading cause of death globally, and is expected to account for 14.2% of all deaths by 2030. The emergence of novel technologies from cardiothoracic surgery and interventional cardiology are welcome developments in the light of an overwhelming chronic disease burden. However, as these complementary yet often competing disciplines rely on expensive technologies, hastily prepared resource plans threaten to consume a substantial proportion of limited healthcare resources. By describing procedural and professional trends as well as current and emerging technologies, this review aims to provide useful knowledge to help managers make informed decisions for the planning of cardiovascular disease management. Since their inception, developments in both specialties have been very rapid. Owing to differences in patient characteristics, interventions and outcomes, results of studies comparing cardiothoracic surgery and interventional cardiology have been conflicting. Outcomes for both specialties continue to improve through the years. Despite the persistent demand for coronary artery bypass surgery (CABG) as a rescue procedure following percutaneous coronary intervention (PCI), there is a widening gap between the numbers of PCI and CABG. Procedural volumes seem to have affected career choices of physicians. Emerging technologies from both disciplines are eagerly awaited by the medical community. For long-term planning of both disciplines, conventional health technology assessment methods are of limited use due to their rapid developments. In the absence of established prediction tools, planners should tap alternative sources of evidence such as changes in disease epidemiology, procedural volumes, horizon scan reports as well as trends in disease outcomes.
Cardiology ; trends ; Decision Making ; Humans ; Internationality ; Thoracic Surgery ; trends

INTRODUCTIONVenous thromboembolism (VTE), including its most serious clinical subtype, pulmonary embolism (PE), is a potentially preventable disease. While current assessment tools do not include ethnicity as a risk factor, studies suggest that Asians have lower risk of VTE compared to Caucasians. This study aims to describe 2006 in-hospital and projected population based incidence rates of VTE and PE in Singapore.

MATERIALS AND METHODSData on 2006 admissions at 3 major NHG hospitals, cases of VTE and their demographics were obtained from the ODS, a large administrative database of the National Healthcare Group (NHG). Demographic characteristics of the 2006 Singapore resident population were obtained from the 2006 Singapore Statistics website.

RESULTSIn 2006, there were 860 cases of VTE out of 98,121 admissions in these 3 hospitals. Overall and secondary VTE age adjusted in-hospital burden was 73 and 54 per 10,000 patients, respectively. Caucasians and Eurasians had VTE rates in excess of 100 per 10,000 while Chinese, Malays and Indians each had rates below 100 per 10,000. Assuming that 42.5% of the 2006 Singapore population was served by NHG, the estimated population-based incidence of VTE and PE is 57 and 15 per 100,000, respectively.

CONCLUSIONSAs patterns across ethnic groups point to lower VTE rates among Asians compared to Caucasians and Eurasians, analytic studies should be considered to test this hypothesis. There may be a need to develop locally applicable risk assessment tools which can be used to support local guidelines for VTE prophylaxis, thus leading to more acceptable and cost-effective care.

Adolescent ; Adult ; Aged ; Aged, 80 and over ; Child ; Child, Preschool ; Databases, Factual ; Female ; Humans ; Infant ; Infant, Newborn ; Inpatients ; Male ; Middle Aged ; Pulmonary Embolism ; epidemiology ; prevention & control ; Singapore ; epidemiology ; Venous Thromboembolism ; epidemiology ; ethnology ; prevention & control ; Young Adult

The instability of most critically ill patients necessitates regular monitoring of hemodynamic parameters, including blood volume and pulmonary capillary wedge pressure (PCWP). However, the invasiveness and technological complexity of the standard modality restricts its usefulness to an eligible subset of patients with access to it. The vascular pedicle is a radiographic structure whose width may be a valid tool for assessing PCWP. This study aims to determine the diagnostic accuracy of the vascular pedicle width (VPW) in differentiating high from low-to-normal PCWP in critically ill cardiac patients from the Cardiac Care Unit of SLMC. Information from seventy-three chest radiographs, with corresponding PCWP tracings by Swan-Ganz pulmonary artery catheters were prospectively collected from June 2003 to January 2004. Three independent radiologists read the films, following a standard protocol for VPW measurement. Results show that the over-all sensitivity of the test is 59.3 percent, with a specificity of 73.9 percent, likelihood ratio (+) and (-) of 2.27 and 0.55, respectively. Stratified analyses suggest that the test is more useful when the radiograph is taken with the patient in the supine rather than semi-sitting position. It is also more useful in obese, rather than non-obese patients. In the absence of modalities that are less invasive, at the same time objective, available, and accessible, the VPW is a good alternative for the assessment of hemodynamic status in critically ill patients.

Critical Illness ; Pulmonary Wedge Pressure