CV Disease : A Major Threat to Public Health International Atomic Energy Agency United Nations, Vienna - Austria João V. Vitola, MD, PhD Cardiologist and Nuclear Medicine Physician QUANTA Diagnostico & Terapia, Curitiba Brazil Consultant IAEA, Vienna Austria Chairman International Advisory Panel, ASNC, USA
Cardiovascular Mortality Worldwide Leader Cause of Mortality in Adults Men and Women Source: WHO
80% of 17.5 mi Deaths Due to CVD are in Low to Mid Income Countries Significant Economic Burden Source: WHO
CV mortality causes brain vs heart vs others MALES FEMALES Source: WHO
Ischemic Heart Disease Where is mortality higher? Source: WHO
Ischemic Heart Disease The first infarct AHA s Heart Disease and Stroke Statistics www.americanheart.org
Clinical Case # 1 - from Curitiba - Brazil 51 yo, Man, HTN, obese, DM, Fam Hx CAD NO HISTORY OF CAD Episodes of chest pain at rest and exercise Referred for outpatient MIBI
Clinical Case # 2 - from Curitiba - Brazil Female, 54 yo, obese, atypical chest pain, referred for MIBI NO HISTORY OF CAD 3 min AFTER low workload exercise on the treadmill Ischemia Induced Cardiac Arrest Would probably be fatal outside hospital/clinic OUTCOME Successful defibrilation, Cath (3 V disease) Surgical revascularization, ALIVE AND WELL
Projected Percentage of Deaths from Cardiovascular Disease Among Those 35-64 yrs Health Affairs Jan/Feb 2007
Rising health care cost of chronic disease caused by: Smoking/obesity / lack of exercise / DM $$$$
Main risk factors for all cause deaths Implication for CV mortality Source: WHO
Prevalence of Obesity in the World
DIABETES
World Scenario Estimation for 2025 Source: Diabetes International Federation
Diabetes is Increasing Mostly in Developing Countries (middle age) Source WHO
Impact of BMI and DM in SPECT abnormal rate Data from Curitiba Brazil (n=6917) Vitola J, Cerci R, Cunha C et al.. QUANTA database (in progress)
Impact of DM added to other risk factors in SPECT abnormal rate (n=32384) Risk factors: Smoking, Family history, dyslipidemia, high blood pressure Source: Vitola J, Cerci R, Cunha C et al, QUANTA database (in progress) Curitiba - Brazil
In 2013 What technologies are available?
Clinical Case # 3 from Curitiba - Brazil 36 yo, Man DM, Obese (IMC: 30.1), HTN, High Cholesterol Denies Chest Pain TMT Rest ECG LAHB Bruce : 10 min HR: 84... 159 (85% = 156 bpm) BP: 130/80...180/90 mmhg No ST segment changes At peak exercise right shoulder pain, Not Limiting Duke Score Duke: exer min 5x ST 4x angina Duke = (+10) (5x0) (4x1) = + 6
False Negative Exercise Testing Positive Nuclear Cortes Tomográficos-Referencia ESV: 70 ml, LVEF: 45% High Risk Findings Revascularization + Optimized Medical Therapy
Cost Effectiveness of treating CVD Conservative vs Invasive management
ECONOMIC IMPLICATIONS OF REVASCULARISATION WITHOUT SELECTING BASED ON ISCHEMIA Leslee Shaw et al. JACC 1999;33:661-669
Shaw JACC 1999;33:661-669
IAEA, Vienna, Austria, 2008 Organized by Maurizio Dondi Adel Allam Egypt Amalia Peix Cuba Annare Ellmann South Africa Bon Nang Lee Malaysia C. Siritara - Thailand Felix Keng Singapore Fernando Mut- (Co-chairman) - Uruguay Gianmario Sambucetti Italy Gregory Thomas USA João V. Vitola (Chairman) - Brazil Kevin Allman Australia Leslee Shaw USA Maurizio Dondi - IAEA - Austria Marla Kiess Canada Pilar Orellana Chile Raffaele Giubbini Switzerland Salaheddine Bouyoucef Algeria Zuo Xiang He China
Worldwide Utilization of Nuclear Cardiology Underutilized in Many Nations High Moderate High Moderate Moderate Low Low Inexistente Vitola JV, Shaw L, Allam A et al JNC, 2009
Health care expenditure per capita Nuclear use influenced by: - Economy GDP Healthcare Policies -Information Organized scientific groups Local Scientific Production Training -Neighboring coutries Comunication Training Scientific meetings Nuclear Cardiology utilization per 100.000 inhab Sources : WHO Vitola JV, Shaw L, Allam A et al. JNC 2009
Investing in healthcare (prevention + diagnosis + treatment) how countries invest?
Investing in healthcare (prevention + diagnosis + treatment) how do we know investment works?
US decline in heart disease mortality Jemal, A. et al. JAMA 2005;294:1255-1259.
Are there differences in SPECT abnormal rates among countries? Comparison of 2 referral centers in a developed and developing country Source: Rozanski A, Gransar H, et al, JACC, 2013 Los Angeles - USA Source: Vitola J, Cerci R, Cunha C et al, QUANTA database Curitiba - Brazil It seems that developing countries, needing the most, are using less of technology
Can we decrease discrepancies in life expectancy around the world? Can we be more effective in reducing mortality due to CVD? Can we invest more resources and in a more rational way?
Confronting the Epidemics of CVD Worldwide: Time to Stop and Think About Cardiac Care Awareness about increasing mortality in developing countries (80% of deaths) Obesity and DM are contributing to increasing CVD mortality worldwide. Prevention is essential! Life expectancy can be increased by increasing investments and strategies involving prevention + appropriate use of technology for diagnosis/prognosis + guiding to appropriate treatment Imaging can be used to assess risk and guide management cost effectivelly. Wide variation - under and over utilization of technology worlldwide (GDP and information) Considering increasing costs of healthcare it is essential to rationalize investigation and management
Wish you all a great meeting and a good week in Vienna! joaovitola@quantamn.com.br QUANTA Curitiba, Brazil