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      Forecasting coronary heart disease incidence, mortality, and cost: the Coronary Heart Disease Policy Model.

      , , , , ,

      American Journal of Public Health

      American Public Health Association

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          Abstract

          A computer simulation model was developed to project the future mortality, morbidity, and cost of coronary heart disease (CHD) in the United States population. The model contains a demographic-epidemiologic (DE) submodel, which stimulates the distribution of coronary risk factors and the conditional incidence of CHD in a demographically evolving population; a "bridge" submodel, which determines the outcome of the initial CHD event; and a disease history (DH) submodel, which simulates subsequent events in persons with a previous CHD event. The user of the model may simulate the effects of interventions, either preventive (i.e., risk factor modification) or therapeutic, upon mortality, morbidity, and cost for up to a 30-year period. If there were no future changes in risk factors or the efficacy of therapies after 1980, baseline projections indicate that the aging of the population, and especially the maturation of the post-World War II baby-boom generation, would increase CHD prevalence and annual incidence, mortality, and costs by about 40-50 per cent by the year 2010. Unprecedented reductions in risk factors would be required to offset these demographic effects on the absolute incidence of CHD. The specific forecasts could be inaccurate, however, as a consequence of erroneous assumptions or misestimated baseline data, and the model awaits validation based on actual future data.

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          Most cited references 29

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          Coronary artery surgery study (CASS): a randomized trial of coronary artery bypass surgery. Survival data.

          (1983)
          CASS includes a multicenter patient registry and a randomized controlled clinical trial. It is designed to assess the effect of coronary artery bypass surgery on mortality and selected nonfatal end points. From August 1975 to May 1979, 780 patients with stable ischemic heart disease were randomly assigned to receive surgical (n = 390) or nonsurgical (n = 390) treatment and were followed through April 15, 1983. At 5 years, the average annual mortality rate in patients assigned to surgical treatment was 1.1%. The annual mortality rate in those receiving medical therapy was 1.6%. Annual mortality rates in patients with single-, double-, and triple-vessel disease who were in the surgical group were 0.7%, 1.0%, and 1.5%; the corresponding rates in patients in the medical group were 1.4%, 1.2%, and 2.1%. The differences were not statistically significant. Nearly 75% of the patients had entry ejection fractions of at least 0.50. The annual mortality rates in patients in the surgical group in this subgroup with single-, double-, and triple-vessel disease were 0.8%, 0.8%, and 1.2% and corresponding rates in the medical group were 1.1%, 0.6%, and 1.2%. The annual rate of bypass surgery in patients who were initially assigned to receive medical treatment was 4.7%. The excellent survival rates observed both in CASS patients assigned to receive medical and those assigned to receive surgical therapy and the similarity of survival rates in the two groups of patients in this randomized trial lead to the conclusion that patients similar to those enrolled in this trial can safely defer bypass surgery until symptoms worsen to the point that surgical palliation is required.
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            The Thrombolysis in Myocardial Infarction (TIMI) Trial: Phase I Findings

              (1985)
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              The Decline in Ischemic Heart Disease Mortality Rates

               LEE GOLDMAN (1984)
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                Author and article information

                Journal
                American Journal of Public Health
                Am J Public Health
                American Public Health Association
                0090-0036
                1541-0048
                November 1987
                November 1987
                : 77
                : 11
                : 1417-1426
                Article
                10.2105/AJPH.77.11.1417
                1647098
                3661794
                3b118ae9-9f21-44b5-8192-393b3020ea4f
                © 1987

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