Showing papers by "Zhong Chen published in 2018"

Cost-effectiveness of a risk-stratified approach to cardiac resynchronisation therapy defibrillators (high versus low) at the time of generator change.

Abstract: Objective Responders to cardiac resynchronisation therapy whose device has a defibrillator component and who do not receive a therapy in the lifetime of the first generator have a very low incidence of appropriate therapy after box change. We investigated the cost implications of using a risk stratification tool at the time of generator change resulting in these patients being reimplanted with a resynchronisation pacemaker. Methods A decision tree was created using previously published data which had demonstrated an annualised appropriate defibrillator therapy risk of 2.33%. Costs were calculated at National Health Service (NHS) national tariff rates (2016–2017). EQ-5D utility values were applied to device reimplantations, admissions and mortality data, which were then used to estimate quality-adjusted life-years (QALYs) over 5 years. Results At 5 years, the incremental cost of replacing a resynchronisation defibrillator device with a second resynchronisation defibrillator versus resynchronisation pacemaker was £5045 per patient. Incremental QALY gained was 0.0165 (defibrillator vs pacemaker), resulting in an incremental cost-effectiveness ratio (ICER) of £305 712 per QALYs gained. Probabilistic sensitivity analysis resulted in an ICER of £313 612 (defibrillator vs pacemaker). For reimplantation of all patients with a defibrillator rather than a pacemaker to yield an ICER of less than £30 000 per QALY gained (current NHS cut-off for approval of treatment), the annual arrhythmic event rate would need to be 9.3%. The budget impact of selective replacement was a saving of £2 133 985 per year. Conclusions Implanting low-risk patients with a resynchronisation defibrillator with the same device at the time of generator change is not cost-effective by current NHS criteria. Further research is required to understand the impact of these findings on individual patients at the time of generator change.

Personalized Modeling Pipeline for Cardiac Electrophysiology Simulations of Cardiac Resynchronization Therapy in Infarct Patients

Abstract: Cardiac Resynchronization Therapy (CRT) is associated with increased arrhythmogenic risk in infarct patients when pacing adjacent to a scar. We investigated the role of pacing location relative to scar on dispersion of repolarization, as a surrogate for arrhythmogenic risk. For this task, we developed a personalization and simulation pipeline that allows fast development of personalized computational models and simulation of cardiac electrophysiology. Twenty four models of left ventricular anatomy and scar morphology were built and repolarization sequences were simulated. Simulation results show that CRT increases dispersion of repolarization around a scar when pacing adjacent to it, thus, providing a mechanistic explanation of increased arrhythmogenic risk in infarct patients undergoing CRT.