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Global Cardiovascular Strategies
PRIORITIZATION IN CARDIOLOGY. IMPACT ON GUIDELINES
Nina Rehnqvist, MD, Sweden
National Board of Health and Welfare, Stockholm, Sweden
Proceedings on 14th International Congress
THE "NEW FRONTIERS" OF ARRHYTHMIAS 2000
Swedish Program of Prioritization in Cardiology
In Sweden we are now in the process of trying to operationalise these considerations both in the production of guidelines for ischemic heart disease and in making a survey of the resources spent within different areas of cardiology in three regions. Cardiology is chosen since the proportion of measures that are actually evidence based is higher in cardiology than in any other speciality although the total level does not exceed 50%.Some groups of patients have been identified as belonging to the highest priority group. To this group belongs life threatening conditions as acute myocardial infarction. Rehabilitation after myocardial infarction and secondary or primary prevention are being considered to belong to group 2 less severe disorders but still considered appropriate to be covered by public means. In both these examples the next step in the prio-process is to look at cost-effectiveness and chose according to that. This means that pressure has to be put both on providers of health care and the health care industry to openly declare both clinical effectiveness as well as cost-effectiveness and of the profession and public to ask for this information both from a safety point of view and from prioritisational aspects.
Epidemiologic research is the basis for defining needs but political and ethical aspects are also important. Cardiac disorders belonging to group 3, less severe and not unquestionally to be provided by public means are more difficult to exemplify but perhaps treatment of lower grade of obesity with some increased cardiac risk may belong to this group.
Unquestionally all these considerations are until now very immature but a thorough discussion on these matters are to my mind absolutely necessary in order to avoid wrong allocation of resources. In these discussions patients, the public, politicians, both as the public voice and meansproviders at least in systems where taxes are involved need to participate along with the various professions in cardiology. Nurses, physiotherapists, physicians, surgeons technicians, dieticians etc, all need to take part in the discussion. All of these professional groups need to in the future to have records of what they may provide to what effect and what cost.
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