PMID- 28886892 OWN - NLM STAT- In-Process DA - 20170909 LR - 20170918 IS - 2174-2030 (Electronic) IS - 0870-2551 (Linking) VI - 36 IP - 9 DP - 2017 Sep TI - The Atlantic divide in coronary heart disease: Epidemiology and patient care in the US and Portugal. PG - 583-593 LID - S0870-2551(17)30557-7 [pii] LID - 10.1016/j.repc.2016.09.021 [doi] AB - INTRODUCTION AND OBJECTIVES: We aimed to compare access to new health technologies to treat coronary heart disease (CHD) in the health systems of Portugal and the US, characterizing the needs of the populations and the resources available. METHODS: We reviewed data for 2000 and 2010 on epidemiologic profiles of CHD and on health care available to patients. Thirty health technologies (16 medical devices and 14 drugs) introduced during the period 1980-2015 were identified by interventional cardiologists. Approval and marketing dates were compared between countries. RESULTS: Relative to the US, Portugal has lower risk profiles and less than half the hospitalizations per capita, but fewer centers per capita provide catheterization and cardiothoracic surgery services. More than 70% of drugs were available sooner in the US, whereas 12 out of 16 medical devices were approved earlier in Portugal. Nevertheless, at least five of these devices were adopted first or diffused faster in the US. Mortality due to CHD and myocardial infarction (MI) was lower in Portugal (CHD: 72.8 vs. 168 and MI: 48.7 vs. 54.1 in Portugal and the US, respectively; age- and gender-adjusted deaths per 100000 population, 2010); but only CHD deaths exhibited a statistically significant difference between the countries. CONCLUSIONS: Differences in regulatory mechanisms and price regulations have a significant impact on the types of health technologies available in the two countries. However, other factors may influence their adoption and diffusion, and this appears to have a greater impact on mortality, due to acute conditions. CI - Copyright (c) 2017 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier Espana, S.L.U. All rights reserved. FAU - Lobo, Mariana F AU - Lobo MF AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal. Electronic address: marianalobo@med.up.pt. FAU - Azzone, Vanessa AU - Azzone V AD - Department of Health Care Policy, Harvard Medical School, Boston, MA, United States. FAU - Resnic, Frederic S AU - Resnic FS AD - Department of Cardiovascular Medicine, Lahey Hospital and Medical Center, Burlington and Tufts University School of Medicine, Boston, MA, United States. FAU - Melica, Bruno AU - Melica B AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Servico de Cardiologia, Unidade de Diagnostico e Intervencao Cardiovascular, Centro Hospitalar de Vila Nova de Gaia e Espinho, Vila Nova de Gaia, Portugal. FAU - Teixeira-Pinto, Armando AU - Teixeira-Pinto A AD - School of Public Health, Faculty of Medicine, The University of Sydney, Sydney, Australia. FAU - Azevedo, Luis Filipe AU - Azevedo LF AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal. FAU - Freitas, Alberto AU - Freitas A AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal. FAU - Nisa, Claudia AU - Nisa C AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal. FAU - Bacelar-Nicolau, Leonor AU - Bacelar-Nicolau L AD - Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal. FAU - Rocha-Goncalves, Francisco Nuno AU - Rocha-Goncalves FN AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Portuguese Institute of Oncology Porto (IPO-Porto), Porto, Portugal. FAU - Pereira-Miguel, Jose AU - Pereira-Miguel J AD - Institute of Preventive Medicine and Public Health and ISAMB - Institute of Environmental Health, Faculdade de Medicina, Universidade de Lisboa, Lisbon, Portugal. FAU - Costa-Pereira, Altamiro AU - Costa-Pereira A AD - Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal; Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Porto, Portugal. FAU - Normand, Sharon-Lise AU - Normand SL AD - Department of Health Care Policy, Harvard Medical School, Boston, MA, United States; Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States. LA - eng LA - por PT - Journal Article DEP - 20170906 PL - Portugal TA - Rev Port Cardiol JT - Revista portuguesa de cardiologia : orgao oficial da Sociedade Portuguesa de Cardiologia = Portuguese journal of cardiology : an official journal of the Portuguese Society of Cardiology JID - 8710716 OTO - NOTNLM OT - Access OT - Acesso OT - Cardiologia de intervencao OT - Comparacao internacional OT - Coronary heart disease OT - Diffusion OT - Difusao OT - Doenca coronaria OT - Health systems OT - Health technologies OT - International comparison OT - Interventional cardiology OT - Sistemas de saude OT - Tecnologias em saude EDAT- 2017/09/10 06:00 MHDA- 2017/09/10 06:00 CRDT- 2017/09/10 06:00 PHST- 2016/09/01 [received] PHST- 2016/09/04 [accepted] AID - S0870-2551(17)30557-7 [pii] AID - 10.1016/j.repc.2016.09.021 [doi] PST - ppublish SO - Rev Port Cardiol. 2017 Sep;36(9):583-593. doi: 10.1016/j.repc.2016.09.021. Epub 2017 Sep 6.