New study shows the association between the risk of recurrent cardiac events and treatment-related social and healthcare costs (1)

According to a new study, a patient's risk of recurrent cardiac events and their risk factor profile are significantly associated with the overall costs of social and healthcare services. Based on the study results, classifying patients with coronary heart disease according to their risk of recurrent events could facilitate individualized treatment planning and potentially result in cost savings in healthcare expenditure.¹

Cardiovascular diseases are the leading cause of death in Finland. They have a significant impact on patients' daily functional and working capacity and overall quality of life. Additionally, these diseases result in an estimated annual cost of nearly three billion euros to society, considering both direct and indirect costs.²

In a study conducted by pharmaceutical company Novartis, the wellbeing services county of North Karelia - Siun Sote, and health economics analytics company ESiOR Oy, the association between the risk of recurrent disease events among patients who have experienced an acute cardiac event and the treatment-related social and healthcare costs was examined. Based on the study results, further improvements will be made in the treatment of patients who have experienced cardiovascular events. The research has been published in the European Heart Journal Open in June 2024.¹

In the study, patients were divided into five risk categories based on their likelihood of developing a new cardiovascular event, such as a myocardial infarction, within the next five years. The risk of recurrent events during the five-year follow-up period ranged from 20 to 41 percent, depending on the risk category. Additionally, the social and healthcare costs were examined according to the risk categories.¹

Study results anticipate possibilities for cost savings in healthcare expenditure

According to the study, in the group with the lowest risk of recurrent events, cumulative social and healthcare costs amounted to 15,511 euros per patient over a five-year period. In contrast, in the group with the highest risk of recurrent events, the costs totaled 44,859 euros per patient. In total, the cumulative social and healthcare service costs for the patients included in the study were approximately 94 million euros over five years. It should be noted that not all of these costs are directly related to services associated with heart disease.¹

- The study suggests that improved management of risk factors could significantly reduce healthcare costs, in addition to improving patients' prognosis and quality of life after a cardiac event, says Tuomas Rissanen, Chief Cardiologist at Siun Sote.

The execution of the recently published study has been made possible due to the unique health data available from Siun Sote. In the study, patient data has been processed without directly identifiable information in the secure SPESiOR® analytics environment, approved by Valvira in accordance with the Act on the Secondary Use of Health and Welfare.  

The study demonstrates the importance of targeted allocation of resources

- Describing the possibilities of prevention helps organizations understand how even small actions can have significant cost implications in the broader management of cardiovascular diseases. Prevention is also challenging in terms of decision-making, as the results become most visible only years later, beyond the budget period. Therefore, such studies are important in advocating for the importance of preventive measures even in times of economic constraints, where one must dare to invest in the future, says Petri Kivinen, Chief Administrative Physician at Siun Sote.

The wellbeing services counties are currently striving to reform the organization of health and social services and allocate resources more effectively. Effectiveness refers to how the available resources are targeted in a way that maximizes the benefits for both patients and society.

- As a pharmaceutical company, we are part of the healthcare system. The study conducted in Siun Sote is an example of how a pharmaceutical company, in collaboration with wellbeing services counties, can contribute to developing more effective patient care. By allocating resources intelligently, we can ensure that patients continue to receive the best possible care and that our healthcare system can adopt new innovations, says Annukka Kivelä, Medical Lead at Novartis.

After the publication of the study, the next step in the collaboration between Novartis, Siun Sote, and ESiOR is to model how influencing risk factors for cardiovascular diseases reduces the overall risk of recurrent cardiac events and the impact on treatment costs. In practice, it will examine, for example, how achieving LDL cholesterol targets affects the risk of recurrent cardiac events and the resulting costs for the wellbeing services county. The goal is to ensure that patients receive timely and necessary treatment.

Summary of the study results

The study published in the European Heart Journal Open (CORONARY study: Long-Term Clinical Outcomes and Cumulative Costs after Acute Coronary Syndrome: A Risk-Stratified Real-World Study with 5-Year follow-up in the Finnish population) is a retrospective study conducted in Siun Sote in collaboration between Novartis, wellbeing services county of North Karelia - Siun Sote, and ESiOR. The study examined the risk of recurrent cardiac events and the associated social and healthcare costs in patients who had experienced an acute cardiac event within the defined clinical risk categories during the five-year follow-up period after the initial event.¹

The study included all patients aged 45-85 (n=3303) who had been admitted to the North Karelia Central Hospital for an acute coronary syndrome between 2017 and 2022 (n=1923) or underwent an elective procedure (percutaneous coronary intervention or coronary artery bypass grafting, n=1380). The risk of recurrent acute coronary events in the next five years for patients was assessed using the SMART-REACH risk calculator, which classified patients into five equally sized risk categories based on the risk assessment. SMART-REACH is an algorithm that calculates the risk of recurrent cardiovascular disease events based on baseline variables of the patient. The study also examined the patients' utilization of social and healthcare services (emergency visits, outpatient and inpatient visits and admissions to primary and secondary healthcare, invasive procedures, and social services) and the associated costs during the five-year follow-up period according to risk categories.¹

The CORONARY study demonstrated that LDL cholesterol levels were consistently high compared to treatment guideline recommendations. At baseline, only less than 10% of patients had reached their LDL cholesterol target, and this proportion increased to 16% at one year. There was also inadequate monitoring of LDL cholesterol levels. Almost all patients had their LDL cholesterol levels recorded at baseline, but at the three-month follow-up, LDL cholesterol data were missing for 27% of patients, and at one year, it was missing for 38% of patients.¹

According to the SMART-REACH risk calculator suitable for secondary prevention patients, patients could be further divided into five different risk groups based on the assessment of the risk of recurrent cardiac events in the next five years. The risk of recurrent cardiac events varied significantly among the different risk groups. In the lowest-risk group according to the SMART-REACH calculator, the risk of recurrent cardiac events was 20%, while in the highest-risk group, it was 41%.¹

The CORONARY study also examined the cumulative social and healthcare service costs over the five-year period, which amounted to approximately 94 million euros for all patients included in the study. The cumulative costs per patient for social and healthcare services were significantly associated with the magnitude of the risk of recurrent cardiac events. In the lowest-risk group, the cumulative costs were 15,511 euros per patient, while in the highest-risk group, they were 44,859 euros per patient.¹

The CORONARY study demonstrated that the SMART-REACH risk calculator makes it possible to further categorize high-risk secondary prevention patients into subgroups with significantly different risks of recurrent cardiac events and cumulative costs1. This means that this type of risk stratification could be a practical tool to identify patients who have experienced an acute cardiac event and are at particularly high (or low) risk of recurrent events. Additionally, this classification would enable more targeted treatment planning and allocation of limited resources, potentially leading to long-term cost savings.

More info on:

Siun Sote 
Tuomas Rissanen, [email protected], tel. 050 599 8022

Novartis Finland Oy
Annukka Kivelä, Medical Lead, [email protected], tel. 040 704 6999

Esior 
Janne Martikainen, partner, [email protected], p. 0440 718 243

Siun Sote in brief

The wellbeing services county of North Karelia – Siun Sote provides public social and healthcare, rescue services, and environmental health services for approximately 163,400 residents in North Karelia. The wellbeing services county of North Karelia operates in Joensuu, Kitee, Lieksa, Nurmes, Outokumpu, Kontiolahti, Ilomantsi, Juuka, Liperi, Polvijärvi, Rääkkylä, Tohmajärvi, and Heinävesi. Our mission is to support, secure, and promote well-being to ensure a good quality of life in North Karelia.
The groundwork for the wellbeing services county has been done in the Siun sote consortium, which has been in operation since 2017. The responsibility for organizing services and the approximately 8,000 staff members transferred to the North Karelia wellbeing services county as of January 1, 2023.

Novartis in brief

Novartis is a healthcare company that develops innovative pharmaceutical products. We are one of the world's leading pharmaceutical companies and we create new treatments to address significant medical needs through innovative research and digital technologies. Our investments in research and development are among the largest in the world. Novartis products are used by over 250 million people globally. In Finland, the company is represented by Novartis Finland Oy. For more information, visit www.novartis.fi.

ESiOR in brief

ESiOR Oy is a healthcare consulting and analytics company that provides services to demonstrate the value of treatments and services, improve efficiency, and promote cost-effectiveness. The company's SPESiOR® analytics environment offers a cloud-based solution for secure handling of health data.