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Introduction Cigarette smoking causes many chronic diseases that are costly and result in frequent hospitalisation. Hospital-initiated smoking cessation interventions increase the likelihood that patients will become smoke-free. We modelled the cost-effectiveness of the Ottawa Model for Smoking Cessation (OMSC), an intervention that includes in-hospital counselling, pharmacotherapy and posthospital follow-up, compared to usual care among smokers hospitalised with acute myocardial infarction (AMI), unstable angina (UA), heart failure (HF), and chronic obstructive pulmonary disease (COPD). Methods We completed a cost-effectiveness analysis based on a decision-analytic model to assess smokers hospitalised in Ontario, Canada for AMI, UA, HF, and COPD, their risk of continuing to smoke and the effects of quitting on re-hospitalisation and mortality over a 1-year period. We calculated short-term and long-term cost-effectiveness ratios. Our primary outcome was 1-year cost per quality-adjusted life year (QALY) gained. Results From the hospital payer's perspective, delivery of the OMSC can be considered cost effective with 1-year cost per QALY gained of $C1386, and lifetime cost per QALY gained of $C68. In the first year, we calculated that provision of the OMSC to 15 326 smokers would generate 4689 quitters, and would prevent 116 rehospitalisations, 923 hospital days, and 119 deaths. Results were robust within numerous sensitivity analyses. Discussion The OMSC appears to be cost-effective from the hospital payer perspective. Important consideration is the relatively low intervention cost compared to the reduction in costs related to readmissions for illnesses associated with continued smoking. [ABSTRACT FROM AUTHOR]

Reports the development, testing and clinical utility of a risk stratification tool for evaluation of patients with unstable angina/non--ST-segment elevation myocardial infarction. Methods; Results; Conclusion that the Thrombolysis in Myocardial Infarction (TIMI) risk score is a simple prognostic scheme that categorizes a patient's risk of death and ischemic events and provides a basis for therapeutic decision making.

Question In patients with systemic lupus erythematosus (SLE), does modifying the Framingham Risk Score (FRS) improve prediction of coronary artery disease (CAD)? Methods Design Prospective cohort study. Setting University of Toronto Lupus Clinic in Canada. Patients Patients 30 to 75 years of age who had SLE and did not have CAD or diabetes. Patients were randomly assigned to the derivation (335 patients, mean age 44 y, 90% women) or validation (678 patients, mean age 42 y, 89% women) cohort. Predictors for the validation cohort were measured from 10 years before the first CAD event or the last visit for patients without events. Description of prediction guides The FRS calculates 10-y risk for CAD based on age, total cholesterol level, high-density lipoprotein (HDL) level, blood pressure, smoking status, and diabetes status. The 2FRS multiplies each variable in the FRS by 2 to derive a risk score. Risks for both prediction guides were categorized as very low/low (< 10%) or moderate/high (= 10%). Outcomes CAD (myocardial infarction, angina, or sudden death) at 10 years. Main results CAD occurred in 9.9% of the derivation cohort and 9.1% of the validation cohort. The operating characteristics for the validation cohort are in the Table; hazard ratios for predicted 10-year CAD were 2.14 (95% CI 1.15 to 3.96) for 2FRS and 3.11 (CI 0.61 to 15.78) for FRS. Conclusion In patients with systemic lupus erythematosus who did not have diabetes, a modified Framingham Risk Score (calculated by multiplying factors by 2) predicted moderate to high risk for coronary artery disease for more patients than the original score. [ABSTRACT FROM AUTHOR]