Prevenzione cardiovascolare primaria: lusso per ricchi
o investimento in salute? L’esperienza di Cardio50
Paolo Bordin, Francesca Picco, Francesca Valent, Bruna Mattiussi, Luigino Vidotto, Anna Fabbro, Stefano Miceli,
Rosanna Comoretto, Giorgio Brianti
Introduction Cardiovascular diseases are the main cause of death and morbidity worldwide, in Europe, and Italy. Preventive interventions, both drug-based and lifestyle-based, can reduce significantly their incidence. The World Health Organization adopted an action plan aiming at reducing the prevalence of incorrect lifestyles. In 2015, the Health Agency of Udine, in Friuli Venezia Giulia, joined a national project involving 22 Health Agencies from 11 Italian Regions, named “Cardio50”, an organized cardiovascular screening program with the ultimate goal of reducing mortality and morbidity through the identification and treatment of unknown cases of high blood pressure, blood glucose, and cholesterol.
Materials and Methods In Udine, 3,127 eligible 50-year-old persons (the 1964 birth cohort) were invited in the program. 844 out of 2,325 participants had at least one abnormal blood or pressure parameter and underwent a subsequent cardiologic visit, exams, counseling, and start of pharmacological treatment where appropriate. In a subgroup of 242 subjects undergoing a follow up visit after counselling, the prevalence of most incorrect lifestyles was reduced. We evaluated the cost of annual screening and eventual cardiologic visit and exams in this cohort and estimated the cost of a possible extension of the program to the entire 1,200,000-inhabitant Friuli Venezia Giulia Region, with a 50-year-old population of approximately 20,000. We also estimated the number of acute cerebrovascular events and diabetes cases that would be potentially avoidable with one year of program implementation in the Region and the relative saving of economic resources.
Results We estimated that the yearly implementation of the program would cost approximately € 624,000, including 12,500 nurse-hours and 2,500 cardiologist-hours and could prevent approximately 34 acute cerebrovascular events and 14 cases of diabetes mellitus with an estimated saving of about € 823.000 (€ 614,000 for acute cerebrovascular events and € 209,000 for diabetes mellitus).
Conclusion This low-technology and relatively inexpensive program has the potential to identify subjects at higher cardiovascular risk and prevent serious health outcomes through lifestyle changes or early pharmacological reduction of risk factors.
Key words: screening; cardiovascular prevention; counselling; lifestyle, cost/benefit