The Predicted Impact of Heart Disease Prevention and Treatment Initiatives on Mortality in Lithuania, a Middle-Income Country || Preventing Chronic Disease: November 2011: 10_0198

 

The Predicted Impact of Heart Disease Prevention and Treatment Initiatives on Mortality in Lithuania, a Middle-Income Country

Thomas E. Kottke, MD, MSPH; Lina Jancaityte, MD; Abdonas Tamosiunas, PhD; Vilius Grabauskas, DrSc

Suggested citation for this article: Kottke TE, Jancaityte L, Tamosiunas A, Grabauskas V. The predicted impact of heart disease prevention and treatment initiatives on mortality in Lithuania, a middle-income country. Prev Chronic Dis 2011;8(6):A139. http://www.cdc.gov/pcd/issues/2011/nov/10_0198.htm. Accessed [date].

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Abstract

Introduction
Disease-prevention programs compete with disease-treatment programs for scarce resources. This analysis predicts the impact of heart disease prevention and treatment initiatives for Lithuania, a middle-income Baltic country of 3.3 million people.
MethodsTo perform the analysis, we used data from clinical trials, the Lithuanian mortality registry, the Kaunas Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) register, Kaunas University Hospital and, when data from Lithuania were not available, the United States. We used the predicted reduction in all-cause mortality (as potentially postponable deaths) per 100,000 people aged 35 to 64 years as our outcome measure.
ResultsThe number of potentially postponable deaths from risk factor prevention and management in the population without apparent heart disease is 556.3 (plausible range, 282.3-878.1). The number of potentially postponable deaths for people with stable heart disease is 280.4 (plausible range, 90.8-521.8), 7.0 with a public-access defibrillator program (plausible range, 3.8-8.9), and 119.0 for hospitalized patients (plausible range, 15.9-297.7).
ConclusionAlthough improving treatment of acute events will benefit individual patients, the potential impact on the larger population is modest. Only programs that prevent and manage risk factors can generate large declines in mortality. Significant reductions in both cardiac and noncardiac death magnify the impact of risk-factor prevention and management.

Introduction

Lithuania, a country of 3.3 million in Northern Europe, lies on the eastern shore of the Baltic Sea, north of Poland, south of Latvia, and west of Belarus. It regained independence from the Soviet Union in 1990. Having a per capita gross national income (GNI) about one-quarter that of the United States, Lithuania is classified by the World Bank as an upper middle-income country (1). As with the United States, Canada, and the countries of Northern and Eastern Europe, coronary heart disease (CHD) is the leading cause of decreased life expectancy among middle-aged Lithuanians (2). Preventing chronic disease through lifestyle improvement is a priority in Lithuania, but privatization of health services, coupled with health care costs that are growing at a rate far greater than that of the GNI, could divert resources from disease prevention (3). Because prevention programs compete with treatment programs for scarce resources, policy makers need evidence that allocating resources to disease prevention programs will have the greatest effect on the population’s burden of disease (personal communication between Lithuanian Minister of Health, Raimondas Šukys, and Vilius Grabauskas, November 9, 2010).
To document the potential impact of public health and clinical intervention strategies, we used a model that accounts for the entire population and is relevant to both public health and clinical interventions (4). With this model, we can evaluate existing or proposed interventions at any point along the heart disease continuum, from prevention of risk factors to treatment of advanced disease. In this article, we report the expected impact of interventions that are currently available or might be developed to prevent and treat heart disease for the Lithuanian population aged 35 to 64 years.

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Preventing Chronic Disease: November 2011: 10_0198