The predicted impact of heart disease prevention and treatment initiatives on mortality in Lithuania, a middle-income country
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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. METHODS: To 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. RESULTS: The 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). CONCLUSION: Although 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.