Ischemic Heart Disease: Cost-Effective Acute Management and Secondary Prevention

Authors: Chandrasagar Dugani, Andrew Moran, Robert Bonow, Thomas Gaziano


This chapter explores the global burden of Ischemic Heart Disease (IHD), with a focus on low- and middle-income countries (LMICs), reviewing the cost-effective management of acute IHD and subsequent secondary prevention and discussing the challenges that IHD poses to the global community and solutions that may help reduce attendant mortality and morbidity. Over the past two decades, although age-standardized IHD mortality has decreased in most regions, the global burden of IHD has increased by 29 percent to 29 million disability-adjusted life years (DALYs), in part because of a larger aging population and overall population growth. Several cost-effective interventions exist for acute and chronic management of acute coronary syndrome (ACS) and for long-term management of IHD risk factors. In acute settings, the medical management of ACS proves cost-effective, but not all regions have the facilities providing this type of care. Once patients leave acute settings, a combination of reducing risk factors, increasing access and adherence to medications, and using the placement of cardiac resynchronization therapy (CRT) and implantable cardioverter defibrillators (ICDs) can lower subsequent mortality and morbidity if available.