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Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm.

Saidi, O; O'Flaherty, M; Zoghlami, N; Malouche, D; Capewell, S; Critchley, J; Bandosz, P; Romdhane, HB; Guzman Castillo, M (2019) Comparing Strategies to Prevent Stroke and Ischemic Heart Disease in the Tunisian Population: Markov Modeling Approach Using a Comprehensive Sensitivity Analysis Algorithm. Computational and Mathematical Methods in Medicine, 2019. p. 2123079. ISSN 1748-670X https://doi.org/10.1155/2019/2123079
SGUL Authors: Critchley, Julia

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Abstract

Background. Mathematical models offer the potential to analyze and compare the effectiveness of very different interventions to prevent future cardiovascular disease. We developed a comprehensive Markov model to assess the impact of three interventions to reduce ischemic heart diseases (IHD) and stroke deaths: (i) improved medical treatments in acute phase, (ii) secondary prevention by increasing the uptake of statins, (iii) primary prevention using health promotion to reduce dietary salt consumption. Methods. We developed and validated a Markov model for the Tunisian population aged 35–94 years old over a 20-year time horizon. We compared the impact of specific treatments for stroke, lifestyle, and primary prevention on both IHD and stroke deaths. We then undertook extensive sensitivity analyses using both a probabilistic multivariate approach and simple linear regression (metamodeling). Results. The model forecast a dramatic mortality rise, with 111,134 IHD and stroke deaths (95% CI 106567 to 115048) predicted in 2025 in Tunisia. The salt reduction offered the potentially most powerful preventive intervention that might reduce IHD and stroke deaths by 27% (−30240 [−30580 to −29900]) compared with 1% for medical strategies and 3% for secondary prevention. The metamodeling highlighted that the initial development of a minor stroke substantially increased the subsequent probability of a fatal stroke or IHD death. Conclusions. The primary prevention of cardiovascular disease via a reduction in dietary salt consumption appeared much more effective than secondary or tertiary prevention approaches. Our simple but comprehensive model offers a potentially attractive methodological approach that might now be extended and replicated in other contexts and populations.

Item Type: Article
Additional Information: Copyright © 2019 Olfa Saidi et al. +is is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Keywords: 0102 Applied Mathematics, 0903 Biomedical Engineering, Bioinformatics
SGUL Research Institute / Research Centre: Academic Structure > Population Health Research Institute (INPH)
Journal or Publication Title: Computational and Mathematical Methods in Medicine
ISSN: 1748-670X
Dates:
DateEvent
29 January 2019Published
18 December 2018Accepted
Publisher License: Creative Commons: Attribution 4.0
Projects:
Project IDFunderFunder ID
n223075Seventh Framework Programmehttp://dx.doi.org/10.13039/501100004963
UNSPECIFIEDMedical Research Councilhttp://dx.doi.org/10.13039/501100000265
URI: http://openaccess.sgul.ac.uk/id/eprint/110649
Publisher's version: https://doi.org/10.1155/2019/2123079

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