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Lesson 2
Lesson 2 - Epidemiology

2. PCM Demographics

Combat Perioperative Cardiac Morbidity!Why do I need to know PCM demographics? Well, you need to know the scope of the problem. Is this a big problem or a little problem? If it is a big problem, we need a solution. PCM is a big problem. 65 million Americans have cardiovascular disease. 600 thousand undergo cardiac surgery each year in the United States with 100 thousand episodes of PCM. 3.2% die. This 600 thousand operations per year is an important number because if I suggest a therapy that leads to many more cardiac surgeries, do we have enough surgeons? Operating rooms? Money to pay for it? If I suggest using a therapy that has a 3.2% mortality rate and costs $20,000+, there had better be some benefit to that therapy.

Here is a really big number. There are 30 million non-cardiac operations per year in the United States. Of these, 6 million have either known coronary artery disease or known vascular disease, or risk factors for coronary artery disease. So what we are talking about with BBAC is a quarter of all patients scheduled for surgery. If I tell you to use some therapy, or some test, you need to multiply the cost of that test or therapy by 6 million (6,000,000) to see the real cost. Let's try this out. I suggest using a $1,500 test as a preoperative evaluation for patients at risk for cardiac disease undergoing non-cardiac surgery. How much does my recommendation cost the U.S. health care system? That's right $9 billion ($9,000,000,000). Now, don't you hope it works? Nine billion dollars is real money as they say in Washington, D.C..

There are 50,000 perioperative MI's and 20,000 perioperative deaths each year in the U.S. You can imagine the scenario, "Yes, Mrs. So and So, I have some good news and some bad news. We did an excellent job with the surgery on your husband's XYZ. It is fixed. Unfortunately, he has had a heart attack, and may die, but his XYZ is fixed. We have all been in this situation. BBAC is designed to reduce the risk.

PCM Demographics

bullet 65 Million Americans have cardiovascular disease
bullet 600 Thousand undergo cardiac surgery
bullet 100 Thousand cardiac PCM
bullet 30 Million undergo non-cardiac surgery
bullet 6 Million at risk for PCM
bullet 50,000 MI’s
bullet 20,000 Deaths

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Content by Art Wallace MD PhD
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