Simulating and Evaluating Local Interventions to Improve Cardiovascular Health

Figure 3. Projected changes in the death rate from first-time cardiovascular disease (CVD) events and in total consequence costs per capita when 15 interventions are combined, expressed in terms of clusters of interventions, simulation model for cardiovascular health outcomes.

Key:
Blue line = base case results.
Gray line = outcomes if all risk factors were reduced to zero.
Red line = implement the 3 interventions that improve the use and quality of primary care (Care).
Green line = add the 6 interventions related to air quality and smoking (Air).
Black line = add the 5 interventions related to improved nutrition and physical activity and the 1 intervention that would reduce sources of stress (Lifestyle). This scenario includes all 15 interventions and is identical to the black line in Figure 2.

This figure consists of 2 line graphs that portray simulated death rate and cost outcomes for topical clusters of interventions, layered additively and building up to a 15-component intervention. All interventions are implemented in 2009. Three Care interventions improve the quality of primary care. Six Air interventions are related to air quality and smoking. Six Lifestyle interventions are related to improved nutrition and physical activity and reduced sources of stress.

The graph on the left has an X axis labeled with the years 1990 to 2040 and a Y axis labeled “Deaths from CVD per 1,000.” The Y axis ranges from zero to 4. A blue line indicates the base case, with a death rate that starts at 3.70 deaths per 1,000 in 1990, dips to a low point of 2.37 in 2003, and rises gradually to 3.23 in 2040. A red line indicates the effect of the Care cluster (3 interventions). It quickly drops to 2.18 deaths per 1,000 in 2010 (compared with 2.50 in the base case), then gradually rises to 2.93 in 2040. A green line indicates the effect of the combined Air and Care clusters (9 interventions). It quickly drops to 2.04 deaths per 1,000 in 2010, then gradually rises to 2.73 in 2040. A black line indicates the effect of the combined Air, Care, and Lifestyle clusters  (15 interventions). It quickly drops to 2.04 deaths per 1,000 in 2010, then gradually rises to 2.62 in 2040. A gray line indicates a CVD death rate if all risk factors are set to zero. It begins at a rate of 1.32 deaths per 1,000 in 1990, declines to a low point of 0.96 in 2003, and rises gradually to 1.35 in 2040.

The graph on the right has an X axis labeled with the years 1990 to 2040 and a Y axis labeled “Total Consequence Costs per Capita (2005 Dollars per Year).” The Y axis ranges from zero to 3,000. A blue line indicates the base case, with a consequence cost per capita that starts at 2,934 in 1990, declines to 2,304 in 2004, and continues declining more gradually to 2,196 in 2040. A red line indicates the effect of the Care cluster (3 interventions). It declines only slightly to 2,184 in 2010, and then remains essentially flat or rising very slightly, ending at 2,189 in 2040. A green line indicates the effect of the combined Air and Care clusters (9 interventions). It declines to 1,859 in 2020 (compared with 2,211 in the base case), then declines more gradually to 1,796 in 2040. A black line indicates the effect of the combined Air, Care, and Lifestyle clusters (15 interventions). It declines to 1,756 in 2020, then declines more gradually to 1,631 in 2040. A gray line indicates the cost if all risk factors are set to zero. It starts in 1990 at 476, declines slightly to a low point of 371 in 2003, and rises slightly to 455 in 2040.

Volume 7: No. 1, January 2010