Acute Myocardial Infarction

CARE OF PATIENTS WITH A LOW PROBABILITY OF ACUTE MYOCARDIAL INFARCTION: AN ASSESSMENT

This research assesses a study by Fineberg, et al. (1984, pp. 13011307), concerning appropriate strategies for emergency room patients complaining of acute chest pain (only those patients not requiring intensive care for advanced arrhythmias or congestive heart failure were included in the analysis). The researchers drew their conclusions on the basis of a costbenefit analysis. Therefore, this assessment focuses on the study's application of costbenefit analysis. Specifically, this assessment considers the potential for builtin bias in the study's quantification, the reliability of the study's findings, and what could have been done differently to improve the study, as well as an overall assessment of the study.

Although the maximum nurse/patient ratio assumed by the researchers for intermediate care units was twice that assumed for coronary care units, the researchers assumed that patients committed to intermediate care units would receive lidocaine to reduce ventricular fibrillation at a rate 75 percent that which would be received in a coronary care unit. With respect to successful resuscitation from primary ventricular fibrillation, the researchers assumed a halfway point between the average in coronary care units and the rate for outofhospital resuscitations begun within five minutes of cardiac arrest. As a consequence of these assumptions

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the researchers. Similarly, in comparing intermediate care with routine care, the lives saved by prevention would have been 1,721 as opposed to the 1,954 estimated by the researchers. Using the revised data, the total savings in terms of lives saved would have been 722 instead of the 489 estimated by the researchers when comparing coronary care with intermediate care and 1,965 instead of the 2,198 estimated by the researchers when comparing intermediate care with routine hospital care. In terms of years of lives saved, the total would have been 9,670 instead of the 7,167 estimated by the researchers when comparing coronary care with intermediate care and 25,016 instead of the 29,509 estimated by the researchers when comparing intermediate care with routine hospital care. Applying the above data to the researcher's cost of care assumptions, the costs per life saved difference between coronary care and intermediate care would have been $1.38 million as opposed to the $2.04 million estimated by the researchers, and the costs per year of life saved difference between coronary care and intermediate care would have been $103,000 as opposed to the $139,000 estimated by the researchers. Similarly, in the comparison of intermedia

Category: Medical - A