Care of acute myocardial infarction by nonivasive and invasive cardiologist: Procedure use, cost and outcome
| Autor: | A.J. Conrad Smith, Donald M. Lloyd-Jones, Kim A. Eagle, Sumita D. Paul, Patrick T. O'Gara, Thomas G. Di Salvo, Syed Iftikhas Hussain, Geraldo Villarreal-Levy, Vitasta Bamezai |
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| Rok vydání: | 1996 |
| Předmět: |
Male
Cardiac Catheterization medicine.medical_specialty Time Factors medicine.medical_treatment Cardiology Myocardial Infarction Coronary Angiography Cohort Studies Angina Hospitals Urban Recurrence Internal medicine medicine Humans Prospective Studies cardiovascular diseases Myocardial infarction Angioplasty Balloon Coronary Hospital Costs Practice Patterns Physicians' Aged Cardiac catheterization business.industry Incidence (epidemiology) Length of Stay medicine.disease Pulmonary edema Outcome and Process Assessment Health Care Shock (circulatory) Female medicine.symptom Cardiology and Cardiovascular Medicine business Cost of care Perfusion Boston Follow-Up Studies |
| Zdroj: | Journal of the American College of Cardiology. 27:262-269 |
| ISSN: | 0735-1097 |
| Popis: | To determine if physician subspecialization influences practice style and resource utilization, we prospectively studied 292 consecutive emergency room admissions with MI under the care of noninvasive (NON, n = 213) or invasive (INV, n = 79) cardiologists and compared the use of cardiac procedures, cost, and outcome. Results Patient age, gender, CAD risk factors, history of angina, MI, CHF, and prior cardiac catheterization, PTCA or CABG were comparable. Presentation of MI. non-O/Q-wave MI, use of thrombolytic therapy, peak CK, and EF did not differ. Procedures, cost, and length of stay were as follows: NON INV p-value Thall Ett (%) 45 36 NS Catheterization (%) 59 67 NS CABG (all pts, %) 13 12 NS PTCA (3VD, %) 17 35 NS PTCA (1 or 2-VD, %) 39 60 l 0.05 Total hospital days 14 17 l 0.05 ICU days 31 5.4 l 0.01 Hospital costs ($) 19,400 25,500 0.01 There were no differences between groups in the incidence of postMI complications (shock, pulmonary edema, post-MI angina, VT/VF) or reversible thallium perfusion defects. Overall, 61% of patients underwent cardiac catheterization; there were an equal number of patients with 1, 2, and 3-vessel CAD in each group. Multivariate predictors of PTCA in patients with 1 or 2-vessel CAD were previous PTCA, Q-wave MI, and care by INV. Outcome In-hospital reinfarction and mortality (8.7% vs 12.7%) did not differ; during median 12-month follow-up (96% of pts), reinfarction and mortality (11.3% vs 10.3%) were similar, Conclusion In this pilot study, subspecialization impacted upon the cost of care of MI and led to increased PTCA in patients with 1 or 2-vessel CAD; larger studies are needed to determine the influence of subspecialization on long-term clinical outcomes. |
| Databáze: | OpenAIRE |
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