The Cost of Treating Uncomplicated Myocardial Infarction
The authors of the New England Journal of Medicine article "Cost Effectiveness of Early Discharge After Uncomplicated Acute Myocardial Infarction" (N Engl J Med. 2000;342:749-755) led by L. Kristin Newby, report on their analysis of 22,361 patients in the (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) GUSTO-1 trial. The patients had myocardial infarctions that were uncomplicated for the first 72 hours of the episode. The authors looked at the complications that developed between 72 to 96 hours after the infarct was treated with thrombolytic agents. They identified 16 patients who had ventricular fibrillation on the fourth day of hospitalization. Of the 16 patients, 13 survived, presumably because they were in the hospital where treatment was readily available. No data are given regarding their long-term follow-up.
The authors attempt to judge the cost-effectiveness of retaining the patient in the hospital for 4 days, rather than 3.
They conclude that the hospitalization of patients with uncomplicated myocardial infarction for 4 -- rather than 3 -- days after instituting thrombolysis is economically unattractive.
My own view is that it is difficult, if not impossible, to make sound judgment about the value of hospitalizing a patient for 3 versus 4 days. I would favor 4 days, even though the data show that only 16 patients out of 22,361 patients with uncomplicated infarcts treated with thrombolytic agents had ventricular fibrillation after 72 hours. My reasons: errors in observation do occur, and warning signs of complications to come may be overlooked. In addition, such patients must be taught many things.
As a rule, the goal is accomplished when the physician spends more time with the patient than is permitted by 3-day admissions.
The authors of the New England Journal of Medicine article "Cost Effectiveness of Early Discharge After Uncomplicated Acute Myocardial Infarction" (N Engl J Med. 2000;342:749-755) led by L. Kristin Newby, report on their analysis of 22,361 patients in the (Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries) GUSTO-1 trial. The patients had myocardial infarctions that were uncomplicated for the first 72 hours of the episode. The authors looked at the complications that developed between 72 to 96 hours after the infarct was treated with thrombolytic agents. They identified 16 patients who had ventricular fibrillation on the fourth day of hospitalization. Of the 16 patients, 13 survived, presumably because they were in the hospital where treatment was readily available. No data are given regarding their long-term follow-up.
The authors attempt to judge the cost-effectiveness of retaining the patient in the hospital for 4 days, rather than 3.
They conclude that the hospitalization of patients with uncomplicated myocardial infarction for 4 -- rather than 3 -- days after instituting thrombolysis is economically unattractive.
My own view is that it is difficult, if not impossible, to make sound judgment about the value of hospitalizing a patient for 3 versus 4 days. I would favor 4 days, even though the data show that only 16 patients out of 22,361 patients with uncomplicated infarcts treated with thrombolytic agents had ventricular fibrillation after 72 hours. My reasons: errors in observation do occur, and warning signs of complications to come may be overlooked. In addition, such patients must be taught many things.
As a rule, the goal is accomplished when the physician spends more time with the patient than is permitted by 3-day admissions.
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