Reduced progression in carotid intima-media thickness was observed after dietary counselling, whereas omega-3 PUFA supplementation imposed a favourable effect on arterial elasticity.

Reduced progression in carotid intima-media thickness was observed after dietary counselling, whereas omega-3 PUFA supplementation imposed a favourable effect on arterial elasticity.

A computer system to be used in the emergency room has been developed for estimating the risk of acute coronary heart disease (ACHD). The system uses data on 38 case history and clinical variables collected consecutively over a year from 918 patients with acute chest pain. A statistical procedure based on Bayes' formula is used to estimate disease probabilities. A quadratic scoring rule was used for variable selection. The score increased markedly until 15-20 variables had been added, reached a maximum after inclusion of about 30 variables and then deteriorated slightly. Thus, the number of variables carrying additional information on the presence/absence of ACHD seems to be much larger than the number normally utilized by doctors and by other decision support systems. Reclassification into two groups, those with and without ACHD, gives a diagnostic accuracy of 89%. We conclude that analysing detailed case histories by computer is a promising decision support system for use in the emergency room as a supplement to ECG analysis.

A decision support computer program (DSP) was used by the emergency room physician as a diagnostic tool on patients admitted with acute chest pain to guide the referral of these patients either to the Coronary Care Unit (CCU) or general ward. The DSP used Bayes’ theorem on 38 anamnestic and clinical variables to classify patients into one of nine diagnoses. During a six months trial period 32 physicians used the DSP to diagnose 493 patients admitted with acute chest pain. The physicians referred the patients to CCU or general ward based on their clinical judgements, the ECG findings and the diagnostic estimates given by the DSP. The program correctly diagnosed 150 (84%) of 178 patients with acute myocardial infarction and 63 of 112 patients with unstable angina. However, acute ischemic heart disease (acute myocardial infarction or unstable angina) was correctly classified by the DSP for 259 (89%) of 290 patients. By using the DSP, the number of patients unnecessarily referred to CCU was reduced from 35% to 19% and the number of patients in need of CCU observation misallocated to general ward was reduced from 13% to 10%. Thus, use of the DSP in the emergency room on easily available anamnestic and clinical variables may improve referrals to the CCU, optimize therapy and resource use.

A recently designed computer based decision support system (DSP), almost exclusively based on case history data, was developed to facilitate immediate differentiation between patients with and without urgent need for coronary care unit (CCU) transferral from the emergency room, and additionally to distinguish between patients with and without acute myocardial infarction (MI). One-year's prospective testing in a consecutive series of 1252 patients with acute chest pain revealed that the DSP, used in addition to ECG and clinical examination, demonstrated a sensitivity of 96% in the detection of patients in need of CCU observation (MI-sensitivity of 98%), and a specificity of 56% in excluding patients who were not in need of CCU observation. The proportion of referrals to the CCU judged to be unnecessary was only 17% of the total number of patients seen in the emergency room.