Angiographic Correlates of the Treadmill Scores in Non-High-Risk Patients with Unstable Angina

Tamargo, J; Martín-Ambrosio, Eugenio Simarro; Tarín, Enrique Romero; Fernández, Marı́a Martı́n; Nava, Sergio Hevia; Álvarez, Vicente Barriales; Morís, César

doi:10.1159/000105320

Cited by 2 publications

(2 citation statements)

References 55 publications

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“…Regarding the accuracy of the various diagnostic strategies examined for identifying CAD, Khare et al. rely on high‐quality meta‐analyses . Khare et al.…”

Section: Was the Effectiveness Of The Healthcare Decision Established?mentioning

confidence: 99%

Cost‐effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective

April

Murray

2017

Academic Emergency Medicine

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Cost-effectiveness is an important goal for emergency care delivery. The many diagnostic, treatment, and disposition decisions made in the emergency department (ED) have a significant impact upon healthcare resource utilization. Cost-effectiveness analysis (CEA) is an analytic tool to optimize these resource allocation decisions through the systematic comparison of costs and effects of alternative healthcare decisions. Yet few emergency medicine leaders and policymakers have any formal training in CEA methodology. This paper provides an introduction to the interpretation and use of CEA with a focus on application to emergency medicine problems and settings. It applies a previously published CEA to the hypothetical case of a patient presenting to the ED with chest pain who requires risk stratification. This paper uses a widely cited checklist to appraise the CEA. This checklist serves as a vehicle for presenting basic CEA terminology and concepts. General topics of focus include measurement of costs and outcomes, incremental analysis, and sensitivity analysis. Integrated throughout the paper are recommendations for good CEA practice with emphasis on the guidelines published by the U.S. Panel on Cost-Effectiveness in Health and Medicine. Unique challenges for emergency medicine CEAs discussed include the projection of long-term outcomes from emergent interventions, costing ED services, and applying study results to diverse patient populations across various ED settings. The discussion also includes an overview of the limitations inherent in applying CEA results to clinical practice to include the lack of incorporation of noncost considerations in CEA (e.g., ethics). After reading this article, emergency medicine leaders and researchers will have an enhanced understanding of the basics of CEA critical appraisal and application. The paper concludes with an overview of economic evaluation resources for readers interested in conducting ED-based economic evaluation studies.

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“…Regarding the accuracy of the various diagnostic strategies examined for identifying CAD, Khare et al. rely on high‐quality meta‐analyses . Khare et al.…”

Section: Was the Effectiveness Of The Healthcare Decision Established?mentioning

confidence: 99%

Cost‐effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective

April

Murray

2017

Academic Emergency Medicine

View full text Add to dashboard Cite

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“…However, only a small number of patients, in total of 562, were studied. Barriales et al studied only 300 patients and found that DM was an independent risk factor for atrial fibrillation (10). In the International Journal of Cardiology Mohaved et al retrospectively analysed discharge diagnoses and concluded that diabetes mellitus was a strong and independent risk factor for occurrence of AF.…”

Section: Diabetes Mellitusand Atrial Fibrillationmentioning

confidence: 99%

Atrial fibrillation and its association with type 2 diabetes

Prystupa¹,

Lopatyński²,

Mieczkowska³

2008

Annales UMCS, Medicina

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Atrial fibrillation and its association with type 2 diabetesAtrial fibrillation is the common sustained arrhythmia in North American and European patients. In the United States, atrial fibrillation affects approximately 2.2 million adults with a median age of 75; nearly 10% of individuals over the age of 80 manifest this arrhythmia (I). The prevalence of atrial fibrillation is increasing markedly in industrialized nations, secondary to growth in population of elderly individuals in these societies. Atrial fibrillation is approximately 1.5 times more likely to develop in men than in women.The traditional view of AF mechanisms is that the arrhythmia results from multiple re-entrant wavelets that move randomly throughout the atria. Re-entry is promoted by decreased atrial refractory periods, slowed conduction and an increased mass of cardiac tissue (2).The clinical presentation of AF is highly variable, ranging from the complete absence of symptoms to heart failure and hemodynamic collapse. Symptoms result from the irregular and often rapid ventricular response, as well as from ensuing autonomic reflex changes and loss of atrial systole. In the Canadian Registry of Atrial Fibrillation, only 21% of patients were asymptomatic on presentation (3). Among the 79% of patients with symptoms, palpitations occurred in 50%, chest pain and fatigue in more than 25% and dizziness, presyncope or syncope in about 25%. The most feared complication of AF is stroke, which is often caused by thromboembolism from clotting in the left atrial appendage: AF increases the risk of stroke about 5 times and is a single factor most commonly associated with stroke in those over 75 years of age. Risk factors for stroke in patients with AF include advanced age. diabetes, hypertension, previous cerebrovascular accident and left ventricular dysfunction (4).The majority of patients with atrial fibrillation have associated cardiovascular disease that has been shown to correlate with the presence of this arrhythmia. Common cardiovascular conditions that predispose to atrial fibrillation include hypertension, valvular heart disease, arteriosclerotic heart disease and myocardial infarction and congestive heart failure. Non-cardiovascular diseases that predispose to atrial fibrillation include diabetes mellitus, hyperthyroidism, acute and chronic alcohol abuse, and a variety of pulmonary diseases such as chronic obstructive lung disease, pneumonia, empyema, and pulmonary embolism. Potential iatrogenic causes of atrial fibrillation include cardiac and non-cardiac surgery and administration of a variety of medications including bronchodilating beta-agonists, various non-prescription cold remedies, antihistamines and local anaesthetics (5).However, in many patients the cause of atrial fibrillation remains unclear. Lone atrial fibrillation is defined as atrial fibrillation in the absence of structural heart disease or other identifiable cause for the arrhythmia such as hyperthyroidism or alcohol abuse (6).

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Angiographic Correlates of the Treadmill Scores in Non-High-Risk Patients with Unstable Angina

Cited by 2 publications

References 55 publications

Cost‐effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective

Cost‐effectiveness Analysis Appraisal and Application: An Emergency Medicine Perspective

Atrial fibrillation and its association with type 2 diabetes

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