The Increased Use of Diagnostic Procedures in Patients With Acute Myocardial Infarction

Gore, Joel M.; Goldberg, Robert J.; Alpert, Joseph S.; Dalen, James E.

doi:10.1001/archinte.1987.00370100043009

Arch Intern Med

1987

DOI: 10.1001/archinte.1987.00370100043009

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The Increased Use of Diagnostic Procedures in Patients With Acute Myocardial Infarction

Joel M. Gore

Robert J. Goldberg

Joseph S. Alpert

et al.

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Cited by 22 publications

(1 citation statement)

References 16 publications

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“…For instance, no study has demonstrated an increase in survival in ARDS [4] or severe cardiogenic shock [5] patients since the statue of the art included the use of PEEP and bedside pulmonary artery catheterization. For instance, no study has demonstrated an increase in survival in ARDS [4] or severe cardiogenic shock [5] patients since the statue of the art included the use of PEEP and bedside pulmonary artery catheterization.…”

mentioning

confidence: 99%

Mechanical Ventilation: Defining the Standard of Care

Curley

Irwin

1988

J Intensive Care Med

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mentioning

confidence: 99%

Mechanical Ventilation: Defining the Standard of Care

Curley

Irwin

1988

J Intensive Care Med

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Of Hydras, Lemmings, and Diagnostic Tests

Robin¹

1987

Arch Intern Med

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The Impact of Clinical Trials on the Use of Medications for Acute Myocardial Infarction

Col

McLaughlin²,

Soumerai³

et al. 1996

Arch Intern Med

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Background: The impact of clinical trials on medical practice remains controversial, in part because of weak study designs and nonrepresentative study samples. Objective: To assess changes in trends in medication use in the setting of acute myocardial infarction (AMI) before and after publication of two large clinical trials: the Second International Study of Infarct Survival (ISIS-2) trial that supported the use of aspirin after AMI and the Multicenter Diltiazem Postinfarction Trial that reported no overall benefit from the use of calcium antagonists after AMI. Methods: Study patients consisted of 2114 patients hospitalized with AMI in 16 hospitals in metropolitan Worcester, Mass, during 1986,1988, and 1990. Data were obtained from medical records. We used multivariable logistic regression models to examine the rate of change in the use of selected medications before and after trial publication, controlling for medical history, characteristics and complications of AMI, medications taken, and procedures performed during hospitalization. The dependent variable was receipt of the specific medication under investigation. Results: Before publication of ISIS-2, 26% of patients with AMI received aspirin while hospitalized compared with 66% after its publication. However, in-hospital aspirin use began to rise before ISIS-2 with an immediate increase in the level of use occurring after trial publication but with no significant change in the rate of increase. Before publication of the Multicenter Diltiazem Postinfarction Trial, 57% of patients with AMI were new recipients of calcium antagonists compared with 51% after trial publication. The decrease in calcium antagonist use began after trial publication (odds ratio, 0.79 per 6-month period; 95% confidence interval, 0.71 to 0.88). Conclusions: The published results of large trials of cardiovascular therapies have had variable impact on medication use. Efforts to assess the effects of publication of new scientific information on medical care need to consider prior trends in treatment patterns and the varying contexts of medical care. They should consider both direct and indirect routes of influence.

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The Increased Use of Diagnostic Procedures in Patients With Acute Myocardial Infarction

Cited by 22 publications

References 16 publications

Mechanical Ventilation: Defining the Standard of Care

Mechanical Ventilation: Defining the Standard of Care

Of Hydras, Lemmings, and Diagnostic Tests

The Impact of Clinical Trials on the Use of Medications for Acute Myocardial Infarction

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