The low risk cardiac patient: an opportunity for cost containment.
The pressure to maintain high standards in the face of diminished medical funding has promoted a search for a low risk group of patients seen in cardiac practice in whom diagnostic and therapeutic technologies can be kept to a minimum. This study reports experience in a single cardiology practice in which all patients had a history taken, a clinical examination performed, and most had an electrocardiogram. Thereafter investigation and treatment was tailored to the individual patient's need. A retrospective study of 113 patients revealed that 93 (82%) had high risk characteristics prior to their death: cardiac failure; unstable coronary heart disease; clinical or laboratory evidence of poor systolic function of the left ventricle or inoperable coronary artery disease; elective major surgery; evidence of poor prognosis due to non-cardiac disease. In contrast, only 124 (21%) of 588 consecutive patients seen in consultation had high risk characteristics. The prevalence adjusted mortality ratio of high to low risk cases was 17.4/1 and in one third of cases, high risk status was less than 6 months duration. In a prospective study, 144 cases were classified at high risk and 373 at low risk. Three year survival rates were 74 and 91% respectively (p < 0.0001). 46 (12.3%) of the 373 patients initially at low risk subsequently developed clinical features which permanently placed them in the high risk category. The 3 year survival in the low to high risk converters was 47% compared with 97% survival in those remaining at low risk throughout the period of observation (p < 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)
Jelinek
M V
MV
St Vincent's Hospital, Fitzroy, Melbourne, Victoria, Australia.
Chow
M O
MO
Santamaria
J
J
D003363:Cost Control; D004562:Electrocardiography; D006296:Health Services / Q000191:economics; D006331:Heart Diseases / Q000401:mortality*; D006801:Humans; D008499:Medical Records; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate