Evaluation of two acute cardiac ischemia decision-support tools in a rural family practice

This study investigated the applicability in a primary care setting of two decision-support tools for evaluating the necessity of admitting patients with suspected acute cardiac ischemic disease to a cardiac intensive care unit. The heart disease predictive instrument (HDPI) of Pozen et al and the electrocardiogram scoring method of Brush et al were applied to records from all patients with cardiac-related diagnoses admitted to a family practice service. A retrospective review of medical records of all patients admitted with suspected acute ischemic heart disease to a rural community hospital family practice service was conducted. Of 147 patients identified, 108 were admitted primarily for suspected ischemia. Twenty-four myocardial infarctions occurred among these 108 patients (22.2 percent). Patients with HDPI probabilities of less than 50 percent were very unlikely to sustain infarction and in no case required intensive intervention for any problem not apparent at admission. Only 15 instances of the four types of complications that the instrument of Brush et al is designed to predict occurred; this incidence was too low to allow statistical testing. In summary, the heart disease predictive instrument reliably identified patients unlikely to require intensive care services in this population. Because of the low incidence of complications in this population, the instrument described by Brush et al was not found to be clinically useful.