[Evaluation of care in the ischemic cardiopathies. Advantages and limits]

Ischemic heart disease is a major public health problem in all countries with high living standards. In France, in 1978, myocardial infarction was responsible for a quarter of cardiovascular deaths, which themselves represent 37% of all deaths. The economic burden of coronary artery disease may be assessed quantitatively in terms of hospital admission to departments of cardiology and cardiac surgery, and qualitatively, in terms of incapacity or invalidity, the socio-professional effects of which are considerable. This naturally incites cardiologists to examine closely the true context of their investigatory procedures, their comparative value and their ethical and financial consequences. Several factors must be taken into consideration: --increasing the availability of new techniques, which necessitates their critical evaluations; --specialisation within the medical team may affect relationships; --the efficacity and increasing risks of diagnostic evaluation and medical and surgical therapy. The evolution of cardiac treatment may be used to assess decisions taken during hospital admissions and so help avoid duplication of complementary investigations, unnecessary hospital admission and investigations. This research based on audits should help the cardiologist realise the true contribution of non-invasive investigations in the diagnosis of cardiac disease. By underlying the importance of his attitude, adapted to the patients' real needs, the cardiologist will abandon an often too subjective appreciation in favour of better management from the scientific, ethical and eventually, economical points of view. However, this type of assessment has its limits. It would be a worthless task to make all medical procedures generally available to all cardiologists in France. Local, epidemiological or scientific specificities would be disregarded. Similarly, excessive normalisation is incompatible with clinical research which implies high level, costly, scientific activity. But is this not one of the fundamental objectives of teaching hospitals?