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The low risk cardiac patient: an opportunity for cost containment
M V Jelinek1, M O Chow, J Santamaria
1St Vincent's Hospital, Fitzroy, Melbourne, Victoria, Australia.
Insights
Identifying high-risk cardiac patients is crucial for resource allocation. This study found that a significant majority of patients who died had high-risk characteristics, highlighting the importance of risk stratification in cardiology practice.
Area of Science:
- Cardiology
- Clinical Medicine
- Health Economics
Background:
- Diminished medical funding necessitates identifying low-risk patient groups for minimized diagnostic and therapeutic interventions.
- Cardiac practice faces pressure to maintain standards while optimizing resource utilization.
Purpose of the Study:
- To identify high-risk patient characteristics in a cardiology practice.
- To evaluate the prognostic value of risk stratification in cardiac patients.
- To inform resource allocation by distinguishing between high- and low-risk cardiac patients.
Main Methods:
- Retrospective analysis of 113 deceased patients to identify pre-mortem high-risk characteristics.
- Analysis of 588 consecutive consultations to determine the prevalence of high-risk patients.
- Prospective study classifying 517 patients into high- and low-risk groups.
- Three-year survival follow-up for prospective cohorts.
Main Results:
- 82% of deceased patients exhibited high-risk characteristics (e.g., cardiac failure, unstable coronary heart disease, poor left ventricular systolic function).
- Only 21% of all consulted patients were classified as high-risk.
- The mortality ratio of high-risk to low-risk cases was 17.4:1.
- Three-year survival rates were 74% for high-risk and 91% for low-risk patients (p < 0.0001).
- 12.3% of initially low-risk patients converted to high-risk status within three years, with a significantly lower survival rate (47% vs. 97%).
Conclusions:
- Risk stratification is essential in cardiology to identify patients requiring intensive management.
- A substantial proportion of patients initially deemed low-risk can transition to high-risk status, necessitating ongoing monitoring.
- Accurate identification of high-risk cardiac patients can guide clinical decisions and resource allocation effectively.
Abstract:
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)