OBJECTIVE: To determine whether information from the physician's initial evaluation of patients with suspected coronary artery disease predicts coronary anatomy at catheterization and 3-year survival. DESIGN: Prospective validation of regression model estimates in an outpatient cohort. SETTING: University medical center. PATIENTS: A total of 1030 consecutive outpatients referred for noninvasive testing for suspected coronary artery disease; 168 of these patients subsequently underwent catheterization within 90 days. MEASUREMENTS: Information from the initial history, physical examination, electrocardiogram, and chest radiograph was used to predict coronary anatomy (the likelihood of any significant coronary disease, severe disease [left main or three-vessel], and significant left main disease) among 168 catheterized patients and to estimate 3-year survival among all patients. These estimates were compared with those based on treadmill testing. Cardiovascular testing charges were calculated for all patients. RESULTS: Predicted coronary anatomy and survival closely corresponded to actual findings. Compared with the treadmill exercise test, initial evaluation was slightly better able to distinguish patients with or without any coronary disease and was similar in the ability to identify patients at increased risk for dying or with anatomically severe disease. Based on arbitrary definitions, 37% to 66% of patients were at low risk and responsible for 31% to 56% of the charges for cardiovascular testing. CONCLUSIONS: The physician's initial evaluation, despite the subjective nature of much of the information gathered, can be used to identify patients likely to benefit from further testing. The development of strategies for cost-conscious quality care must begin with the history, physical examination, and simple laboratory testing.
OBJECTIVE: To determine whether information from the physician's initial evaluation of patients with suspected coronary artery disease predicts coronary anatomy at catheterization and 3-year survival. DESIGN: Prospective validation of regression model estimates in an outpatient cohort. SETTING: University medical center. PATIENTS: A total of 1030 consecutive outpatients referred for noninvasive testing for suspected coronary artery disease; 168 of these patients subsequently underwent catheterization within 90 days. MEASUREMENTS: Information from the initial history, physical examination, electrocardiogram, and chest radiograph was used to predict coronary anatomy (the likelihood of any significant coronary disease, severe disease [left main or three-vessel], and significant left main disease) among 168 catheterized patients and to estimate 3-year survival among all patients. These estimates were compared with those based on treadmill testing. Cardiovascular testing charges were calculated for all patients. RESULTS: Predicted coronary anatomy and survival closely corresponded to actual findings. Compared with the treadmill exercise test, initial evaluation was slightly better able to distinguish patients with or without any coronary disease and was similar in the ability to identify patients at increased risk for dying or with anatomically severe disease. Based on arbitrary definitions, 37% to 66% of patients were at low risk and responsible for 31% to 56% of the charges for cardiovascular testing. CONCLUSIONS: The physician's initial evaluation, despite the subjective nature of much of the information gathered, can be used to identify patients likely to benefit from further testing. The development of strategies for cost-conscious quality care must begin with the history, physical examination, and simple laboratory testing.
Authors: Venkatesh L Murthy; Masanao Naya; Courtney R Foster; Jon Hainer; Mariya Gaber; Gilda Di Carli; Ron Blankstein; Sharmila Dorbala; Arkadiusz Sitek; Michael J Pencina; Marcelo F Di Carli Journal: Circulation Date: 2011-10-17 Impact factor: 29.690
Authors: Robert Roehle; Viktoria Wieske; Georg M Schuetz; Pascal Gueret; Daniele Andreini; Willem Bob Meijboom; Gianluca Pontone; Mario Garcia; Hatem Alkadhi; Lily Honoris; Jörg Hausleiter; Nuno Bettencourt; Elke Zimmermann; Sebastian Leschka; Bernhard Gerber; Carlos Rochitte; U Joseph Schoepf; Abbas Arjmand Shabestari; Bjarne Nørgaard; Akira Sato; Juhani Knuuti; Matthijs F L Meijs; Harald Brodoefel; Shona M M Jenkins; Kristian Altern Øvrehus; Axel Cosmus Pyndt Diederichsen; Ashraf Hamdan; Bjørn Arild Halvorsen; Vladimir Mendoza Rodriguez; Yung Liang Wan; Johannes Rixe; Mehraj Sheikh; Christoph Langer; Said Ghostine; Eugenio Martuscelli; Hiroyuki Niinuma; Arthur Scholte; Konstantin Nikolaou; Geir Ulimoen; Zhaoqi Zhang; Hans Mickley; Koen Nieman; Philipp A Kaufmann; Ronny Ralf Buechel; Bernhard A Herzog; Melvin Clouse; David A Halon; Jonathan Leipsic; David Bush; Reda Jakamy; Kai Sun; Lin Yang; Thorsten Johnson; Jean-Pierre Laissy; Roy Marcus; Simone Muraglia; Jean-Claude Tardif; Benjamin Chow; Narinder Paul; David Maintz; John Hoe; Albert de Roos; Robert Haase; Michael Laule; Peter Schlattmann; Marc Dewey Journal: Eur Radiol Date: 2018-03-19 Impact factor: 5.315