A Comparison of Management Patterns after Acute Myocardial Infarction in Canada and the United States
New England Journal of MedicinePublished 18 March 1993
Jean L. Rouleau, Lemuel A. Moyé, Marc A. Pfeffer, J. Malcolm O. Arnold, Victoria Bernstein, T. Edward Cuddy
Citations314
SJR quartileQ1
SJR score19.08
SNIP13.47
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The threshold for the admission of patients to a coronary care unit or for the use of invasive diagnostic and therapeutic interventions in the early and late periods after an infarction is higher in Canada than in the United States, which is associated with a higher frequency of activity-limiting angina.
Abstract
The threshold for the admission of patients to a coronary care unit or for the use of invasive diagnostic and therapeutic interventions in the early and late periods after an infarction is higher in Canada than in the United States. This is not associated with any apparent difference in the rate of reinfarction or survival, but is associated with a higher frequency of activity-limiting angina.
Keywords
Medicine
Journal of the Royal Statistical Society Series B (Statistical Methodology)Regression Models and Life-Tables
39,259 Citations1972D. R. Cox
New England Journal of MedicineEffect of Captopril on Mortality and Morbidity in Patients with Left Ventricular Dysfunction after Myocardial Infarction
5,925 Citations1992Marc A. Pfeffer, Eugene Braunwald +16 more
In patients with asymptomatic left ventricular dysfunction after myocardial infarction, long-term administration of captopril was associated with an improvement in survival and reduced morbidity and mortality due to major cardiovascular events.
New England Journal of MedicinePreliminary Report: Effect of Encainide and Flecainide on Mortality in a Randomized Trial of Arrhythmia Suppression after Myocardial Infarction
3,290 Citations1989The Cardiac Arrhythmia Suppression Trial (CAST) Investigators
It is concluded that neither encainide nor flecainide should be used in the treatment of patients with asymptomatic or minimally symptomatic ventricular arrhythmia after myocardial infarction, even though these drugs may be effective initially in suppressing ventricular arrhythmia.
New England Journal of MedicineComparison of Invasive and Conservative Strategies after Treatment with Intravenous Tissue Plasminogen Activator in Acute Myocardial Infarction
1,019 Citations1989The TIMI Study Group*
The ejection fraction and the incidence of death in the two groups were similar during the hospital period and total mortality within the first 6 days and at 42 days was also similar; the latter comparison was considered statistically significant according to the study criteria.
CirculationComparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale.
980 Citations1981Lee Goldman, Beverly E. Hashimoto +2 more
The easily administered Specific Activity Scale was equally reproducible and valid when used by a nonphysician and was especially better than the other systems for the evaluation of true class II patients and was significantly less likely to underestimate treadmill performance.
New England Journal of MedicineThe Effect of Diltiazem on Mortality and Reinfarction after Myocardial Infarction
828 Citations1988The Multicenter Diltiazem Postinfarction Trial Research Group
TechnometricsStatistical Methods for the Analysis of Biomedical Data
584 Citations1989Eric Ziegel, Robert F. Woolson
New England Journal of MedicineA Computer-Derived Protocol to Aid in the Diagnosis of Emergency Room Patients with Acute Chest Pain
512 Citations1982Leonard B. Goldman, M Weinberg +10 more
A decision protocol in the format of a simple flow chart to identify infarction on the basis of nine clinical factors, which preserved for detecting infarctions and significantly improved the specificity and positive predictive value of admission to an intensive-care area.
CirculationEffect of propranolol after acute myocardial infarction in patients with congestive heart failure.
408 Citations1986Karan R. Chadda, Sidney Goldstein +2 more
Baseline characteristics predictive of the occurrence of congestive heart failure by multivariate analyses included an increased cardiothoracic ratio, diabetes, increased heart rate, low baseline weight, prior myocardial infarction, age, and more than 10 ventricular premature beats per hour.
New England Journal of MedicineControlling Health Expenditures — the Canadian Reality
250 Citations1989Robert G. Evans, Jonathan Lomas +9 more
A comparison of the Canadian and American data on expenditures for health care shows the Canadian approach has avoided or solved several of the more intractable problems facing the United States.
New England Journal of MedicineRationing Intensive Care — Physician Responses to a Resource Shortage
234 Citations1983Daniel E. Singer, Phyllis L. Carr +2 more
It is suggested that physicians can respond to moderate resource limitations by more efficient use of intensive-care resources.
The American Journal of CardiologyOutcome in suspected acute myocardial infarction with normal or minimally abnormal admission electrocardiographic findings
170 Citations1987Douglas K. Slater, Mark A. Hlatky +4 more
The initial emergency room electrocardiogram can effectively separate patients into high- and low-risk groups for AMI and serious complications, and admission to a monitored intermediate care ward may be an acceptable practice in patients with chest pain and a normal or minimally changed initial electrocardiological findings.
New England Journal of MedicineHow Does Canada Do It?
167 Citations1990Victor R. Fuchs, James S. Hahn
Critical Care MedicinePredictors of myocardial infarction in emergency room patients
135 Citations1985William M. Tierney, Bruce J. Roth +8 more
A decision rule which would have admitted to intensive care those patients with a high probability ofinfarction who were not admitted by the emergency room physicians, would have increased the sensitivity for detecting infarction to 95% with no appreciable decrease in specificity or yield of infarctions among patients admitted tointensive care.
Annals of Internal MedicineThe Coronary Care Unit Turns 25: Historical Trends and Future Directions
107 Citations1988Thomas H. Lee, LEE GOLDMAN
The application of management algorithms and the development of intermediate care units as alternative triage sites for low-risk patients may be important future trends as a distinction is made between intensive coronary care and careful coronary observation.
New England Journal of MedicineThe Effectiveness of a Regulatory Strategy in Containing Hospital Costs
79 Citations1983Allan S. Detsky, Sidney R. Stacey +1 more
It is concluded that regulation can contain the growth of real inputs employed in the hospital sector even in the face of an incentive structure that does not promote cost consciousness on the part of patients or physicians.
New England Journal of MedicineHospital Care for Elderly Patients with Diseases of the Circulatory System
63 Citations1989Geoffrey M. Anderson, Joseph P. Newhouse +1 more
Elderly Canadians appeared to have access to cardiovascular surgery, with the exception of coronary bypass surgery, and to other hospital care for cardiovascular disease similar to that of elderly people in the United States.
New England Journal of MedicineCanada's Health Care System Faces Its Problems
59 Citations1990John K. Iglehart
Canada's provincial health insurance plans have demonstrated an impressive capacity to operate successfully despite a basic policy conflict that says health care funding must be public and universal, physicians must retain their professional autonomy, consumers must have free choice of doctors and first-dollar coverage, and provincial governments must control their budgets.
American Heart JournalRisk identification at the time of admission to coronary care unit in patients with suspected myocardial infarction
39 Citations1988Mihai Gneorghiade, Joseph Anderson +8 more
It is concluded that based on readily available clinical criteria at the time of admission, a subgroup of patients at low risk for developing life-threatening complications requiring coronary care unit interventions can be identified and admitted directly to an intermediate-care unit.
PubMedAssigning priority to patients requiring coronary revascularization: consensus principles from a panel of cardiologists and cardiac surgeons.
37 Citations1991Naylor Cd, Baigrie Rs +8 more
The pattern or severity of the patient's anginal symptoms and the response of those symptoms to medical therapy emerged as the single most important determinant of the level of urgency, and was the key determinants of priority for coronary revascularization.
New England Journal of MedicineThe United States and Canada: Different Approaches to Health Care
25 Citations1986Arnold S. Relman
A large number of people would agree that the health care system in wealthy, technically advanced countries like the United States and Canada ought to have as its primary objective access of all citizens to ade...
Medical CareGlobal Budgeting and the Teaching Hospital in Ontario
22 Citations1986Allan S. Detsky, Howard Abrams +2 more
This study presents a meta-analyses of the immune system’s response to chemotherapy and shows clear patterns of decline in the number of women diagnosed with central giant cell granuloma and in the severity of their disease.
PubMedCoronary artery bypass profile in Canada and the United States.
12 Citations1990Morin Je, Symes Jf +3 more
Health AffairsI. Essay: A New Financial Framework: Lessons From Canada
10 Citations1989Thomas W. Moloney, Barbara Paul
PubMedAdmissions to a coronary-care unit over the past seven years (1973-79).
2 Citations1981B. Williams
There has been little change in the pattern of admissions and the mortality rate of myocardial infarction as seen in this coronary-care unit at Green Lane Hospital.