Prognostic stratification of patients with known or suspected cardiovascular disease influences both the effectiveness and efficiency of their management. Physicians currently perform such analyses informally in a variety of settings when making triage decisions. This project will test the hypothesis that the accuracy of these analyses can be enhanced by providing information from predictive algorithms derived through multivariate analysis, leading to improvements in diagnostic performance and efficiency of resource utilization. Algorithms for the prediction of myocardial infarction and complications requiring intensive care will be derived through analysis of clinical and electrocardiographic data from 1382 previously-seen emergency room patients, including 259 with myocardial infarctions, and from an additional group of 985 patients with acute myocardial infarction seen in the Multicenter Investigation of the Limitation of Infarct Size (MILIS). Advantages and disadvantages of competing multivariate techniques will be explored. Algorithms will be tested prospectively and compared with the performance of physicians on patients from both teaching and community hospitals, with subgroup analysis examining the performance of the algorithms in different settings and the impact of baseline data on diagnostic accuracy. The impact of results of cardiac isoenzyme assays in the emergency room on the probability of myocardial infarction will be examined through techniques of multivariate analysis. Cost-effectiveness analysis will be used to determine probability ranges within which specific management courses are recommended. In an intervention phase, algorithm predictions and recommendations from cost-effectiveness analysis will be provided to physicians during the emergency ward evaluation. The impact of these interventions on diagnostic accuracy and resource utilization will be measured.

Agency
National Institute of Health (NIH)
Institute
National Heart, Lung, and Blood Institute (NHLBI)
Type
Clinical Investigator Award (CIA) (K08)
Project #
5K08HL001796-04
Application #
3082165
Study Section
Research Manpower Review Committee (MR)
Project Start
1985-07-01
Project End
1990-06-30
Budget Start
1988-07-01
Budget End
1989-06-30
Support Year
4
Fiscal Year
1988
Total Cost
Indirect Cost
Name
Brigham and Women's Hospital
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02115