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Use as a Predictor of Clinical Course and Facility Utilization

Capt Mark E. Stark, MC, USAF; James L. Vacek, MD

Arch Intern Med. 1987;147(5):843-846.

Abstract
• The first electrocardiogram obtained on presentation for suspected myocardial infarction was examined for its usefulness in predicting clinical course and facility use. We studied 221 patients consecutively admitted to a nonuniversity hospital coronary care unit. High-risk patients were identified if the electrocardiographic diagnoses included myocardial infarction, ischemia, left ventricular hypertrophy, left bundle-branch block, or paced rhythm. These 63 patients (29% of total) had significantly greater incidences of serious events, need for procedures, and death than low-risk patients whose initial electrocardiograms did not carry the above diagnoses. Patients with a low-risk initial electrocardiogram may not require the facilities of a coronary care unit and perhaps could be safely observed in an intermediate care area. However, many hospitals do not have an intermediate care facility available, and in those that do, daily costs may not be markedly different than for treatment in a coronary care unit. Whether these low-risk patients could be safely treated in general medicine beds, where potential cost savings would be much greater, is unknown.

(Arch Intern Med 1987;147:843-846)

Author Affiliations
From the Department of Medicine, US Air Force Medical Center, Keesler AFB, Biloxi, Miss (Dr Stark); and the Department of Medicine, Section of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City (Dr Vacek).

Footnotes
Accepted for publication Oct 24, 1986.

Reprint requests to Department of Medicine, Section of Cardiovascular Diseases, University of Kansas Medical Center, 39th Street and Rainbow Boulevard, Kansas City, KS 66103 (Dr Vacek).

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