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Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction: Conclusion

Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction: ConclusionAs an illustrative example, the coronary care unit was introduced in the mid-1960s with the expectation that these specialized care units would reduce hospital mortality associated with AMI in part by rapidly detecting and treating ventricular fibrillation. Acceptance of this approach to the management of AMI by clinicians was relatively slow at first followed by rapid acceptance and widespread utilization of such units. However, following the publication of two randomized trials in Great Britainthat failed to show any advantage of coronarycare units over home care in patients with mildto moderate AMI, debate ensued as to the appropriate use of these units and their cost-effectiveness. A period of waning enthusiasm then followed and expectations were reassessed for patient outcomes that might be favorably influenced by hospitalization in a coronary care unit and for those services and therapies that were associated with hospitalization in these units. canadian drug mall

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Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction: Discussion

Of the various diagnostic procedures used in patients with AMI, PA catheterization is widely recommended to be of diagnostic and therapeutic benefit” and, therefore, is frequently utilized. However, the practice of PA catheterization has come under scrutiny and criticism as being commonly performed without adequate assessment of its appropriate utilization and benefit A Few studies have examined the demographic and clinical characteristics of patients with AMI undergoing PA catheterization, particularly so from a community-wide perspective; the likelihood of selection biases that may occur in examining the profile of patients with AMI undergoing PA catheterization at individual hospitals is minimized in examining these relationships from a multihospital, population-based perspective. In examining the benefit, or lack thereof, of PA catheterization in the setting of AMI, it is important to recognize the demographic and clinical factors associated with PA catheter use in order to control for these potentially confounding factors when examining the association of PA catheterization to selected outcome measures.
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Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction: Results

Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction: ResultsTemporal Trends in PA Catheter Utilization
Use of the PA catheter in all patients with AMI studied increased from 1975 to 1984 with a consistent decline thereafter (Fig 1). In the 2,441 patients with complicated AMI in whom utilization rates of the PA catheter were between approximately one and one half to two times greater than in all patients with AMI studied, use of PA catheterization progressively increased from 1975 through 1988 with a decline in use in 1990 (Fig 1). Overall, 14.7 percent of all patients with AMI received a PA catheter during hospitalization while 25.4 percent of those with complicated AMI underwent PA catheterization. www.canadian-familypharmacy.com

Profile of Patients With AMI Undergoing PA Catheterization
In examining the univariate associations of a variety of patient-related characteristics with PA catheterization in the total study sample (Table 1), patients 65 to 84 years of age, those with a history of angina or hypertension, patients hospitalized in teaching institutions, those with an anterior, Q wave, complicated AMI, and those who died during hospitalization were significantly more likely to undergo PA catheterization than respective comparison groups (p<0.05). Among patients with complicated AMI, age, gender, type of hospital admission, development of Q-wave AMI, and hospital survival status were significantly associated with PA catheterization (p<0.05) (Table 2). Time trends in the utilization of PA catheterization according to selected patient characteristics are also shown separately in Tables 1 and 2 respectively for all patients and for those with complicated AML
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Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction: Data Analysis

The medical records of all patients with a primary or secondary hospital discharge diagnosis of AMI (Ninth International Classification of Disease Codes 410 and 411) from participating hospitals were individually reviewed and validated according to predefined diagnostic criteria that have been described previously. In brief, these criteria included satisfaction of at least two of the following three factors: clinical history, serum enzyme level elevations, and serial electrocardiographic findings. The occurrence of selected complications during hospitalization for AMI was assessed on the basis of information available from the clinical charts. Congestive heart failure was regarded as present when there was evidence of pulmonary edema or bilateral basilar rales with an S3 gallop. Cardiogenic shock was considered present when the systolic blood pressure was less than 80 mm Hg in the absence of hypovolemia and associated with cyanosis, cold extremities, changes in mental status, and persistent oliguria. The definition of these complications remained the same over the periods under study and were defined so that patients with classic signs and symptoms of these complications would be included. In addition, all autopsy-proved cases of AMI were included irrespective of the other criteria. cialis professional

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Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial Infarction

Temporal Trends and Factors Associated With Pulmonary Artery Catheterization in Patients With Acute Myocardial InfarctionThe care of patients with acute myocardial infarction (AMI) has undergone significant change over the past several decades, in part due to the introduction and use of bedside hemodynamic monitoring. The flow-directed pulmonary artery (PA) catheter was introduced by Swan and associates in 1970 and has been widely used in scores of critically ill patients since that time. It has been estimated that approximately 100,000 patients with AMI undergo PA catheterization annually in the United States. Use of the PA catheter provides hemodynamic information that may be of benefit in selecting therapeutic options and monitoring outcomes in patients with various complications of AMI. Furthermore, PA catheterization provides data that can be utilized to stratify patients at differential risk of dying during the short-term hospitalization. buy tavist online

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