Medicine of the Future in America

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.
The results of this community-based study show that the use of PA catheterization in patients hospitalized with validated AMI increased almost threefold between 1975 and 1984 but declined thereafter; PA catheter utilization rates in 1990 were approximately the same as those seen 15 years earlier. Among patients with complicated AMI in whom use of the PA catheter was consistently higher, there was a steady increase in the use of these catheters until 1990 when their usage declined (Fig 1). cialis professional

As with other technologic advances and procedural approaches, one needs to consider the appropriate utilization rates of such newly introduced technologies as well as the profile of patients likely or not to benefit from their use. A somewhat analogous situation to that observed in the present study has been seen with the introduction of other technologies. What is commonly observed is that a new technology is slowly accepted and incorporated into clinical practice after its initial introduction. Rapid and more widespread use of this new procedure then follows based on favorable reviews. A decline in use may then occur after unacceptable side effects or adverse reactions are noted leading to dampened enthusiasm and reassessment of the new technology. While this process should ideally be carried out before the introduction of a new technique into clinical practice, all too often patient guidelines for use are delineated only after the advantages and disadvantages of a new device are observed in actual clinical situations.

This entry was posted in Pulmonary function and tagged acute myocardial infarction, angina, catheterization, congestive heart failure, hospitalization.
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