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New Information from AHRQ: December 19, 2000
A new Agency for Healthcare Research and Quality (AHRQ) evidence report concludes that there is limited evidence on technologies to diagnose patients with acute cardiac ischemia (ACI)—defined as acute myocardial infarction or unstable angina—in emergency departments. More than 6 million patients with chest pain or related symptoms visit U.S. emergency departments annually.
The New England Medical Center Evidence-based Practice Center in Boston reviewed a wide range of technologies and concluded that some of these may have good diagnostic sensitivity, which is the probability of correctly identifying a disease. The technologies include echocardiography, a diagnostic ultrasound examination of the heart; sestamibi perfusion imaging, a scan to trace cardiac blood flow; and stress electrocardiography, a graphic record of the actions of the heart muscle.
The report also indicated that biomarkers—biochemistry tests—have a low sensitivity for diagnosing patients with ACI. Serial biomarkers increase the sensitivity for diagnosing acute myocardial infarction at the cost of additional time to make the diagnosis.
In addition, the use of an Acute Cardiac Ischemia Time-Insensitive Predictive Instrument (ACI-TIPI), an add-on to the standard electrocardiogram, allowed emergency departments to appropriately triage a high percentage of patients with ACI and reduce unnecessary hospitalizations.
The report recommends future research on the under-evaluated technologies and the various technological combinations and clinical outcomes studies.
The topic was requested by the National Heart, Lung, and Blood Institute of the National Institutes of Health to update information on these technologies for its National Heart Attack Alert Program.
The summary of the evidence report, Evaluation of Technologies for Identifying Acute Cardiac Ischemia in Emergency Departments, is available online at http://www.ahrq.gov/clinic/epcsums/cardsum.htm. Printed copies are available from the AHRQ Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907, or by calling 800-358-9295. Copies of the full report are expected to be available from the Clearinghouse in early 2001.
For more information, please contact AHRQ Public Affairs, (301) 427-1364.
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