RESUMO
The appropriate use criteria (AUC) has become an integral part of the cardiologist's daily practice and have evolved greatly since their inception over a decade ago. However, as health care costs continue to rise, the AUC has come to play an even more pivotal role in the way medicine-specifically cardiology-is practiced today. This editorial describes two opposing viewpoints commonly held by practicing clinicians of the AUC. Written from the perspective of two fellows-in-training looking ahead at the challenges and opportunities of clinical practice (under the auspices of several experienced clinicians and leaders of the American College of Cardiology), this article provides a fresh perspective on the impact AUC has on our patients, clinicians, and the health care system.
Assuntos
Cardiologia/normas , Tomada de Decisão Clínica , Fidelidade a Diretrizes/normas , Segurança do Paciente/normas , Guias de Prática Clínica como Assunto/normas , Padrões de Prática Médica/normas , Cardiologia/economia , Redução de Custos , Análise Custo-Benefício , Fidelidade a Diretrizes/economia , Custos de Cuidados de Saúde , Humanos , Segurança do Paciente/economia , Padrões de Prática Médica/economia , Medição de Risco , Procedimentos Desnecessários/normasAssuntos
Cardiologia , Sociedades Médicas , California , Cardiologia/economia , Cardiologia/educação , Certificação , Educação de Pós-Graduação em Medicina , Educação de Pós-Graduação em Enfermagem , Custos de Cuidados de Saúde , Humanos , Revisão da Utilização de Seguros , Reembolso de Seguro de Saúde , Medicare , Profissionais de Enfermagem/educação , Estados UnidosRESUMO
The topic of anticoagulant prescription in patients with nonvalvular atrial fibrillation, for the primary and secondary prevention of stroke, provides a forum for discussion of current challenges in anticoagulation management and ways in which the introduction of ximelagatran will provide an opportunity to overcome many of them. Anticoagulation with warfarin has been shown to reduce stroke rates by 68%, providing significant net monetary savings. However, physician fear of hemorrhagic side effects, the need for regular INR monitoring, food and drug interactions, and patient noncompliance have all played a part in either suboptimal utilization or complete avoidance of anticoagulant therapy, even in patients at high risk for stroke. Ximelagatran, a new oral direct thrombin inhibitor, circumvents most of these problems and provides a more physician- and patient-friendly method of stroke prophylaxis. With the utilization of this new anticoagulation method, the incidence of stroke in high risk groups, and the corresponding quality-of-life and economic impact, can potentially be greatly reduced.