Asunto(s)
Insuficiencia de la Válvula Aórtica/inducido químicamente , Depresores del Apetito/efectos adversos , Fenfluramina/efectos adversos , Insuficiencia de la Válvula Mitral/inducido químicamente , Fentermina/efectos adversos , Inhibidores Selectivos de la Recaptación de Serotonina/efectos adversos , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/fisiopatología , Depresores del Apetito/administración & dosificación , Velocidad del Flujo Sanguíneo/efectos de los fármacos , Relación Dosis-Respuesta a Droga , Ecocardiografía Doppler en Color , Electrocardiografía/efectos de los fármacos , Femenino , Fenfluramina/administración & dosificación , Humanos , Masculino , Persona de Mediana Edad , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/fisiopatología , Contracción Miocárdica/efectos de los fármacos , Observación , Variaciones Dependientes del Observador , Fentermina/administración & dosificación , Estudios Retrospectivos , Factores de Riesgo , Inhibidores Selectivos de la Recaptación de Serotonina/administración & dosificación , Función Ventricular Derecha/efectos de los fármacosRESUMEN
BACKGROUND: No formal criteria have been developed to guide medical therapy for angina prior to revascularization, and no comparisons have been made between health maintenance organization (HMO) and fee-for-service (FFS) hospitals with respect to angina treatment. HYPOTHESIS: Using a literature-based measure of medical intensity, we tested the hypothesis that there is no difference in anginal medical therapeutic intensity between HMO and FFS systems. METHODS: For each antianginal drug, we developed a model from which an intensity score between 0 and 100 could be calculated. Average and maximal daily doses of drug were fit to a sigmoid curve such that they represented scores of 50 and 99, respectively. Overall intensity scores were obtained by weighted and unweighted averaging of three scores from nitrates, calcium-channel blockers, and beta blockers. This model was applied to 199 patients undergoing angiography at an FFS and an HMO hospital. RESULTS: HMO patients were taking more classes of antianginal drug (1.9 vs. 1.0, p < 0.001). Overall unweighted (17.7 vs. 11.7, p = 0.02) and weighted (27.3 vs. 16.9, p = 0.003) intensity scores for both HMO and FFS patients were low. HMO intensity scores for the use of beta blockers were greater than FFS scores (19.2 vs. 9.6, p = 0.002). The intensity scores for the use of nitrates and calcium blockers were similar. CONCLUSIONS: Models for the measurement of anginal medical therapy intensity can provide important information regarding medical therapy prior to revascularization. The overall intensity of medical therapy was low in both health care systems. These findings have important implications for patient management, guideline development, and national healthcare policy.