| Patient preferences for thrombolytic therapy in acute myocardial infarction. | |
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MedLine Citation:
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PMID: 9343805 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Despite extensive professional debate regarding the optimal thrombolytic therapy strategy in acute myocardial infarction (AMI), patient preferences have not been explored. METHODS: Preferences among patients with known or suspected coronary artery disease for treatment with tissue plasminogen activator (tPA) or streptokinase (SK) for AMI were determined using a questionnaire presenting GUSTO-1 trial and drug cost data. Preferences were based on consideration of 30-day mortality (M) alone, hemorrhagic stroke rate (SR) alone, overall preference (M + SR), drug acquisition costs, and the estimated annual costs of using a single agent to treat all AMIs. Cost-related responses were provided under payer designations of self, third-party insurance, and federal government. RESULTS: The response rate was 81% (101/125 patients). tPA was preferred by 84%, and SK by 66%, for M alone and SR alone, respectively (chi 2, p < 0.01). Overall preference (M + SR) favored tPA (78%, p < 0.01). tPA preference decreased to 43% considering drug acquisition costs under the self-pay option (p < 0.01 vs M + SR). Similar trends of lesser magnitude were also observed for the third-party and government-payer options. CONCLUSIONS: Under conditions of zero cost and consideration of mortality plus stroke-risk data, tPA were preferred overall due to its lower mortality. Introduction of drug-cost data significantly shifted the preference toward SK, particularly under the self-payer designation. Patient preferences for thrombolytic therapy in AMI indicate tradeoffs between clinical attributes and costs, and should assist in framing medical debate and decision making. |
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Authors:
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E J Stanek; J W Cheng; P J Peeples; R J Simko; S A Spinler |
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Publication Detail:
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Type: Comparative Study; Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Medical decision making : an international journal of the Society for Medical Decision Making Volume: 17 ISSN: 0272-989X ISO Abbreviation: Med Decis Making Publication Date: 1997 Oct-Dec |
Date Detail:
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Created Date: 1997-11-20 Completed Date: 1997-11-20 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 8109073 Medline TA: Med Decis Making Country: UNITED STATES |
Other Details:
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Languages: eng Pagination: 464-71 Citation Subset: IM |
Affiliation:
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Department of Pharmacy Practice and Pharmacy Administration, Philadelphia College of Pharmacy and Science, PA 19104, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adult Aged Aged, 80 and over Attitude to Health* Cerebrovascular Disorders / epidemiology Decision Making* Drug Costs Female Humans Male Middle Aged Myocardial Infarction / drug therapy*, mortality Plasminogen Activators / therapeutic use Regression Analysis Streptokinase / therapeutic use Thrombolytic Therapy* / economics Tissue Plasminogen Activator / therapeutic use United States / epidemiology |
| Chemical | |
Reg. No./Substance:
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EC 3.4.-/Streptokinase; EC 3.4.21.-/Plasminogen Activators; EC 3.4.21.68/Tissue Plasminogen Activator |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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