Document Detail


A gender-specific hazard-based clinical and noninvasive coronary risk scoring system for patients with suspected coronary artery disease.
MedLine Citation:
PMID:  10156938     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: An outpatient-based scoring system was developed for at-risk patients with coronary artery disease based on data derived from the clinical history and noninvasive testing results for the prediction of an adverse event, the development of risk subsets, and the evaluation of the appropriateness of utilization patterns in an ambulatory care patient population. METHOD: This was a hospital-based cohort study. From a population of 3,795 consecutively tested patients, 872 with suspected coronary artery disease were enrolled from a midwestern university tertiary medical center from 1988 to 1989. RESULTS: Multivariable Cox modeling was used to develop scoring weights with scores ranging from -1.6 to 8.5 points. Significant multivariable disease predictors of cardiac death or myocardial infarction were use of nitroglycerin or insulin, ST-T wave changes, female gender, left ventricular hypertrophy, and a reversible thallium 201 defect. Receiver operating characteristics curves by use of the hazard score were comparable by gender. A probability threshold of .30 for cardiac death or myocardial infarction yielded a cut point of acceptable sensitivity and specificity for prompting medical management decisions. Below this threshold, the rate of follow-up diagnostic testing was 16.9% for women and 57.8% for men (p=.00001). Above this threshold, the rate of follow-up diagnostic testing was 40.6% for women and 64.3% for men (p= .04). CONCLUSION: Use of cardiac diagnostic services and cardiac event-free survival varies by gender in patients screened by noninvasive testing. For men at low risk of cardiac death or myocardial infarction, a statistically greater use of follow-up diagnostic testing was reported, thus reflecting more aggressive treatment and overuse of services for men as compared with women.
Authors:
L J Shaw; D D Miller; K N Gillespie; L T Younis; B R Chaitman; J C Romeis
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  Clinical performance and quality health care     Volume:  3     ISSN:  1063-0279     ISO Abbreviation:  Clin Perform Qual Health Care     Publication Date:    1995 Oct-Dec
Date Detail:
Created Date:  1996-06-19     Completed Date:  1996-06-19     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9305935     Medline TA:  Clin Perform Qual Health Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  209-17     Citation Subset:  H    
Affiliation:
Duke University Medical Center, Durham, NC 27705, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Cardiology Service, Hospital / standards*
Cohort Studies
Coronary Disease / diagnosis*,  epidemiology,  therapy*
Disease-Free Survival
Female
Hospitals, University
Humans
Male
Middle Aged
Missouri
Patient Selection*
Risk Factors
Sex Factors
United States
Women's Health Services / standards*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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