(Circulation. 1998;98:1831-1833.)
© 1998 American Heart Association, Inc.
Editorials |
Management of Acute Coronary Syndromes Based on Risk Stratification by Biochemical Markers
An Idea Whose Time Has Come
From the Department of Medicine, Section of Cardiology, Baylor College of Medicine, Houston, Tex.
Key Words: Editorials • myocardial infarction • risk factors • prognosis
The watchword for
modern health care has become cost-effectiveness. This is as true in
cardiovascular disease as in any other area of
medicine. Hospitalization has been identified as a cost source, and
efforts at reducing hospitalizations, length of stay, and unnecessary
procedures occupy practitioners and administrators alike.
The goal of cost reduction must be balanced with the imperative to
provide high-quality patient care. It is ironic that medicine is
entering an era with emphasis on cost-effective delivery, while
simultaneously, molecular genetics and recombinant DNA
techniques are promising a new and exciting paradigmal shift to
diagnosis, risk stratification, and preventive treatment based on
genotyping.1 2 Despite the random coincident
timing of these 2 trends, 1 from medical economics and the other from
inventive technology, it is hoped that one will not be at the expense
of the other. Although the merger will be difficult, it must not lower
the quality of health care but rather provide for the implementation of
future advances that would better the health of the nation. A major
problem for the nation is the $120 billion cost of
cardiovascular disease. Unnecessary admission to the
hospital of patients with chest pain is estimated to cost more than $12
billion.3 It is hoped that some of these advances
can provide high-quality health care and help to contain cost. The
cause of chest pain in most patients presenting to the Emergency
Department and the most appropriate therapy cannot be reliably
ascertained with the conventional clinical armamentarium; this has
represented a dilemma
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