Key result
The AHCPR guideline's recommendation for triage disposition of low-risk patients with suspected acute cardiac ischemia was argued to be applicable to more than 1% of patients, contrary to prior claims.
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This letter critiques a prior study on the AHCPR unstable angina algorithm, suggesting it underestimated the proportion of eligible low-risk patients.
To Editor. —While topic of article by Katz et al1is timely, their conclusion that the [AHCPR] guideline's recommendation for triage disposition of low-risk patients would apply to less than 1% of all patients with suspected acute cardiac ischemia who present to is overstated for 2 reasons. First, authors probably did not identify all eligible candidates for this study. Even though a patient with unstable angina has a history of worsening chest pain, it is usually an especially severe or prolonged episode that actually brings that patient into ED. Often, foremost thought on ED physician's mind is whether that particular event was an MI. At that moment, 2-month history of worsening chest pain is secondary. At my institution, most patients admitted with possible MI or ischemia are admitted as rule out MIs, not unstable angina. To identify all possible candidates, authors
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Richard A. Young (1997) conducted a letter in Suspected acute cardiac ischemia / unstable angina. AHCPR Unstable Angina Algorithm was evaluated. The AHCPR guideline's recommendation for triage disposition of low-risk patients with suspected acute cardiac ischemia was argued to be applicable to more than 1% of patients, contrary to prior claims.
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