Volume 187 - Issue 8
Discordance between level of risk and intensity of evidence-based treatment in patients with acute coronary syndromes
Author: V Michael Jelinek
Med J Aust 2007; 187 (8): 479. || doi: 10.5694/j.1326-5377.2007.tb01377.x
Published online: 15 October 2007
Published online: 15 October 2007
To the Editor: Scott and colleagues have shown that Australia is no different to the rest of the world in applying evidence-based treatment predominantly to patients at lower risk.1 They suggest that therapy may be withheld from high-risk patients because of over-estimation of the risk of treatment, under-estimation of the actual absolute risk of non-treatment, and consideration of cost-effectiveness and social inequalities.
I suggest that their data support the concept that the patient at highest risk who misses out on evidence-based treatment may in fact be being managed with kindness and wisdom. Such a patient is old, has comorbidities, can be frail, and may be taking 10 pills or more per day, so questions of optimal prognostic therapy must be balanced against quality-of-life factors.
There is abundant evidence that patients at highest risk do not receive the maximum amount of therapy. I suspect the kindness and wisdom factor is underestimated in clinical decision making. What we need now is some good qualitative data — market research — to help explain this phenomenon before we intensify the evidence-based mantra.
References
- Scott IA, Derhy PH, O’Kane D, et al. Discordance between level of risk and intensity of evidence-based treatment in patients with acute coronary syndromes. Med J Aust 2007; 187:153-159. 0_BJJBAJEE
Estimating Eligibility for GLP-1 Receptor Agonists for Chronic Weight Management and Cardiovascular Disease in Australia: Cross-Sectional Analysis of National Health Survey Data
Jasmin Castrillon, Chris Schilling, Sharmala Thuraisingam, Michael W. Hii, Priya Sumithran, Peter F. Choong, Michelle M. Dowsey, Cade Shadbolt
Seven Vessel Spontaneous Coronary Artery Dissection and Concurrent Transient Global Amnesia After an Emotional Trigger
Michael J. Stewart, Tom R. Sutherland
Seven Vessel Spontaneous Coronary Artery Dissection and Concurrent Transient Global Amnesia After an Emotional Trigger
Virginia Barbour
Designing Housing to Reduce Overcrowding-Related Harms: Rheumatic Heart Disease as the Canary in the Coal Mine
Simon Quilty, Veronica Matthews, Angus Baumann, James Marangou, Bo Remenyi, Gavin Wheaton, Serena Morton Nabanunga, Norman Frank Jupurrurla, Simon Robinson, Steve Mintern, Cary Duffield, Joshua R. Francis, Paul C. Memmott
Diagnosis and Management of Patent Foramen Ovale for Stroke Prevention: An Australian and New Zealand Consensus Statement Developed by a Modified Nominal Group Approach
Brian R. Chambers, Lauren M. Sanders, Amanda Gilligan, Carlos Garcia-Esperon, Jan Ho, John Fink, Matias Yudi, Matthew Lee-Archer, Vimal Stanislaus, Andrew A. Wong