Wasson J H, O'Connor G T, James D H, Olmstead E M
Department of Medicine, Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire.
J Gen Intern Med. 1992 May-Jun;7(3):298-303. doi: 10.1007/BF02598088.
For many common conditions, such as unstable angina pectoris (UAP) in the elderly, the course of the disease and the influence of treatments on outcome need to be better described. In this report the authors demonstrate how a simple pocket-sized card system can be used by busy clinicians to identify patient cohorts and follow the courses of their illnesses.
Twelve university-based and 12 rural clinicians enrolled consecutive patients over the age of 64 with UAP. One week and six weeks after patient enrollment the physicians described treatments, diagnoses, and patient outcomes.
The median age of the 76 patients was 73 years. Within one week of enrollment for UAP, ten (13%) suffered myocardial infarctions or died; by six weeks this adverse event rate was 26%. The presence of three or more clinical criteria for UAP (odds ratio 9.9; 95% CI 2.4-41.5) and "ST changes" by electrocardiography (odds ratio 9.5; 95% CI 2.5-35.6) were strongly associated with death or myocardial infarction within a week after enrollment.
These findings suggest that the use of a clinician-completed patient registry will allow designation of clinically important high- and low-risk UAP. A registry system such as that described here may be useful for the initial evaluation of treatment and outcomes of illness.
