Initial data indicated that routine invasive therapy was more effective than selective invasive treatment in reducing subsequent major cardiovascular events. More recently, large trials with up to five years' follow-up have had contrasting results.
The researchers enrolled 1,200 patients 18 to 80 years of age between 2001 and
Patients were randomly assigned to receive early invasive therapy or initial medical management with intervention only if clinically indicated...cumulative three-year results for the primary composite end point (death, recurrent myocardial infarction, or hospitalization) were 30 percent in the early invasive group and 26 percent in the selective intervention group (P = .09).
The authors conclude that early invasive treatment did not provide better outcomes over four years than the selective strategy in patients with non-ST-elevation acute coronary syndrome and elevated cardiac troponin.
Friday, November 30, 2007
Sunday, November 11, 2007
No potential medical system can successfully deliver universal coverage while at the same time controlling costs if it does not stimulate the delivery of low cost and free basic services to those most in need.