Patient outcome as a selection criterion in determining treatment mode

Abstract

The climate of health care reform encourages scrutiny of traditional and new forms of medical and surgical therapy. With the emergence of technologically innovative cardiac procedures, therapy advocates must weigh cost versus patient outcomes. Therapies range from purely medical management, through staged interventions, to median sternotomy and cardiopulmonary bypass. Outcomes will necessarily be related to quality of life. A literature search was performed to determine types of medical and surgical therapies associated with patient outcomes as they define quality of life. Medical treatment may include the use of anti-platelet therapy, beta-blockers and diuretics to treat the cardiac patient at low risk who can maintain an acceptable quality of life. Improvements in medical therapies may extend the life of the low-risk patient, eliminating the need to consider bypass surgery. Some patients at high risk, or with left ventricular hypertrophy combined with an impaired ejection fraction, may require coronary artery bypass surgery. Studies indicate that patients undergoing open heart surgery demonstrate significant improvement in functional classification, increased activity and reduction in anti-anginal medications. Proponents of minimally invasive surgery claim potential benefits of lower surgical trauma, shorter hospital stays and shorter recovery times. Quality of life is defined by outcomes. Only by comparing outcomes of all available therapies can a physician or patient make an informed decision regarding treatment.

Perfusion Treatment Algorithm: Methods of Improving the Quality of Perfusion

“…Bypassing of blocked coronary arteries has been shown to relieve such symptoms as angina and dysrhythmia and to prolong life expectancy (2). Methods of treating patients who are at high risk for cardiac surgery because of left heart dysfunction or with impaired ejection fraction have included such procedures as port access bypass grafting (2). The most appropriate treatment mode will depend on the individual's disease category and associated risk factors.…”

“…The climate of health care reform encourages scrutiny of traditional and new forms of medical and surgical therapy. With the emergence of technology and innovative cardiac procedures, advocates must weigh cost versus patient outcomes (3). It has been suggested, based on large cohorts of patients stratified by clinical risk, that the cost of operation can be predicted from models of clinical risk because length of stay (LOS) is highly correlated (4).…”