How many myocardial infarctions should we rule out?

Robert L. Wears*, Li Sergio, John D. Hernandez, Robert C. Luten, David J. Vukich

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

29 Citations (Scopus)


We used computer simulation to estimate the consequences of four admitting strategies (coronary care unit, intermediate care unit, routine ward care, or outpatient follow-up) on cost, outcome, admission threshold probabilities, and false-positive admission rates for patients with acute myocardial infarction. At virtually any probability of acute myocardial infarction, replacing more intensive by less intensive strategies saved money but increased mortality and decreased life expectancy. Therefore, choices among strategies may be made by using the most effective strategy for progressively lower and lower risk patients until the additional cost per additional life saved reaches a cutoff value; then, a less expensive strategy is selected. With sample cutoff values of $1 and $2 million per life saved, the marginal threshold admission probabilities were:.

Original languageEnglish
Pages (from-to)953-963
Number of pages11
JournalAnnals of Emergency Medicine
Issue number9
Publication statusPublished - Sept 1989
Externally publishedYes


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