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Are They Beneficial?

K. Lance Gould, MD

JAMA. 1994;272(11):891-893.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

The article entitled "Does More Intensive Treatment of Acute Myocardial Infarction in the Elderly Reduce Mortality? Analysis Using Instrumental Variables" by McClellan et al¹ in this issue of THE JOURNAL is important for several reasons. The authors describe a new method in medical outcomes research called instrumental variables estimation. In principle, this approach eliminates the bias of patient selection on mortality in the Medicare population receiving varying intensities of treatment for acute myocardial infarction, particularly cardiac catheterization and associated coronary revascularization. The authors argue that this approach has the same effect as prospective randomization in eliminating unrecognized biases of patient selection on outcomes of differing treatment intensities.

The article makes the following conclusions for the Medicare population: (1) after acute myocardial infarction, cardiac catheterization and associated revascularization are performed less frequently in women and black men than in white men; (2) cardiac catheterization and associated revascularization have a marginal . . . [Full Text PDF of this Article]

Author Affiliations
From the Division of Cardiology and Positron Diagnostic and Research Center, University of Texas Medical School, Houston.

Footnotes
Reprints requests to Division of Cardiology, Room 4.258 MSB, University of Texas Medical School, 6431 Fannin St, Houston, TX 77030 (Dr Gould).

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