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Biomedical subjects

T M Bateman

Publications and source records attributed to T M Bateman.

65 records · Page 4Linked to original sources
PubMedDate not supplied

Nuclear cardiology in private practice.

The provision of nuclear cardiology services in private-practice settings is probably currently the fastest growing segment of nuclear medicine. One reason is that myocardial perfusion scintigraphy, by determining which patients require coronary angiography and revascularization, has the potential to help a cardiology practice complete more successfully in the managed-care environment. Private practices can establish their own patient databases to determine how scintigraphic findings correlate with patient outcomes and with findings if coronary angiography is performed. Based on these data, pressure can be exerted to modify clinical responses to optimize the relationship between scintigraphic findings, quality of clinical care, and cost-effective patient management. To succeed in a managed-care setting, nuclear cardiologists must demonstrate that, without their services, the quality of cardiac care would be lower and the cost of caring for patients with heart disease would be higher. As in other settings, nuclear cardiologists in private practice must be involved managerially so they will be active participants in the development of clinical-care guidelines and the negotiation of capitated and other types of managed-care contracts.

Algorithms↗
PubMedDate not supplied

Outcome of medical versus invasive treatment strategies for non-high-risk ischemic heart disease.

The purpose of this study was to evaluate the outcomes of medical management compared with invasive management for patients with mild or moderate ischemia (non-high-risk) on stress tomographic myocardial perfusion scintigraphy. Of the 1,352 non-high-risk patients, 116 (9%) subsequently were referred for coronary angiography within the first 30 days after the scan; 99 (85%) of this group also underwent early revascularization procedures. The remaining 1,236 patients (91%) with non-high-risk ischemia did not undergo early invasive management. Unadjusted actuarial 3-year rate of cardiac death or nonfatal infarction was significantly better estimated survival in the medically managed group (2%) compared with the invasively managed group (22%), p = 0.0001. Subsequent coronary revascularization procedures during 3-year follow-up were less frequent in the medically managed group (4%) than in the invasively managed group (42%), p = 0.0001. A multivariable analysis identified invasive management strategy (p = 0.0001) as the only correlate of cardiac events during follow-up. In summary, this study showed that patients with non-high-risk ischemia on stress perfusion imaging can be treated safely with a conservative medical management strategy.

Actuarial Analysis↗
PubMedDate not supplied

Cost-effectiveness of stress echocardiography and nuclear perfusion imaging.

Cost-effectiveness analysis is a method of comparing societal economic value of 2 different strategies. Ideally, it defines accurate test-related (direct and downstream) costs and appropriately converts differential patient outcomes into a dollar value. The likelihood that cost-effectiveness analysis translated into a policy-making tool will enhance health care and/or control costs is dependent on the validity of numerous assumptions about relative costs, patient outcomes, and generalizability of the literature to regional capabilities. The purpose of this report is to review the concept of cost-effectiveness analysis as it applies to stress echocardiography and stress myocardial perfusion imaging for selected patient subsets.

Cost-Benefit Analysis↗
PubMedDate not supplied

Predictors of improvement in left ventricular ejection fraction with carvedilol for congestive heart failure.

BACKGROUND: Beta-blocker therapy has been reported to improve survival and left ventricular ejection fraction (LVEF) in the setting of congestive heart failure (CHF). The magnitude and predictors of improved LVEF are unclear. METHODS: A total of 295 patients were enrolled in the study. Inclusion criteria were LVEF <35% at baseline and symptomatic (New York Heart Association class II to IV) CHF despite treatment with at minimum an angiotensin-converting enzyme inhibitor. Carvedilol was initiated at 3.125 mg twice daily and titrated to a target dose of 25 or 50 mg twice daily, depending on the patient's weight. Paired pretreatment baseline and 9 months with treatment follow-up quantitative LVEFs (assessed by resting radionuclide ventriculograms) were obtained in 161 (55 %) of the patients. RESULTS: LVEF improved from 25% +/- 6% at baseline to 36%+/-12% at follow-up (P<.001). Mean change in LVEF (deltaLVEF) was greater for nonischemic cardiomyopathy (NICM) (+14.5+/-2 LVEF points) than ischemic cardiomyopathy (deltaLVEF +/- 7.6+/-10 EF points, P = .001). The deltaLVEF was > or =21 LVEF points in 30% of the NICM group versus 10% of the ischemic cardiomyopathy group. Conversely, the deltaLVEF was unchanged to minimally improved (< or =5 LVEF points) in 21% of the NICM group versus 52% of the ischemic cardiomyopathy group. Multivariable analysis identified NICM and recent onset of congestive heart failure as correlates of improved LVEF. CONCLUSIONS: Carvedilol significantly improved LVEF, especially in patients with NICM and those with recent onset of CHF.

Adrenergic beta-Antagonists↗