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August 28, 1996

Treatment Strategies for Patients With Ischemic Chest Pain-Reply

Author Affiliations

Brigham and Women's Hospital Boston, Mass
Maryland Medical Research Institute Baltimore

JAMA. 1996;276(8):606. doi:10.1001/jama.1996.03540080028020

In Reply.  —The purpose of our registry of patients with unstable angina and non—Q-wave MI was to identify the clinical management strategies and outcomes among patients categorized by age, race, and sex. The study was designed to identify the practice patterns used in these groups of patients, not to investigate the explanations underlying the practice patterns or to investigate causal relationships between practice patterns and clinical outcomes. We observed that elderly patients received less aggressive treatment than younger patients, had more severe coronary disease, and experienced worse clinical outcomes.We welcome Dr Algazy's comments in the debate concerning optimal care for the elderly with unstable angina and non—Q-wave MI. However, he appears to have misinterpreted our main conclusions, since we stated in the last line of the article that aggressive strategies should be directed to those patients with the "greatest likelihood to benefit." As Algazy correctly notes, adverse outcomes may result from