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November 27, 1996

Referral of Patients With Myocardial Infarction and Low Ejection Fraction to Arrhythmia Specialists

Author Affiliations

Bowman Gray School of Medicine Wake Forest University Winston-Salem, NC

JAMA. 1996;276(20):1634. doi:10.1001/jama.1996.03540200020013

To the Editor.  —Despite Drs Stevenson and Ridker's1 cautious interpretation of the likely benefit of routine referral of myocardial infarction survivors with low ejection fraction to arrhythmia specialists, the evidence on which they base their conclusion—"Routine referral to arrhythmia specialists is not warranted for the majority of infarct survivors"—points to an area of continuing difficulty in medical decision making. When are the benefits large enough to warrant application of an intervention?Stevenson and Ridker construct models to estimate the potential effect of global treatment with amiodarone or an implantable defibrillator vs treatment of high-risk patients identified during screening by arrhythmia specialists. Their results suggest that 1 life could be saved for every 25 patients treated for 3.5 years if amiodarone were offered to every survivor of myocardial infarction with an ejection fraction less than 40%. Over the same period, 1 life might be saved for every 14 such patients