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November 27, 1996

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

Author Affiliations

Brigham and Women's Hospital Harvard Medical School Boston, Mass

JAMA. 1996;276(20):1634-1635. doi:10.1001/jama.1996.03540200020014

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In Reply.  —We appreciate Dr Goff' s thoughtful comments regarding our article and in general concur that the NNT concept can be useful in clinical decision making. However, when comparing therapies, the NNT cannot be a sole criterion because it conveys virtually no information concerning adverse effect profiles and oversimplifies issues related to screening, treatment, and quality of life. In the examples of hypercholesterolemia and hypertension that Goff cites, screening for these conditions is inexpensive and devoid of risk, whereas therapy is effective and safe. In marked contrast, in the case of prevention of sudden death after myocardial infarction, screening for malignant arrhythmias can require highly invasive procedures, therapeutic interventions have important toxicities, and the economic costs of screening and treatment are high. Moreover, quality of life among patients following myocardial infarction is often reduced by the treatment itself.In deciding between 2 alternative therapeutic choices, we believe a careful balance must