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March 26, 1997

The AHCPR Unstable Angina Algorithm in Practice

Author Affiliations

John Peter Smith Hospital Fort Worth, Tex

JAMA. 1997;277(12):961-962. doi:10.1001/jama.1997.03540360029015

To the Editor.  —While the topic of the article by Katz et al1 is timely, their conclusion that "the [AHCPR] guideline's recommendation for triage disposition of low-risk patients would apply to less than 1% of all patients with suspected acute cardiac ischemia who present to the ED" is overstated for 2 reasons.First, the authors probably did not identify all eligible candidates for this study. Even though a patient with unstable angina has a history of worsening chest pain, it is usually an especially severe or prolonged episode that actually brings that patient into the ED. Often, the foremost thought on the ED physician's mind is whether that particular event was an MI. At that moment, the 2-month history of worsening chest pain is secondary. At my institution, most patients admitted with possible MI or ischemia are admitted as "rule out MIs," not unstable angina. To identify all possible candidates, the authors