Evidence map›Paper›PMID 20222987›Full record

ArticleBMC cardiovascular disorders2010

Pre-hospital ECG for acute coronary syndrome in urban India: a cost-effectiveness analysis.

Joshua Schulman-Marcus, Dorairaj Prabhakaran, Thomas A Gaziano

Open access · goldAbstract readComparative Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC cardiovascular disorders, 2010. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers, 4 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
14citing papers in PubMed, 4 pooled it
0.4field-weighted citation impact, top 32% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

14 citing papers in PubMed, 4 syntheses or guidelines pooled it, 23 citations in OpenAlex.

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  10. A systematic review of the cost-effectiveness of emergency interventions for stroke in low- and middle-income countries.African journal of emergency medicine : Revue africaine de la medecine d'urgence · 2020
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

3 authors at 3 institutions in 2 countries.

Joshua Schulman-Marcus1Mount Sinai School of Medicine, One Gustave L Levy Place, New York, NY 10029, USA.
Dorairaj Prabhakaran
Thomas A Gaziano
All India Institute of Medical Sciences · INHarvard University · USIcahn School of Medicine at Mount Sinai · US

Funding

Cost-effective prevention of cardiovascular disease in developing countriesK01TW007141 · FIC · BRIGHAM AND WOMEN'S HOSPITAL · PI GAZIANO, THOMAS A · 2004 to 2011
$864k
FIC NIH HHS K01TW007141-01
6 · The paper itself

Abstract

backgroundPatients with acute coronary syndrome (ACS) in India have increased pre-hospital delay and low rates of thrombolytic reperfusion. Use of ECG could reduce pre-hospital delay among patients who first present to a general practitioner (GP). We assessed whether performing ECG on patients with acute chest pain would improve long-term outcomes and be cost-effective.

methodsWe created a Markov model of urban Indian patients presenting to a GP with acute chest pain to compare a GP's performing an ECG versus not performing one. Variables describing the accuracy of a GP's referral decision in chest pain and ACS, ACS treatment patterns, the effectiveness of thrombolytic reperfusion, and costs were derived from Indian data where available and other developed world studies. The model was used to estimate the incremental cost-effectiveness ratio (ICER) of the intervention in 2007 US dollars per quality adjusted life years (QALY) gained.

resultsUnder baseline assumptions, the ECG strategy cost an additional $12.65 per QALY gained compared to no ECG. Sensitivity analyses around the cost of the ECG, cost of thrombolytic, and referral accuracy of the GP yielded ICERs for the ECG strategy ranging between cost-saving and $1124/QALY. All results indicated the intervention is cost-effective under current World Health Organization recommendations.

conclusionsWhile direct presentation to the hospital with acute chest pain is preferable, in urban Indian patients presenting first to a GP, an ECG performed by the GP is a cost-effective strategy to reduce disability and mortality. This strategy should be clinically studied and considered until improved emergency transport services are available.

Indexed as

Urban PopulationAcute Coronary SyndromeCost-Benefit AnalysisElectrocardiographyEmergency Medical ServicesFamily PracticeHumansIndia

Identifiers

PMID20222987
PMCPMC2848184
OpenAlexW2033423237

What OpenQuestion holds

Textmetadata
LicenceCC BY
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.