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Prescribing Advice for GPs

An NHS Prescribing Advisers' Blog

EBM improves MI survival

The British Medical Journal has published the results of a study that aimed to assess trends in long term survival in patients alive 28 days after myocardial infarction (MI) in the context of evidence based medical treatments.

The study was a population-based analysis of 4,451 consecutive cases of acute MI between 1984 and 1993 in Perth, Western Australia. The entire cohort was divided into three groups based on date of admission and analysed for all-cause and cardiovascular mortality.

There was a 7.6% absolute reduction in the risk of all-cause mortality when comparing the most recent cohort to the least recent. This improved survival remained after correcting for several variables including demographic factors, coronary risk factors and severity of disease. The difference was not apparent after adjustment for changes in medical treatments within 12 months of diagnosis.

The authors conclude that, "The improving trends in 12 year survival are associated with progressive use of evidence based treatments". They further surmise that these changes are "contributing to the continuing decline in mortality from coronary heart disease".

Action: Clinicians should be reassured that the implementation of interventions that are backed by a sound evidence base are likely to result in reduced mortality and morbidity.

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2 Comments to “EBM improves MI survival”

  1. Strange this post is totaly irrelevant to the search query I entered in google but it was listed on the first page. - Whenever you find yourself on the side of the majority, it is time to pause and reflect. - Mark Twain 1835 - 1910

    Comment by Joshua Jin — April 8, 2010 #

  2. Burden Of Proof

    Upon information and belief, evidence-based medicine (EBM) is how health care providers practice medicine based on the efforts of evidence based researchers. These researchers consider EBM the apex for their approach as they conduct randomized controlled trials.
    The health care providers assess the risks and benefits of how they choose to treat or not to treat their patients. This paradigm of a practicing fully utilizing EBM allows the health care provider to better predict the clinical outcomes from the ideal treatment options concluded according to EBM.
    EBM implemented by health care providers recognize the need for improved quality in medicine. They also strive to place tremendous value on the restoration of the health of their patients- and they perceive the EBM approach to be the standard approach in their medical practices.
    It is believed that there are three areas of evidence-based medicine:
    1. Treat patients according to what is reasonable and necessary based on the evidence that exists regarding the treatment options health care providers select.
    2. Health care providers review this evidence in order to judge and assess the best treatment for their patients.
    3. Recognize that evidence-based medicine is in fact a movement that emphasizes the usefulness of this method to practice medicine.
    A standard of care is created as a result.
    It is also believed that there are two types of evidence-based medicine:
    1. Evidence-based guidelines- Policies and regulations are produced to ensure optimal health care.
    2. Evidence-based individual decision making- This is how restoring the health of others is practiced by the health care provider.
    While critics claim that EBM is too restrictive in practicing medicine and treating patients, EBM seems to be the preferred way to practice medicine instead of relying on possibly biased medical guidelines. Rather than EBM being restrictive, it is in fact potentially improved by enhancements such as electronic health records.
    Medical guidelines for a particular disease state are created from a combination of clinical studies in which conclusions are drawn to reflect national standards of care for a particular disease state. Guidelines were implemented during the 1980s as an alternative to relying on only EBM.
    At times, these guidelines are privately sponsored by those profitable medical industries that are able to gain profit depending on what such guidelines state about treatment considerations. This makes guidelines, at times, unreliable due to bias, as they are without independent systematic review or quality considerations by others.
    Unlike evidence-based medicine, guidelines can have major flaws and inaccuracies due to toxic factors such as commercial sponsorship received to create such guidelines. It is likely because of flaws such as this that most doctors do not follow medical guidelines, yet are rewarded and reimbursed by programs such as Medicare if they do follow medical guidelines that are established.

    Dan Abshear

    Comment by Dan — February 28, 2009 #

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