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The Beta Blocker and Clonidine Protocol

Lesson 3
Risk Stratification

2. Testing and Care

World's Greatest test Stories!How about a test? Isn't there some test we can do to tell who is going to have a problem? Let's examine what we would like in the test. First, it must be able to predict who is going to have perioperative cardiac morbidity (a.k.a. death, MI, etc). Second, the test must have low risk and high predictive value because we are going to apply it to 6 million patients per year in the U.S.. Thirdly, the cost of the test times 6 million, plus the therapy times some fraction of 6 million, must be affordable. Finally, the risk of the test, plus the risk of the therapy, must be less than some other approach.

World's Greatest Test

bullet Able to predict perioperative cardiac morbidity
bullet Able to apply to large numbers of people for minimum cost
bullet Low risk
bullet High predictive value.
bullet Total Cost = 6 * 106 (Cost of Test) + x*(Cost of Therapy)
bullet Risk of Test + Risk of Therapy < Risk of Prophylactic Therapy without Testing

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Content by Art Wallace MD PhD
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