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ARTICLE |

The AHCPR Unstable Angina Algorithm in Practice-Reply

David A. Katz, MD, MSc; John L. Griffith, PhD; Joni R. Beshansky, RN, MPH; Harry P. Selker, MD, MSPH; Demetrios S. Theodoropoulos, MD, MSc
JAMA. 1997;277(12):962. doi:10.1001/jama.1997.03540360030016.
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In Reply.  —We agree with the authors of both letters that the inclusion criteria are critical to both the clinical application and the evaluation of the AHCPR unstable angina guideline. Our data suggest that, among ED patients diagnosed with unstable angina, a very small proportion will be defined as "low risk" by the guideline's criteria. As detailed in our article, we used the Imminent Myocardial Infarction Rotterdam (IMIR) inclusion criteria, which include not only chest pain and the usual chest pain equivalents (chest discomfort, arm pain, neck pain) but also shortness of breath, dizziness, palpitations, and other symptoms suggestive of acute cardiac ischemia. We then restricted our analysis to a broad spectrum of unselected patients with unstable angina, including patients for whom the ED diagnosis of unstable angina was less than certain.The letters also question why our evaluation did not include patients with diagnoses other than unstable angina, such as "rule

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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