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Am J Manag Care. 2009 Mar;15(2 Suppl):S36-41.

Acute coronary syndromes: morbidity, mortality, and pharmacoeconomic burden.

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Department of Medicine, Hospital of The University of Pennsylvania, 9 Gates W, 3400 Spruce St, Philadelphia, PA 19104, USA.


Acute coronary syndromes (ACS), which include unstable angina and myocardial infarction (MI) with or without ST-segment elevation, are life-threatening disorders that remain a source of high morbidity and mortality despite advances in treatment. Nearly 1.5 million hospital discharges involve patients with ACS. According to statistics from the American Heart Association (AHA), approximately 18% of men and 23% of women over the age of 40 will die within 1 year of having an initial recognized MI. The economic burden of ACS is also very high, costing Americans more than $150 billion, according to AHA estimates. Approximately 20% of the ACS patients are rehospitalized within 1 year, and nearly 60% of the costs related to ACS result from rehospitalization. However, the evidence-based therapeutic management of ACS remains suboptimal. An understanding of the drivers of morbidity, mortality, and costs associated with ACS will help in developing strategies to reduce the burden of the disease. The evidence regarding the effects of early revascularization and stenting on survival rates in ACS patients is discussed. Currently available evidence-based and new practice guidelines determine the pros and cons of invasive versus conservative strategies for treating ACS. By evaluating the predictors of optimal medical therapy and mortality post-discharge, healthcare providers involved in the managed care play a key role in providing efficient, safe, and cost-effective ACS treatment.

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