The rate of change of plasma procainamide concentration during 36 hours of constant-rate intravenous infusion was examined in five acute myocardial infarction patients. It was observed that a steady-state plasma concentration was established in about 16 hours, which is consistent with simulations of plasma concentrations based on pharmacokinetic constants obtained from studies in young healthy volunteers. However, the steady-state level that was attained in these patients was markedly higher than that which the simulations predicted. Thus, on the average, acute myocardial infarction patients have lower total body clearances of procainamide than normal volunteers.

Adult↗

PubMedDate not supplied

Specialty care at the crossroads: electrophysiology practice in the managed-care era.

The economics of the managed-care era have declared that there is an o ver supply of specialists. Especially vulnerable to the changing marketplace are electrophysiologists whose technology is poorly understood by managed-care plans. To be successful, electrophysiology (EP) practices must develop strategies to contend with the new reality. Over the past decade, electrophysiologists at Good Samaritan Hospital (Los Angeles, CA) have worked with the leadership of a large managed-care organization (Family Health Plan [FHP]) to develop guidelines for clinical EP procedures that optimize clinical outcome and cost for EP procedures. The important elements of a successful guideline are that it be a distillation of the best current medical literature and that it be carefully followed and routinely improved. Using the guidelines developed for radiofrequency ablation, FHP found that it was cheaper ($21,166 v $26,448) for FHP patients drug-resistant to supraventricular tachycardia to undergo ablation than to be treated medically. This was for 14 months of care. In addition to the development and implementation of guidelines, a number of factors are important in developing a successful managed-care approach. The physicians should be the "high quality-low cost" provider, with demonstrable excellent clinical outcomes, low complication rates, and competitive pricing. In addition, there must be an efficient short-stay system, with a premium on personal service to the patient and family. Also important is a strong hospital partner as well as sophisticated marketing and contracting support. A new marketplace paradigm is upon us that calls for a change in practice style from that of a decade ago if electrophysiologists are to survive in the managed-care marketplace.

Cardiology↗