The above is a copy of the first article in that first issue from NEJM. It is interesting to think that heart problems were the first to be discussed. Nabel and Braunwald have an interesting article detailing cardiology over this period. What is compelling about the article is Figure 1 which depicts an almost 80% reduction in heart death over this period. Yet the cost of achieving this has been substantial. In light of the current debates on health care costs one should look at this and consider progress versus costs.
As the authors state:
Until 1961, patients with acute myocardial infarction — if fortunate enough to survive until they reached a hospital — were placed in beds located throughout the hospital and far enough away from nurses’ stations that their rest would not be disturbed. Patients were commonly found dead in their beds, presumably from a fatal tachyarrhythmia. Indeed, the risk of death occurring in the hospital was approximately 30%. The development of the coronary care unit, which provided continuous monitoring of the electrocardiogram, closed-chest cardiac resuscitation, and external defibrillation, reduced in-hospital mortality by half among patients admitted with acute myocardial infarction.
Was it better in 1961, for the costs were lower, or are we better off today. I would argue the latter, but there are some who believe the costs are excessive, until perhaps they become that 30%.
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