The Canadian journal of cardiology · 1994
Patterns of practice analysis for acute myocardial infarction.
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Tsuyuki R T, Gill S, Hilton J D
Аннотация
OBJECTIVE: To assess the level of use of acetylsalicylic acid (ASA), beta-blockers and thrombolytic therapy--proven efficacious therapies in the management of acute myocardial infarction (AMI)--in contemporary patients admitted with AMI, and to assess the role of contraindications and other patient-specific factors in the use or nonuse of these treatments.
DESIGN: The demographics and treatment course of patients admitted with a diagnosis of AMI were reviewed. Specifically targeted therapies were ASA, beta-blockers and thrombolytic therapy. Rates of use were calculated as 'gross utilization' (overall use) and 'adjusted utilization' (accounting for late presentation to hospital, initially equivocal diagnosis or contraindications).
SETTING: Tertiary care hospital in suburban Vancouver, British Columbia.
PATIENTS: A total of 372 consecutive patients admitted to Royal Columbian Hospital between September 1, 1990 and September 1, 1991.
INTERVENTIONS: None.
MAIN RESULTS: Gross utilization of ASA, beta-blockers and thrombolytic therapy was 71, 31 and 21%, respectively. The adjusted utilization rates for early (6 h or less) treatment with ASA was 66%; with early beta-blockers, it was 18% and was 100% for thrombolytic therapy. Adjusted late (more than 6 h, to hospital discharge) use of ASA and beta-blockers was 84 and 57%, respectively.
CONCLUSIONS: With the exception of thrombolytic therapy, proven efficacious medical therapies for AMI appear underused at the study hospital. Ongoing educational efforts and continuing patterns of practice analyses are needed.
DESIGN: The demographics and treatment course of patients admitted with a diagnosis of AMI were reviewed. Specifically targeted therapies were ASA, beta-blockers and thrombolytic therapy. Rates of use were calculated as 'gross utilization' (overall use) and 'adjusted utilization' (accounting for late presentation to hospital, initially equivocal diagnosis or contraindications).
SETTING: Tertiary care hospital in suburban Vancouver, British Columbia.
PATIENTS: A total of 372 consecutive patients admitted to Royal Columbian Hospital between September 1, 1990 and September 1, 1991.
INTERVENTIONS: None.
MAIN RESULTS: Gross utilization of ASA, beta-blockers and thrombolytic therapy was 71, 31 and 21%, respectively. The adjusted utilization rates for early (6 h or less) treatment with ASA was 66%; with early beta-blockers, it was 18% and was 100% for thrombolytic therapy. Adjusted late (more than 6 h, to hospital discharge) use of ASA and beta-blockers was 84 and 57%, respectively.
CONCLUSIONS: With the exception of thrombolytic therapy, proven efficacious medical therapies for AMI appear underused at the study hospital. Ongoing educational efforts and continuing patterns of practice analyses are needed.