Trends in medical management of acute myocardial infarction, Auckland 1983-90.

AIMS: To examine changes in the medical management of acute myocardial infarction in the Auckland region between 1983 and 1990.

METHODS

6190 patients aged 25-64 years with myocardial infarction were identified utilising a population based register, the ARCOS study. Data were collected on resuscitation attempts, transportation to hospital, coronary care unit (CCU) stay and medication use before and during the CCU stay.

RESULTS

The median time delay between onset of symptoms and arrival at the CCU decreased by approximately 7 minutes per year. The average length of CCU stay decreased from 2.9 to 2.7 days and there were between hospital variations in length of CCU stay. The most striking change in drug therapy before the event was the increase in the use of antiplatelet agents from 5% in 1983 to 18.3% in 1990. There was also a big increase in the proportion of patients using antiplatelets (3.5 fold) and thrombolytic drugs (5.5 fold) during the CCU stay, in 1990, 50% of patients received thrombolytic agents and 56% received antiplatelet agents.

CONCLUSION

The use of drugs of proven benefit could be further increased although it appears that major improvements in mortality rates will come primarily from primary prevention.