PATTERNS OF PRACTICE ANALYSIS FOR ACUTE MYOCARDIAL-INFARCTION

OBJECTIVE: To assess the level of use of acetylsalicylic acid (ASA), b eta-blockers and thrombolytic therapy - proven efficacious therapies i n the management of acute myocardial infarction (AMI) - in contemporar y patients admitted with AMI, and to assess the role of contraindicati ons and other patient specific factors in the use or nonuse of these t reatments. DESIGN: The demographics and treatment course of patients a dmitted with a diagnosis of AMI were reviewed. Specifically targeted t herapies were ASA, beta-blockers and thrombolytic therapy. Rates of us e were calculated as 'gross utilization' (overall use) and 'adjusted u tilization' (accounting for late presentation to hospital, initially e quivocal diagnosis or contraindications). SETTING: Tertiary care hospi tal in suburban Vancouver, British Columbia. PATIENTS: A total of 372 consecutive patients admitted to Royal Columbian Hospital between Sept ember 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 earl y (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 a nd 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 pat terns of practice analyses are needed.