Patterns of practice for acute myocardial infarction in a population from ten countries

Background: There is conclusive evidence from large scale randomized clinic al trials (RCTs) that several treatments administered in the acute phase of a myocardial infarction (AMI) reduce mortality. However, only a minority o f patients admitted with AMI receives at the appropriate treatments. Objectives: This study aims at (I) describe the utilization patterns for AM I; (2) determine the appropriateness of prescribing, measured as adherence to the ACC/AHA guidelines; and (3) determine which factors are associated w ith the administration of thrombolytic agents. Methods: The study was a multi-center survey carried out in ten countries ( nine European and one Canadian province) over a 3-month period. Data were p rospectively collected by clinical pharmacists. All consecutive patients ad mitted to the participating hospitals during the study period with a diagno sis of suspected AMI were included in the study. Rates of use were calculat ed as "overall utilization" and "adjusted utilization" (e.g., accounting fo r eligibility). Results: Data were available on 1976 patients from 56 participating centers . The mean age of the patients was 65 years (range 25-95, SD = 12.6) and 29 .7% were women. Adjusted utilization rates were 63.7% for thrombolysis, 88% for aspirin, and 65.9% for beta-adrenergic blocking agents. The most utili zed thrombolytic agent was streptokinase (65.9%). The main reasons given by physicians for not administering thrombolysis was the delay from chest pai n onset to admission. Patients admitted to teaching hospitals were less lik ely to receive aspirin than patients admitted to general hospitals (adjuste d rate 90.1% vs 86%, P = 0.007), but they were more likely to undergo a pri mary invasive procedure (11.0% vs 2.5% P = 0.001). Multivariate analysis sh owed that age greater than 74 years, delay, prior myocardial infarction, an d Killip scale were correlated with the non-utilization of thrombolysis. Conclusion: Recommended treatments are still underutilized in patients with AMI. Increased utilization is required, particularly for elderly people. T here is a wide variability among hospitals with different affiliations (tea ching vs non teaching), demonstrating the different patterns of practice in various settings.