Unjustified variations in patient management for acute myocardial infarction in the Rhone-Alpes region of France

Objectives: To examine determinants of use of cardiac procedures after acut e myocardial infarction and identify variation factors. Methods: Observational prospective cohort study of 2,519 patients in 48 cen ters with a two-level logistic-regression analysis. Results: Elderly patients were less likely to undergo pre- and inhospital t hrombolysis (odds ratios, 0.71 and 0.64; 95% CI, 0.62-0.81 and 0.58-0.69, r espectively). The elderly, females, and patients with heart failure on admi ssion were less likely to undergo noninvasive tests (0.74, 0.62, and 0.51; 95% Cl, 0.67-0.81, 0.46-0.83, and 0.38-0.68, respectively) and coronary ang iography (0.38, 0.53, and 0.67; 95% CI, 0.34-0.42, 0.38-0.74, and 0.52-0.86 , respectively) but not revascularization. Hospital factors were more diffi cult to interpret. Conclusions: Elderly, women, and heart failure patients underwent fewer car diac procedures than lower-risk patients. Physicians should change their at titude toward these groups and use advanced procedures, bearing in mind the patients' needs rather than good procedural outcomes.