Declining hospital mortality in acute myocardial infarction

Abstract

Beta-blockers, nitrates, aspirin and thrombolytic drugs have each separately been shown to reduce mortality in acute myocardial infarction, but the effect of these treatments combined during routine coronary care has not been assessed. The coronary care unit at Ostra Hospital services a stable community of 250,000 inhabitants. Since 1984 all patients have been entered into a computerized database. In addition, information on age, sex, discharge diagnosis and hospital outcome is also available for patients admitted between 1979 and 1983. In 1984, routine treatment with intravenous beta-blockers was introduced, to be followed in 1986 by intravenous nitroglycerin and in 1988 by aspirin in all patients without contraindications. Since 1988, intravenous thrombolytic treatment has been also given routinely to all patients with ST-elevation and chest pain < 6 h. Despite a similar number of patients and an increasing median age, the in-hospital mortality has declined from 18.5% in 1979 to 11.8% in 1990 (P < 0.01). It is concluded that mortality from acute myocardial infarction has declined by almost 40% since 1979. This reduction cannot be explained by a single major therapeutic intervention but may be attributed to the combined use of multi-lead monitoring, early use of beta-blockers, nitroglycerin, aspirin and thrombolytic agents.

Relationship of Therapeutic Improvements and 28-Day Case Fatality in Patients Hospitalized With Acute Myocardial Infarction Between 1978 and 1993 in the REGICOR Study, Gerona, Spain

“…*Reference period was 1978 to 1981. This is an observational study, and no cause-effect relationship should be drawn from our findings that, however, convincingly support the effectiveness of thrombolytic and antiplatelet drugs in daily clinical practice because (1) they are biologically plausible, (2) an increasing protective effect emerges in the last 2 periods studied (when the drugs were used), (3) they are consistent with those of other studies, 6,9,14 (4) the combination of both treatments has been found to provide an optimum additive benefit, and (5) the strength of the relationship between drug use and case fatality reduction is great in terms of OR magnitude. The effect of improvements in primary care and prehospital emergency care, changes in primary prevention, and better lifestyles cannot be readily ascertained.…”

Trends in Acute Coronary Heart Disease Mortality, Morbidity, and Medical Care From 1985 Through 1997

“…Previous analyses suggested that some of the decline in case fatality was due to increased use of thrombolytic therapy. 4,20 Other therapies with established impact on AMI survival, such as aspirin, 21 ACE inhibitors, 22 ␤-blockers, 23,24 anticoagulants, 25 and emergency angioplasty were also used much more frequently in 1995 than in 1985. Two striking features of the trends in the short-term care of hospitalized AMI presented here are (1) their consistency with published results of major clinical trials in the same period and (2) the little to no sex difference in medical intervention in AMI patients in 1995.…”

Epidemiology of acute myocardial infarction with the emphasis on patients who did not reach the coronary care unit and non-AMI admissions

“…Our knowledge about patients who are hospitalised and discharged with a diagnosis of acute myocardial infarction, including data relating to risk factors for mortality [1][2][3], the efficacy of various treatments [4][5][6] and prognosis [7,8], is extensive.…”