Physician practice in the management of patients with uncomplicated myocardial infarction: changes in the past decade.

Abstract

SUMMARY To determine changes in the patterns of care between 1970 and 1980 for patients with uncomplicated acute myocardial infarction, questionnaires were sent to almost 6000 physicians in 1979 and responses were compared with those of a similar survey taken in 1970. Almost all physicians in 1979 reported the availability and use of an intensive care/coronary care unit facility with continuous electrocardiographic monitoring. Progressive-care facilities are also becoming more widely available. The median length of hospitalization has decreased markedly. Early ambulation and an earlier return to work are more common. There is a high level of informal patient and patient-family counseling about myocardial infarction and its management, both during and after hospitalization, and wider use of educational materials. Most physicians continue to recommend progressive physical activity after hospitalization.The routine prescription of anticoagulant therapy during hospitalization has declined, while prescription of prophylactic antiarrhythmic agents has increased. Nitrate drugs and tranquilizers are routinely prescribed by a large percentage of physicians for their patients with uncomplicated myocardial infarction.Use of standard exercise tests has increased among all physician specialties. The treadmill test is most often used, and testing is typically done 6 weeks after infarction. A significant increase in the availability of and familiarity with exercise testing is characteristic of all medical specialties.Symptoms of new chest pain and palpitations are now considered important enough to warrant the recommendation to report immediately to an emergency room. Other current findings include the routine use of coronary angiography by a large percentage of physicians to evaluate the need for surgical intervention, and the routine posthospitalization prescription by only a small percentage of physicians of aspirin and of nitrate drugs for patients with uncomplicated myocardial infarction. IN 1970, PHYSICIAN PRACTICE

Therapeutic trends in the management of patients with acute myocardial infarction (1975–1984): the worcester heart attack study

“…The finding of relatively infrequent use of platelet-active agents during the acute hospital phase of MI is consistent with previous reports (Dalen et al, 1984;Wenger et al, 1982), while relatively frequent use of digitalis is in contrast to national prescribing patterns in patients with acute MI (Dalen et al, 1984;Wenger et al, 1982).…”

“…Between 1975 and 1984, administration of beta blockers increased approximately two and a half-fold, use of lidocaine and nitrates one and a half-fold while the use of other antiarrhythmic agents declined by approximately 25%. Relatively frequent use of beta-blocking agents, lidocaine, and nitrates and relatively infrequent use of antiarrhythmic agents other than lidocaine is consistent with previously published reports (Dalen et al, 1984;Wenger et al, 1982).…”

“…The efficacy of many of these modalities is uncertain and their use varies according to patient and physician characteristics (Bassan et al, 1976;Dalen et al, 1984;Wenger et al, 1982). In a recent survey, we found that physicians' prescribing practices with regard to the treatment of acute myocardial infarction varied widely (Dalen et al, 1984).…”

A Community-Wide Perspective of Secular Trends in the Therapeutic Management of Patients with Acute Myocardial Infarction

“…Between 1975 and 1984, administration of beta-blockers increased approximately 2.5-fold, use of lidocaine and nitrates 1.5-fold while the use of other anti arrhythmic agents declined by approxi mately 25%. Relatively frequent use of beta blocking agents, lidocaine, and nitrates and relatively infrequent use of antiarrhythmic agents other than lidocaine is consistent with previous studies examining such usage [15,37], Administration of digoxin remained rela tively constant over time, while use of anti platelet agents was not so. The finding of rel atively infrequent use of platelet-active agents during the acute hospital phase of MI is consistent with previous reports [15,37], while relatively frequent use of digoxin is in contrast to national prescribing patterns in MI patients [15,37].…”

“…7. 10, 28, 29, 32], Given this background of conflicting ob servational and experimental studies, as well as significant variations in the use of selected in-hospital as well as long-term therapeutic interventions in patients with acute MI [5,15,37], the present study has examined com munity-wide trends in the therapeutic man agement of 3,263 patients hospitalized with validated acute MI in 16 metropolitan Worcester, Mass., hospitals during the time periods 1975, 1978, 1981, and 1984, as well as the association of these therapies to se lected patient demographic and clinical characteristics.…”