Current Practice Patterns in the Management of Acute Myocardial Infarction

Goldberg, Robert J.; Gore, Joel M.; Dalen, James E.

doi:10.1378/chest.92.3.550

Cited by 7 publications

(2 citation statements)

References 20 publications

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“…The decision to treat with thrombolytic agents, angioplasty, or bypass surgery requires a knowledge of the clinical evidence of their various efficacies and risk-to-benefit ratios. 35 Management ofActive Labor: The OB/GYN section has chosen to study the management of active labor for its clinical algorithm. This is an area of very high volume and one where there is wide variation in practice styles.…”

Section: Project Rationalesmentioning

confidence: 99%

Continuous medical education: Using clinical algorithms to improve the quality of health care in hospitals

Green¹,

Robin²,

Schibanoff³

et al. 1992

Journal of Continuing Education in the Health Professions

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Section: Project Rationalesmentioning

confidence: 99%

Continuous medical education: Using clinical algorithms to improve the quality of health care in hospitals

Green¹,

Robin²,

Schibanoff³

et al. 1992

Journal of Continuing Education in the Health Professions

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“…Both have been formally tested in randomized clinical trials and further validated by meta-analysis [1,2] . In contrast, diagnostic and prognostic procedures such as echocardiography, ambulatory ECG monitoring, exercise stress testing, coronary arteriography and use of radionuclides have been introduced into clinical practice in the absence of evidence from controlled trials of their effectiveness profile [3,4] . While pharmaco-epidemiological studies have documented a decreasing variability across countries regarding the use of pharmacological treatments, the heterogeneity of practices related to invasive and noninvasive diagnostic procedures as well as of invasive therapeutic interventions has remained substantial [4][5][6][7] .…”

Section: Introductionmentioning

confidence: 99%

Epidemiology of post-infarction risk stratification strategies in a country with a low volume of revascularization procedures. The GISSI Prognosis Registry

Maggioni¹,

Tavazzi²,

Fabbri³

et al. 1998

European Heart Journal

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AimsThe aims of the GISSI Prognosis Registry were to describe the diagnostic strategies initiated in acute myocardial infarction patients by a representative sample of Italian cardiological centres, and to determine which clinical or hospital characteristics were associated with the initiation of invasive diagnostic or therapeutic procedures. Methods and ResultsBaseline characteristics, major in-hospital events and the indication and results of invasive and non-invasive procedures were collected on 1489 acute myocardial infarction patients discharged alive from 65 Italian cardiological centres over a period of 3 months. Twenty-five percent of centres had on site catheterization laboratories while the rest did not. Statistical significance was analysed by chi-square tests for categorical variables. A two-sample Student t-test was used to compare continuous variables. The adjusted analysis was performed utilizing multiple logistic regression models.The most performed procedures were standard, noninvasive: 57·8% of the patients underwent an exercise stress test, 70·8% ambulatory ECG monitoring and 95·6% twodimensional echocardiography. Nuclear or echocardiographic imaging tests were performed in 40% of acute myocardial infarction survivors. Overall, coronary angiography was planned in 549 patients (36·9%). Variables independently associated with the indication for coronary angiography were residual ischaemia, younger age, contraindication to exercise stress testing, level of patients' education, higher volume of non-invasive diagnostic tests, and male sex. Overall, during a 6-month follow-up period, coronary angiography, percutaneous transluminal coronary angioplasty and coronary artery bypass surgery were performed, respectively in 35%, 10% and 8% of the study population. ConclusionsThe setting where cardiologists practise determines the patterns of care in acute myocardial infarction patients more than the characteristics of the patient. The absence of evidence-based guidelines on the more complex and expensive procedures favour empirical attitudes and practices. The confirmation in a prospective cohort of patients, which aims to represent the care of a whole country, suggests that more effort should be given to the implementation of controlled studies rather than periodical reformulation of guidelines not supported by hard data.

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The Increased Use of Diagnostic Procedures in Patients With Acute Myocardial Infarction

et al. 1987

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Current Practice Patterns in the Management of Acute Myocardial Infarction

Cited by 7 publications

References 20 publications

Continuous medical education: Using clinical algorithms to improve the quality of health care in hospitals

Continuous medical education: Using clinical algorithms to improve the quality of health care in hospitals

Epidemiology of post-infarction risk stratification strategies in a country with a low volume of revascularization procedures. The GISSI Prognosis Registry

The Increased Use of Diagnostic Procedures in Patients With Acute Myocardial Infarction

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