Treatment of myocardial infarction in the United States (1990 to 1993). Observations from the National Registry of Myocardial Infarction.

Relation of Race and Sex to the Use of Reperfusion Therapy in Medicare Beneficiaries with Acute Myocardial Infarction

“…Guidelines on myocardial infarction issued by the American College of Cardiology and the American Heart Association 1 recommend prompt restoration of anterograde coronary blood flow as the main goal of treatment in such patients. Thrombolytic therapy is the most common method used to restore flow, 2 and primary angioplasty has been accepted as an alternative method of reperfusion. [3][4][5] However, there is increasing evidence that reperfusion may be underused among blacks, 6-8 women, [9][10][11][12][13][14] and the elderly.…”

Medication Errors in Acute Cardiac Care

“…44 Omission errors in acute cardiac care are represented most dramatically by the relatively low rates of aspirin administration in the first 24 hours of MI. This omission occurs despite the fact that aspirin reduces mortality and reinfarction, [45][46][47] particularly when given in combination with fibrinolytic therapy. 48 However, in the first National Registry of Myocardial Infarction (NRMI), involving 240 989 patients, only 87% of thrombolytic-treated patients received aspirin.…”

“…48 However, in the first National Registry of Myocardial Infarction (NRMI), involving 240 989 patients, only 87% of thrombolytic-treated patients received aspirin. 45 Similarly, in the Cooperative Cardiovascular Project, only 80% of eligible patients received aspirin. 47 The American Heart Association has published a scientific statement strongly urging physicians to increase the use of aspirin in appropriate patients.…”

“…51 Long-term ␤-adrenergic receptor-blocker therapy after acute MI has been evaluated. 45,47 The available data suggest that fewer than 50% of eligible patients actually receive treatment after hospital discharge. 52 On the basis of the recognized benefits of ␤-blockade, it is believed that as many as 5000 deaths each year are attributable to its omission.…”

“…54 Although emerging trends toward more appropriate treatment are evident, hospital delay times before initiation of fibrinolytic therapy remain long. 45 Trend analyses from 1990 to 1993 suggest that the time from hospital evaluation to initiation of fibrinolytic therapy has shortened. 45 Underutilization of t-PA for acute ischemic stroke is also substantial, as noted earlier, and reflects, in part, the delay in the time from patient arrival to start of therapy.…”