The management of acute myocardial infarction--practical problems in implementing the evidence

Cardiovascular disease is the leading cause of death in Europe. Acute myocardial infarction (AMI) is among the most common of its manifestations. Women and older patients are under-represented in most trials of treatment for AMI, as are those with significant co-morbidities. These patients also have a worse long term outcome after AMI. We sought to evaluate the management of AMI in a small non-academic general hospital. A review was performed of cases of AMI during 2000. Ninety-two cases were analysed, 69% were male. The mean age was 70 years. In-hospital mortality was 12%; 30-day mortality was 14%. There was no gender or age difference in mortality. Of thirty eligible patients, twenty-eight were thrombolysed (93%). Aspirin (81%) and beta-blocker (41%) prescription on discharge were below published European and American rates. Females were significantly less likely to receive aspirin or beta-blockers on discharge. Those aged 70 years or more were less likely to receive beta-blockers, statins or ACE inhibitors on discharge. Those with co-morbidities were less likely to receive beta-blockers or statins on discharge. This study highlights the difficulty in realising evidence based guidelines optimal management of AMI in clinical practice. While the outcome with regard to mortality is similar to national figures, there is a need to enhance care, with particular emphasis on secondary pharmacological measures prescribed on discharge.