Meyers Primary Care Institute; Department of Medicine, Division of Geriatric Medicine
Adult; Aged; Clinical Trials as Topic; Female; Health Services Accessibility; Hospital Mortality; Humans; Male; Middle Aged; Myocardial Infarction; *Myocardial Reperfusion; Patient Selection; Physician's Practice Patterns; Practice Guidelines as Topic; Registries; Risk Factors; Survival Rate; United States
Health Services Research | Primary Care
The National Registry of Myocardial Infarction 2 (NRMI-2) provides a unique opportunity to evaluate the practice patterns among participating cardiology and emergency medicine departments involved in the care of patients with acute myocardial infarction. The data from NRMI-2 suggest that almost 1/3 of all non-transfer-in and non-transfer-out patients are eligible for reperfusion therapy. Furthermore, of those patients who are clearly eligible for reperfusion therapy, 24% are not given this proven therapy. Specifically, women, the elderly, patients without chest pain on presentation, and those patients at highest risk for in-hospital mortality were least likely to be treated with reperfusion therapy. The reason for underuse of reperfusion therapy may in part reflect a concern for adverse bleeding events associated with the use of thrombolytic therapy. The data from NRMI-2 also suggest that patients with contraindications to thrombolysis may be very appropriate for primary angioplasty. Realizing the full potential benefits of reperfusion therapy in terms of reduced cardiovascular morbidity and mortality will require that clinical practice patterns be aligned more closely with the recommended national guidelines, which are based on extensive clinical trial data that show the benefit of reperfusion therapy in a wide range of patients with acute myocardial infarction. By using observational databases, such as the NRMI-2, which describe how clinical care is administered in nonclinical trial settings, we can continually monitor our progress and initiate changes to ensure that patients are given access to the many therapies that have been shown to improve their quality of life and survival.
Cardiol Rev. 1999 May-Jun;7(3):156-60. Link to article on publisher's website
Cardiology in review
Barron, Hal V.; Rundle, Amy Chen; Gurwitz, Jerry H.; and Tiefenbrunn, Alan J., "Reperfusion therapy for acute myocardial infarction: observations from the National Registry of Myocardial Infarction 2" (1999). Meyers Primary Care Institute Publications and Presentations. 253.