Management of acute myocardial infarction. Do we follow guidelines applied in practice?

OBJECTIVE

Acute myocardial infarction (MI) is a major health problem with a substantial fatality and morbidity. The management of patients with acute MI has been addressed in major trials to improve the survival and enhance the quality of life of the patients. Numerous guidelines have been established for the management of such patients. The objective of this study is to determine whether the current practice in managing patients admitted with acute MI in a major community hospital in Riyadh is evidence based compliant.

METHODS

The data were collected from patients admitted to the Coronary Care Unit (CCU), Riyadh Medical Complex (RMC), Riyadh, Kingdom of Saudi Arabia, a 1500 bed community hospital, with a diagnosis of acute MI over one-year period (April 1999 to April 2000). The administration of different therapeutic modalities upon admission as well as discharge medications was obtained. Patients outcome (all cause mortality) post treatment were collected. The data was analyzed and compared with the current guidelines.

RESULTS

A total of 335 patients, 315 males (94%), were admitted to the CCU of RMC with a diagnosis of acute MI. Two hundred and seventy-one patients (80.9%) received thrombolytic therapy. Discharge medications were beta-blocker in 255 (76.1%), angiotensin converting enzyme inhibitors in 206 (61.5%), nitrates in 281 (83.9%), hypolipidemic agents in 15 patients (4.5%), and aspirin in all patients. The outcome of these patients obtained either alive or dead was 313 (93.4%) and 22 (6.6%) (p<0.00001).

CONCLUSION

The patients with acute MI received management compliant with evidence-based practice. However, more awareness to the use of angiotensin converting enzyme inhibitors as well as hypolipidemic agents is needed to provide maximum benefit to these patients. Moreover, national guidelines for the management of acute MI are needed for improvement of quality of care.