The rural physician and myocardial infarction: part 2: the hospital phase of treatment.

A critical review of the literature reveals several facts which are important in helping the rural physician decide where and how patients with myocardial infarction should be treated. The effectiveness of coronary care units has not been well established, even for patients admitted during the early phase of the disease; they do not benefit the majority of patients admitted five or more hours after the onset of symptoms. Transporting patients over relatively long distances during the early phase results in increased mortality. The survival rates for patients treated in small hospitals is quite comparable to that of patients treated in coronary care units. The majority of rural patients with myocardial infarction are therefore more appropriately treated in a small local hospital than by being transferred to a coronary care unit. Those coronary care units which have been established in small hospitals do not appear to have reduced mortality. Patients with myocardial infarction who are being treated in small hospitals should be observed carefully, but electronic monitoring should be used only when there is a specific indication.