[Frequency and conditions of hospitalization of recent myocardial infarcts in France. The ENIM 84 national survey].

The annual number of patients with recent myocardial infarction who were hospitalized in France was evaluated from the results of a survey conducted during 4 consecutive weeks in a random sample of public and private French hospital units. The actual sampling plan followed very closely the sampling plan devised. About 60,000 patients with infarction seem to be hospitalized annually, by if early deaths and undiagnosed or home-treated infarctions are taken into account the total number of cases probably is noticeably over 100,000 per annum. Two-thirds of the patients were male. Mean age was 63.0 +/- 12.9 years for men and 73.3 +/- 10.2 years for women. 54 p. 100 of infarctions occurred before the age of 65 in men, and 62 p. 100 occurred after the age of 74 in women. The incidence of patients hospitalized was lower than that measured in similar foreign surveys, which was in agreement with the moderate mortality rate ascribed to ischaemic heart disease in France. Almost 10 p. 100 of infarctions occurred in patients already in hospital; in the remaining cases 9 out of 10 patients were admitted less than 48 hours after the initial symptoms. In only 2 out of 3 cases the patients were admitted to an intensive care unit or to a cardiology-oriented department. One out of 5 patients was transferred to another department within 24 hours of admission. The frequency of transfers varied considerably according to the unit where the patient was first received, and was very high in some departments (internal medicine, emergencies, specialized departments other than cardiology). The time elapsed before admission was very long with a wide scattering of values (8.4 +/- 9.9 hours), the median time being 5 hours 30 minutes. The time elapsed before an effective treatment was instituted was 12.1 +/- 12.7 hours in the patients transferred. The usual contra-indications to thrombolytic therapy were encountered in 19 p. 100 of patients of all ages (14 p. 100 in patients under 65). However, the proportions of patients without contra-indications and who were admitted within a few hours of the initial symptoms were low: 9 p. 100 at 2 hours, 24 p. 100 at 3 hours and 37 p. 100 at 4 hours; in patients under 65 the corresponding figures were 12 p. 100, 30 p. 100 and 45 p. 100 respectively. The merit of the ENIM survey was to highlight the problem of access to emergency treatment in many cases of myocardial infarction in France.