Physician practice in the management of patients with uncomplicated myocardial infarction: changes in the past decade.

Abstract

To determine changes in the patterns of care between 1970 and 1980 for patients with uncomplicated acute myocardial infarction, questionnaires were sent to almost 6000 physicians in 1979 and responses were compared with those of a similar survey taken in 1970. Almost all physicians in 1979 reported the availability and use of an intensive care/coronary care unit facility with continuous electrocardiographic monitoring. Progressive-care facilities are also becoming more widely available. The median length of hospitalization has decreased markedly. Early ambulation and an earlier return to work are more common. There is a high level of informal patient and patient-family counseling about myocardial infarction and its management, both during and after hospitalization, and wider use of educational materials. Most physicians continue to recommend progressive physical activity after hospitalization. The routine prescription of anticoagulant therapy during hospitalization has declined, while prescription of prophylactic antiarrhythmic agents has increased. Nitrate drugs and tranquilizers are routinely prescribed by a large percentage of physicians for their patients with uncomplicated myocardial infarction. Use of standard exercise tests has increased among all physician specialties. The treadmill test is most often used, and testing is typically done 6 weeks after infarction. A significant increase in the availability of and familiarity with exercise testing is characteristic of all medical specialties. Symptoms of new chest pain and palpitations are now considered important enough to warrant the recommendation to report immediately to an emergency room. Other current findings include the routine use of coronary angiography by a large percentage of physicians to evaluate the need for surgical intervention, and the routine posthospitalization prescription by only a small percentage of physicians of aspirin and of nitrate drugs for patients with uncomplicated myocardial infarction.