Document Detail


Geographic variation in the treatment of acute myocardial infarction: the Cooperative Cardiovascular Project.
MedLine Citation:
PMID:  10029124     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
CONTEXT: Quality indicators for the treatment of acute myocardial infarction include pharmacologic therapy, reperfusion, and smoking cessation advice, but these therapies may not be administered to all patients who could benefit from them. OBJECTIVE: To assess geographic variation in adherence to quality indicators for treatment of acute myocardial infarction. DESIGN: Inception cohort using data from the Health Care Financing Administration Cooperative Cardiovascular Project. SETTING: Acute care hospitals in the United States. PATIENTS: A total of 186800 Medicare beneficiaries hospitalized for treatment of confirmed acute myocardial infarction from February 1994 through July 1995. MAIN OUTCOME MEASURES: Adherence to quality indicators for pharmacologic therapy, reperfusion, and smoking cessation advice for patients judged to be ideal candidates for these therapies. The mean rates of adherence to these quality indicators for the entire United States were determined, and the 20th and 80th percentiles of the age- and sex-adjusted rates for each of 306 hospital referral regions were contrasted (mean rate [20th-80th percentiles]). RESULTS: Aspirin was used frequently both during hospitalization (86.2% [82.6%-90.1%]) and at discharge (77.8% [72.5% -83.9%]). Calcium channel blockers were withheld from most patients with impaired left ventricular function (81.9% [73.6%-90.8%]). Lower rates were seen in the use of angiotensin-converting enzyme inhibitors at discharge (59.3% [49.2%-69.2%]); reperfusion, using thrombolytic therapy or coronary angioplasty (67.2% [59.8%-75.1%]); prescription of beta-blockers at discharge (49.5% [35.8%-61.5%]); and for smoking cessation advice (41.9% [32.8%-51.3%]). CONCLUSIONS: Substantial geographic variation exists in the treatment of patients with acute myocardial infarction, and these gaps between knowledge and practice have important consequences. Therapies with proven benefit for AMI are underused despite strong evidence that their use will result in better patient outcomes.
Authors:
G T O'Connor; H B Quinton; N D Traven; L D Ramunno; T A Dodds; T A Marciniak; J E Wennberg
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Publication Detail:
Type:  Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  JAMA : the journal of the American Medical Association     Volume:  281     ISSN:  0098-7484     ISO Abbreviation:  JAMA     Publication Date:  1999 Feb 
Date Detail:
Created Date:  1999-03-03     Completed Date:  1999-03-03     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7501160     Medline TA:  JAMA     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  627-33     Citation Subset:  AIM; IM    
Affiliation:
Center for the Evaluative Clinical Sciences, Dartmouth Medical School, Hanover, NH 03755, USA. gerald.t.o'connor@dartmouth.edu
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MeSH Terms
Descriptor/Qualifier:
Cardiology Service, Hospital / standards*,  statistics & numerical data
Cardiovascular Agents
Drug Utilization
Female
Guideline Adherence*
Health Knowledge, Attitudes, Practice*
Humans
Logistic Models
Male
Medicare
Myocardial Infarction / therapy*
Myocardial Revascularization / utilization
Physician's Practice Patterns / statistics & numerical data*
Quality Indicators, Health Care*
Smoking Cessation
United States / epidemiology
Chemical
Reg. No./Substance:
0/Cardiovascular Agents

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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