Emergency management of acute myocardial infarction by the general practitioner.
In the Cape GP Emergency Coronary Care Project, 129 general practitioners (GPs) collaborated over a 14-month period. The objectives were to reach all patients with symptoms of acute myocardial infarction as promptly as possible, and to institute therapy according to a simple protocol, where the emphasis was on the prophylactic administration of antidysrhythmic drugs. The results showed that 38% of a total of 333 patients received treatment within 1 hour of the onset of their symptoms, and 75% within 4 hours. The mortality at the end of 1 month was 15% in 333 patients of all ages, and 10,7% for 272 under the age of 70 years. The over-all community death rate from coronary heart disease in the patients of the participating GPs was 28,3% in 445 patients of all ages, and 23,3% in 356 patients under 70 years of age. These death rates are well below those reported in other comparable series. There was a low incidence of arrhythmic death, and only 1 death among patients who had received appropriate antidysrhythmic therapy. No ill-effects of complications occurred after the routine prophylactic administration of antidysrhythmic drugs. It is concluded that in the prehospital phase of acute myocardial infarciton, the Cape GPs were able to administer a service which compared favourably with that of a mobile intensive coronary care unit, at almost no extra cost to the community, and with very little extra strain on their practices.
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000150:complications; D004630:Emergencies; D005194:Family Practice; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D013019:South Africa; D013997:Time Factors