Acute myocardial infarction treatments in 58 Italian hospitals: a drug utilization survey.
OBJECTIVE
To provide an updated and comprehensive profile of therapeutic practice in the management of acute myocardial infarction (AMI) in a sample of Italian hospitals, and to test the possible role of a network of hospital pharmacists in providing drug utilization data.


METHODS
Prospective drug utilization survey. Participating pharmacists collected information on patients consecutively admitted to the hospital with a suspected AMI. The form reproduced those adopted in the Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto miocardico trials.


METHODS
Fifty-eight general hospitals in Italy belonging to the National Health Service, 6 of which are teaching hospitals. Thirty-four hospitals recruited patients from a coronary care unit, 10 from intensive monitoring beds in cardiology wards, and 14 from an intensive care unit.


METHODS
The study population consisted of patients consecutively admitted with a suspected AMI from May 31 through July 5, 1993.


METHODS
The management of AMI in terms of the use of drugs and nonpharmacologic treatments is described.


RESULTS
Of the 676 patients recruited for the study, 47.8% received thrombolytic therapy; alteplase was the preferred agent (55.4% of treated patients). The use of thrombolytic therapy varied significantly according to different demographic and clinical parameters such as age, sex, delay from the onset of symptoms to admission, and Killip scale class. During the first day of hospitalization 63.9% of patients received aspirin, 83.3% received nitrates, 24.8% received beta-blockers, and 77.1% received heparin therapy.


CONCLUSIONS
Thrombolytic therapy was prescribed in a higher percentage of patients than is reported in the US, but lower than that reported in large trials. That a low percentage of patients who experienced a long delay between the onset of symptoms and admission as well as elderly patients received thrombolytic therapy reflects the lower expectations of clinicians for these subgroups of patients. A low proportion of patients received aspirin therapy. This study showed that in Italy an institutional network of hospital pharmacists could be interested observers of therapeutic practice, but further training is needed before high-quality data can be collected.
Venturini
F
F
Centro Studi SIFO (Italian Society of Hospital Pharmacy-Societa Italiana di Farmacia Ospedaliera Research Center), Consorzio Mario Negri Sud, Santa Maria Imbaro Chieti, Italy.
Romero
M
M
Tognoni
G
G
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D017723:Drug Utilization Review; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy*; D010607:Pharmacy Service, Hospital; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*
D000319:Adrenergic beta-Antagonists; D010959:Tissue Plasminogen Activator; D001241:Aspirin