title: Unjustified variations in patient management for acute myocardial infarction in the Rhône-Alpes region of France. PRIMA Group.
abstract: OBJECTIVE
  To examine determinants of use of cardiac procedures after acute myocardial infarction and identify variation factors.
  
  
  METHODS
  Observational prospective cohort study of 2,519 patients in 48 centers with a two-level logistic-regression analysis.
  
  
  RESULTS
  Elderly patients were less likely to undergo pre- and inhospital thrombolysis (odds ratios, 0.71 and 0.64; 95% CI, 0.62-0.81 and 0.58-0.69, respectively). The elderly, females, and patients with heart failure on admission were less likely to undergo noninvasive tests (0.74, 0.62, and 0.51; 95% CI, 0.67-0.81, 0.46-0.83, and 0.38-0.68, respectively) and coronary angiography (0.38, 0.53, and 0.67; 95% CI, 0.34-0.42, 0.38-0.74, and 0.52-0.86, respectively) but not revascularization. Hospital factors were more difficult to interpret.
  
  
  CONCLUSIONS
  Elderly, women, and heart failure patients underwent fewer cardiac procedures than lower-risk patients. Physicians should change their attitude toward these groups and use advanced procedures, bearing in mind the patients' needs rather than good procedural outcomes.
authors.affiliation: Hospices Civils de Lyon.
authors.forename: R
authors.initials: R
authors.lastname: Ecochard
authors.forename: M
authors.initials: M
authors.lastname: Rabilloud
authors.forename: C
authors.initials: C
authors.lastname: Colin
authors.forename: F
authors.initials: F
authors.lastname: Delahaye
authors.forename: C
authors.initials: C
authors.lastname: Ducreux
authors.forename: D
authors.initials: D
authors.lastname: Cao
authors.forename: Y
authors.initials: Y
authors.lastname: Matillon
authors.forename: G
authors.initials: G
authors.lastname: de Gevigney
mesh_terms: D000367:Age Factors; D000368:Aged; D015331:Cohort Studies; D017023:Coronary Angiography / Q000706:statistics & numerical data; D003953:Diagnosis-Related Groups; D005163:Factor Analysis, Statistical; D005260:Female; D005602:France; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000628:therapy*; D018579:Patient Selection; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011446:Prospective Studies; D018570:Risk Assessment; D012737:Sex Factors