Unjustified variations in patient management for acute myocardial infarction in the Rhône-Alpes region of France. PRIMA Group.
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.
Ecochard
R
R
Hospices Civils de Lyon.
Rabilloud
M
M
Colin
C
C
Delahaye
F
F
Ducreux
C
C
Cao
D
D
Matillon
Y
Y
de Gevigney
G
G
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