An Australian comparison of specialist care of acute myocardial infarction.
OBJECTIVE
To determine whether patients hospitalized with acute myocardial infarction (AMI) in an Australian setting receive better pharmacological care if managed by cardiologists than by non-cardiologists.


METHODS
Retrospective chart review of patients hospitalized between 1 January 1997 and 30 June 1998, undertaken by abstractors blind to study objectives.


METHODS
One tertiary and two community hospitals in south-east Queensland, Australia, in which all patients admitted with AMI were cared for by cardiologists and general physicians, respectively.


METHODS
Two cohorts of consecutive patients satisfying diagnostic criteria for AMI: 184 in the tertiary hospital and 207 in the community hospitals.


METHODS
Frequency of use, in highly eligible patients, of thrombolysis, beta-blockers, aspirin, angiotensin-converting enzyme (ACE) inhibitors, lipid-lowering agents, nitrates, and calcium antagonists. Cohorts were compared for differences in prognostic factors or illness severity.


RESULTS
In community hospital patients, there was greater use of thrombolysis [100% versus 83% in the tertiary hospital; difference 17%, 95% confidence interval (CI) 11-26%; P < 0.001] and of ACE inhibitors (84% versus 66%; difference 18%, 95% CI 3-34%; P = 0.02), and lower median length of stay (6.0 days versus 7.0 days; P = 0.001) compared with tertiary hospital patients. Frequency of use of other drugs, and adjusted rates of death and re-infarction were the same for both cohorts.


CONCLUSIONS
With respect to pharmacological management of patients hospitalized with AMI, cardiologists and general physicians appear to provide care of similar quality and achieve equivalent outcomes. Further studies are required to confirm the generalizability of these results to Australian practice as a whole.
Scott
Ian A
IA
Internal Medicine, Princess Alexandra Hospital, Brisbane, Australia. ian_scott@health.qld.gov.au
Heath
Kate
K
Harper
Catherine
C
Clough
Aleesa
A
D002309:Cardiology / Q000379:methods / Q000592:standards*; D016507:Cardiology Service, Hospital / Q000592:standards*; D002317:Cardiovascular Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D017723:Drug Utilization Review; D005194:Family Practice / Q000379:methods / Q000592:standards*; D006764:Hospitals, Community / Q000592:standards; D006801:Humans; D009203:Myocardial Infarction / Q000188:drug therapy*; D017063:Outcome Assessment, Health Care / Q000592:standards; D011379:Prognosis; D011793:Queensland; D012189:Retrospective Studies
D002317:Cardiovascular Agents