title: Cardiologists' and emergency physicians' perspectives on and knowledge of reperfusion guidelines pertaining to ST-segment-elevation myocardial infarction.
abstract: We sought to determine U.S. physicians' knowledge and perspectives regarding the 2004 American College of Cardiology/American Heart Association guidelines for management of patients who have ST-segment-elevation myocardial infarction (STEMI). We invited 45,998 physicians from the American Medical Association's roster to take an Internet survey of U.S. cardiologists and emergency physicians who were hospital-based or who had hospital-admitting privileges. To represent individual and combined populations, data were weighted on the basis of years in practice, sex, and geographic region. Of 505 cardiologists and 509 emergency physicians who completed the survey, 90% worked in an urban or suburban setting and 82% at hospitals with a cardiac catheterization laboratory. Sampling error was +/-3.4%. Most respondents (61%) believed that overall myocardial infarction treatment needed a "great deal" or "fair amount" of improvement; 24% were "somewhat" or "not at all" familiar with the guidelines. Although 84% knew the recommended STEMI treatments for a patient who presents within 3 hours of symptom onset without contraindications to reperfusion or delay to invasive treatment, only 11% knew that there is no preferred approach. If percutaneous coronary intervention proved impossible within 90 minutes of presentation, 21% reported that eligible patients--assuming early presentation, confirmed STEMI diagnosis, and no high-risk STEMI or contraindications to fibrinolysis--would "rarely" or "never" receive guideline-recommended fibrinolysis. Many cardiologists and emergency physicians are unfamiliar with the guidelines and with the uncertainty that surrounds therapeutic approaches, which suggests the need for increased education on effective treatments to expedite myocardial reperfusion in STEMI.
authors.affiliation: Department of Emergency Medicine, Cleveland Clinic, Cleveland, Ohio 44195-0002, USA. Peacocw@ccf.org
authors.forename: W Frank
authors.initials: WF
authors.lastname: Peacock
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.forename: Deborah
authors.initials: D
authors.lastname: Diercks
authors.forename: Ezra
authors.initials: E
authors.lastname: Amsterdam
authors.forename: Abhinav
authors.initials: A
authors.lastname: Chandra
authors.forename: E Magnus
authors.initials: EM
authors.lastname: Ohman
authors.forename: David F M
authors.initials: DF
authors.lastname: Brown
authors.forename: James
authors.initials: J
authors.lastname: Januzzi
mesh_terms: D000328:Adult; D015906:Angioplasty, Balloon, Coronary; D001291:Attitude of Health Personnel; D002309:Cardiology; D002983:Clinical Competence; D004635:Emergency Medicine; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D010820:Physicians; D017410:Practice Guidelines as Topic; D015912:Thrombolytic Therapy; D014481:United States