A prospective national survey of management and clinical outcome of acute myocardial infarction in Israel, 2000

Solomon Behar, Alexander Battler, Avi Porath, Jonathan Leor, Ehud Grossman, Yonathan Hasin, Moshe Mittelman, Zvi Feigenberg, Carmit Rahima-Maoz, Manfred Green, Avraham Caspi, Babeth Rabinowitz, Moshe Garty et al.
Israel Medical Association Journal: IMAJ 2003, 5 (4): 249-54

BACKGROUND: Little information is available on the clinical practice and implementation of guidelines for treating acute myocardial infarction patients in Israel.

OBJECTIVE: To assess patient characteristics, hospital course, management, and 30 day clinical outcome of all AMI patients hospitalized in Israel during a 2 month period in 2000.

METHOD: We conducted a prospective 2 month survey of consecutive AMI patients admitted to 82 of 96 internal medicine departments and all 26 cardiac departments operating in Israel in 2000. Data were collected uniformly by means of a hospital and 30 day follow-up form.

RESULTS: During the survey 1,683 consecutive patients with a discharge diagnosis of AMI were included. Their mean age was 66 years; 73% were male. The electrocardiographic pattern on admission revealed ST elevation, non-ST elevation and an undetermined ECG in 63%, 34% and 4% of patients respectively. Aspirin and heparin were given to 95% of patients. Beta-blockers and angiotensin-converting enzyme inhibitors were given to 76% and 65% of patients respectively. Among hospital survivors, 45% received lipid-lowering drugs. Thrombolytic therapy was administered in 28% of patients, coronary angiography was used in 45%, and 7% of patients underwent primary percutaneous coronary intervention. The 7 and 30 day mortality rates were 7% and 11% respectively.

CONCLUSIONS: This nationwide survey shows that one-third of the AMI patients in Israel are elderly (> or = 75 years). The survey suggests that clinical guidelines for the management of patients with AMI are partially implemented in the community. Data from large surveys representing the "real world" practice are of utmost importance for the evaluation of clinical guidelines, research and educational purposes.

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