Patients suffering MIs without chest pain not treated
optimally
Failure to use beneficial treatment strategies for
myocardial infarction (MI) for patients presenting without chest pain
could be a reason for the poor prognosis associated with this form of
acute MI. This is the conclusion of Dr Mischa Dorsch and colleagues of
the British Heart Foundation Heart Research Centre, Leeds General Infirmary.
The researchers reviewed the medical notes of patients
with suspected MIs and confirmed 2,096 consecutive cases over a three-month
period. The mortality rate at both 30 and 365 days post-MI was higher
for patients presenting without chest pain than for patients presenting
with chest pain. The researchers say that this can partly be explained
by the higher risk factor profile of patients presenting without chest
pain (they were older and more likely to have a history of congestive
heart failure). However, these patients were less likely to be managed
within coronary care units or to be discharged from hospital with prescriptions
for aspirin and beta-blockers.
Because some patients are not diagnosed with MI
on admission, they may not be admitted to coronary care units. However,
this does not explain the failure to discharge patients with appropriate
treatment, as diagnosis has been confirmed at this stage. “Reasons for
this may include preferential focus on symptomatic rather than prognostic
treatment strategies,” they say.
The researchers conclude that implementation of
the National Service Framework for Coronary Heart Disease should improve
the care of these patients (Heart 2001;86:494).
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