Clinical StudiesSuccessful implementation of guidelines for encouraging the use of beta blockers in patients after acute myocardial infarction☆
Section snippets
Setting and patients
This study was conducted in the general internal medicine wards of the Hôpital Cantonal, the main teaching hospital of the University of Geneva School of Medicine. This 1,200-bed urban public hospital is the major primary care hospital for the area. Although coronary care unit and cardiology faculty members are responsible for the initial care of patients with myocardial infarction during the first 48 hours, final hospital discharge decisions are made primarily by internists, as patients are
Results
Characteristics of the patients who were treated for acute myocardial infarction during the control period and the guidelines implementation period are shown in Table 1. The mean age of the patients was 66 years, and the majority were men. One third of the patients were older than 75 years. The past medical histories, cardiovascular risk factors, coexisting diseases (eg, diabetes), comorbidity scores, and the characteristics of the acute myocardial infarction were similar in the two groups.
Discussion
Mortality after myocardial infarction can be reduced by the selective use of aspirin, β blockers, and angiotensin-converting enzyme (ACE) inhibitors 9, 10, 11, 12, 13, 14, 22. Use of β blockers, in particular, is one of the best substantiated and cost-effective preventive strategies (23). However, results of randomized controlled trials often have limited impact on medical practice in general and medication use in particular: even cardiologists used β blockers in only 48% of eligible subjects
Acknowledgements
We would like to thank Sandro Pampallona, ScD, of Med, Geneva, Switzerland, for statistical assistance.
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Supported in part by Grant 32-039288 from the Swiss National Fund for Scientific Research (JMG), by a grant from the “Fonds pour la collaboration entre les cantons de Vaud et Genève,” and by a grant from the Hôpital Cantonal, Geneva, Switzerland.