Evidence-Based Therapies for Myocardial Infarction: Secular Trends and Determinants of Practice in the Community

Perschbacher, James M.; Reeder, Guy S.; Jacobsen, Steven J.; Weston, Susan A.; Killian, Jill M.; Slobodova, Adriana; Roger, Véronique L.
August 2004
Mayo Clinic Proceedings;Aug2004, Vol. 79 Issue 8, p983
Academic Journal
OBJECTIVES: To examine secular trends In the use of evidence-based therapies In a geographically defined cohort of patients with myocardial Infarction (MI) and to test the hypotheses that baseline use Is Increasing and that disparities in use are diminishing. PATIENTS AND METHODS: All consecutively hospitalized patients who were dismissed from Olmsted County, Minnesota, hospitals between 1979 and 1998 with a diagnosis of MI were Identified using standardized criteria (biomarkers, cardiac pain, and electrocardiography). The entire community medical record, available via the Rochester Epidemiology Project, was reviewed to ascertain base-line characteristics Including comorbidity, presence of ST-segment elevation on electrocardiography, and treatment. Logistic regression models were used to examine the association of treatment with age and sex, independent of other baseline characteristics. RESULTS: Between 1979 and 1998, 2317 incident Mls (patient mean ± SD age, 67±14 years; 43% women; 57% aged ≥65 years) occurred In Olmsted County. The use of all evidence-based therapies increased over time, primarily reflecting the introduction of these medications at the time of index MI. Between 1989 and 1998, age was not independently associated with use of aspirin or ACE inhibitors. Disparities in use persisted for reperfusion therapy and β-blockers, Reperfusion therapy or revascularization was used less frequently in older persons, particularly in elderly women (P<.001). Use of β-blockers decreased 16% among persons aged 65 years or older, independent of measurable differences in baseline characteristics and MI severity (hazard ratio, 0.84; 95% confidence interval, 0.74-0.93). CONCLUSIONS: The use of all evidence-based therapies for MI increased markedly over time; however, residual gaps in use were noted. Reperfusion therapy or revascularization is used less frequently In women and elderly persons, and β-blockers are used less frequently in elderly persons. These differences are not explained by measurable differences In baseline characteristics. Women and elderly persons represent an increasing proportion of patients with MIs in the community; therefore, these findings define therapeutic opportunities.


Related Articles

  • Clinical Epidemiology, Clinical Care, and the Public's Health. Lauer, Michael S. // Mayo Clinic Proceedings;Aug2004, Vol. 79 Issue 8, p975 

    Editorial. Comments on J.M. Perschbacher and colleagues' study on the use of accepted evidence-based therapies for acute myocardial infarction in Olmsted County, Minnesota. Definition of clinical epidemiology; Challenges associated with measuring quality of clinical care with epidemiological...

  • Public health education for medical students: reflections over the last two decades. Ben-Shlomo, Yoav // Journal of Public Health;Mar2010, Vol. 32 Issue 1, p132 

    The author offers insights on changes and developments in public health education. He notes that medical students in the 21st century need to be skilled in critical appraisal of evidence, and have an understanding of global health threats such as climate change and pandemics. He asserts that...

  • Decision-Making in Multiple Sclerosis Consultations in Italy: Third Observer and Patient Assessments. Pietrolongo, Erika; Giordano, Andrea; Kleinefeld, Monica; Confalonieri, Paolo; Lugaresi, Alessandra; Tortorella, Carla; Pugliatti, Maura; Radice, Davide; Goss, Claudia; Heesen, Christoph; Solari, Alessandra // PLoS ONE;Apr2013, Vol. 8 Issue 4, p1 

    Objective: To assess decision-making in multiple sclerosis (MS) from third observer and patient perspectives. Method: Audio recordings of first-ever consultations with a participating physician (88 outpatients, 10 physicians) at four tertiary MS care clinics in Italy, were rated by a...

  • Other articles notes.  // Evidence Based Medicine;Aug2006, Vol. 11 Issue 4, p127 

    The article presents a list of articles that have met the criteria to be included in the periodical "Evidence-Based Medicine," but were abstracted. The mentioned articles include "Effect of cholecalciferol plus calcium on falling in ambulatory older men and women: a 3-year randomized controlled...

  • Mortality reduced by evidence-based therapy use in STEMI.  // PharmacoEconomics & Outcomes News;5/14/2011, Issue 628, p6 

    The article discusses a research on the link between evidence-based therapy use and survival for patients with ST-elevation myocardial infarction, which was published in the April 27, 2011 issue of the "JAMA: The Journal of the American Medical Association."

  • Health Management and Evidence-Based Medicine. Makdisse, Marcia; Katz, Marcelo // Einstein (16794508);Jul-Sep2013, Vol. 11 Issue 3, following p399 

    An introduction is presented in which the editor discusses various reports within the issue on topics including the health management, evidence-based medicine (EBM), and the impact of the implementation of the guidelines for the quality indicators of acute myocardial infarction.

  • Evidence-Based Medicine and Psychiatric Practice. Gray, Gregory E.; Pinson, Letitia A. // Psychiatric Quarterly;Dec2003, Vol. 74 Issue 4, p387 

    Evidence-based medicine (EBM) has been defined as �the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients.� EBM requires the ability to apply a knowledge of medical informatics (e.g., efficiently searching the...

  • Introduction to the symposium: what evidence based medicine is and what it is not. Liberati, A.; Vineis, P. // Journal of Medical Ethics;Apr2004, Vol. 30 Issue 2, p120 

    Deals with the concept and functions of evidence-based medicine (EBM). Significance of clinical epidemiology to medical education; Statement issued by proponents of EBM; Contributions of EBM to the field of medicine.

  • The GRADE approach and Bradford Hill's criteria for causation. Schünemann, Holger; Hill, Suzanne; Guyatt, Gordon; AklElie, A.; Ahmed, Faruque // Journal of Epidemiology & Community Health;May2011, Vol. 65 Issue 5, p392 

    An essay is presented on the consideration of the Bradford Hill criteria for causation in the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to grading the quality of evidence and strength of recommendations and the relation of the approach to public health...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics