Current practice patterns in the management of acute myocardial infarction. Survey of the American College of Chest Physicians

Over the past decade, the management of patients with acute myocardial infarction has undergone remarkable change due in part to the availability of new diagnostic and therapeutic modalities. Many of these techniques have gained widespread acceptance and use without the benefit of studies demonstrating efficacy. A survey of 391 members of the Section on Clinical Cardiology of the American College of Chest Physicians was conducted to assess current practice patterns in the management of acute myocardial infarction. Significant differences in the routine (greater than or equal to 50 percent of the time) use of various management approaches were found, with exercise tolerance testing, echocardiography, Holter monitoring, and cardiac rehabilitation frequently employed, whereas electrophysiologic studies, pyrophosphate scans, pulmonary artery catheterization, and cardiac pacing were infrequently used. Significant differences in the use of these procedures were noted with regard to the age of the physician and his or her geographic location of practice. These differences in practice patterns indicate that physicians have not reached consensus with regard to the value of these new diagnostic procedures and therapeutic approaches in the treatment of patients with acute myocardial infarction. Given the incremental costs of these procedures, clinical trials to assess their efficacy are clearly indicated