342 French national survey on the hyperglycemia management in acute coronary syndrome, comparison between coronary care units and out-of-hospital mobile emergency units practices

BackgroundThe 2006 French recommendations concerning acute myocardial infarction management occurring out of cardiologic unit recommend a close control of glycemia. The aim of our study was to assess spread of these recommendations.MethodsWe conducted in 2008 a national phone survey in coronary care units (CCU) and out-of-hospital mobile emergency units (SMUR). Senior physicians were asked about local hyperglycemia protocol management for patients with acute coronary syndrome (ACS).ResultsThe mains answers from the cardiologists and the emergency physicians (EP) are listed in the table.CCU n=125SMUR n=245Systematic glycemia dosage in patients with chest pain55%55%Systematic glycemia dosage in patients with ACS59%63%Specific insulin protocol in patients with ACS5514Same hyperglycemia treatment for diabetic and non diabetic patient52%62%% of physicians who have already treated hyperglycemia during ACS98%37%Only 50 percent of the SMUR have insulin for out of hospital treatment. In the CCU the first result of glycemia is a capillary dosage for 64% and a blood dosage for 36%.The glycemia threshold for the insulin treatment ranges from 1 to 3 g/l. For 14% of EP there is no indication of hyperglycemia treatment during the out of hospital management of ACS. For 99% of cardiologists there is an indication of treatment by insulin for hyperglycemia during the ACS.ConclusionThe early management of hyperglycemia in patients with ACS is more widespread in CCU than in out of hospital emergency context. Recommendations concerning early hyperglycemia management in patients with ACS have to be more spread among emergency physicians