After the infarct

Use of secondary prophylaxis against myocardial infarction in the north of England

OBJECTIVE

To record the use of secondary prophylactic drugs in patients discharged from hospital having had a myocardial infarction.

DESIGN

Prospective postal questionnaire survey of a random one in two sample of general practitioners in the region.

SETTING

The nine family practitioner committee areas within the Northern Regional Health Authority.

PATIENTS

Patients who had had a myocardial infarction and were discharged to their general practitioner.

MAIN OUTCOME MEASURE

Whether beta blockers or aspirin, or both, were given on discharge.

RESULTS

Of 267 patients, 158 (59%) were treated suboptimally in that they did not receive a secondary prophylactic drug to which they had no contraindication. For most patients this entailed underuse of one drug, but 17 (6%) of patients received no treatment. beta Blockers were 2.5 times less likely to be used than aspirin. Treatment was not associated with the age or sex of the patient, risk of further infarction, or hospital of discharge.

CONCLUSIONS

Secondary prophylaxis after myocardial infarction is practised haphazardly. It should be offered to all patients who can tolerate it, after a trial period to assess any side effects of the drugs if necessary.

Effect of rapid mobilization on ejection fractions and ventricular volumes after acute myocardial infarction

Despite the current practice of early mobilization and early hospital discharge after uncomplicated acute myocardial infarction (AMI), physicians are reluctant to permit normal physical and social activity for several weeks after the AMI "to allow the heart to heal." This study tested whether it was possible to identify a low risk group of patients on day 3 after AMI, and whether vigorous early mobilization from days 4 through 7 affected left ventricular function and volumes (studied by gated blood pool scan on days 4 and 14). There was 1 death in 3 months in 45 patients with uncomplicated AMI suitable for randomization to activity (group A) compared with 11 deaths in 55 patients unsuitable for rapid early mobilization (group B) (p less than 0.01). Early vigorous mobilization in 24 of the group A patients compared with sedentary care in 20 did not affect change in ejection fraction, end-diastolic volume, end systolic-volume, stroke volume, heart rate or cardiac output between days 4 and 14. A very low risk group suitable for early vigorous mobilization can be defined on day 3 after AMI; further, vigorous early mobilization does not affect left ventricular function or volumes. Early return to physical, social and occupational activity after uncomplicated AMI should result in marked reduction in direct and indirect costs of AMI.