Assessment of management approach for myocardial infarction by family physicians in central India: a cross sectional survey
Keywords:Myocardial infarction, Family physician
Background: Myocardial infarction (MI) is the most common cause of mortality globally. Patients generally consult their family physicians first and hence the role of these physicians in management of is very important. it is thus pertinent to assess the approach to management of MI patients by the primary health care physicians.
Methods: A cross-sectional survey was conducted with a validated questionnaire among 232 family physicians in central India.
Results: Combination of aspirin, clopidogrel and statins was the treatment of choice by 69.82% of physicians. Use of morphine was not preferred by 87.93% of physicians due to non-availability. Tramadol, diclofenac and pethidine were the analgesics preferred. Use of aspirin was stressed by 91.37% of physicians, of these 56.89% preferred the use of soluble aspirin and 43.10% enteric coated. 91.37% were familiar with ECG findings of MI. As latest treatment of choice 41.37% thought of immediate thrombolysis with tenecteplase whereas 47.41% considered coronary angiogram followed by angioplasty in a nearby cardiac center and 29.74% immediate thrombolysis with streptokinase. Regarding referral to hospital with catheterization laboratory facility, 65.94% opined 3 hours as maximum time period of referral from onset of attack of MI and 43.96% opined it to be 6 hours.
Conclusions: Family practitioners play a key role in timely management of acute MI. Hence updating them on the management of acute MI through various continuing medical education programs is considered mandatory so that timely management can help significantly reduce mortality rates in our country.
Gupta R. Recent trends in coronary heart disease epidemiology in India. Indian Heart J. 2008;60(2): B4-18.
Nallamothu BK, Bradley EH, Krumholz HM. Time to treatment in Primary coronary intervention. N Engl J Med. 2007;357:1631-8.
Yuxiang Dai, Junbo Ge. Clinical use of aspirin in treatment and prevention of cardiovascular disease. Thrombosis. 2012;2012.
Vergnion M, Degesves S, Garcet L, Magotteaux V. Tramadol, an alternative to morphine for treating posttraumatic pain in the prehospital situation. Anesth Analg. 2001;92:1543-6.
Muir N, Nichols D, Clifford JM, Stilling MR, Hoare RC. The influence of dosage form on aspirin kinetics: implications for acute cardiovascular use. Current medical research and opinion. Informa healthcare. 1997;13(10):547-53.
Cox D, Maree AO, Dooley M. Effect of enteric coating on antiplatelet activity of low-dose aspirin in healthy volunteers. Stroke. 2006;37:2153-8.
Nordt T K, Bode C. Thrombolysis: newer thrombolytic agents and their role in clinical medicine. Heart. 2003;89(11):1358-62.
Chesebro JH, Knatterud G, Robberts R, Borer J, Cohen LS, Dalen J et al. Thrombolysis in Myocardial Infarction (TIMI), Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987;76:142-54.
Otall PS, Talwar KK. Limitation of currently available thrombolytic therapy. Indian heart journal. 2009;470-5.
Hong MK. Recent advances in the treatment of ST-Segment elevation myocardial infarction. Scientifica. Hindawi Publishing Corporation. 2012;6836683.
Alward P. Acute myocardial infarction: early treatment. Aust prescr. 1996;19:52-4.
Trujillo E, Bellido I, Pablo JD, Garcia Arnes JA, Alteplase was more efficient than streptokinase, reteplase and tenecteplase in elevated-ST-segment acute myocardial infarction treatment. Proceedings of british pharmacological society. pA2 online E-journal of british pharmacological society. 2012;10(3):Abst395P.
Tanswell P, Modi N, Combs D, Danays T. Pharmacokinetics and Pharmacodynamics of tenecteplase in fibrinolytic therapy of acute myocardial infarction. Clinical pharmacokinetics. 2002;41(15):1229-45.
Saran RK, Sethi R, Nagori M. Tenecteplase- The best among the equals. Indian Heart J. 2009;61:4454-8.
Antman E, Hand M, Armstrong P, et al : 2007 focused update of the ACC/AHA 2004 guidelines for the management of patient with ST-Elevation myocardial infarction: A report of the American college of cardiology/ American heart association task force on practice guidelines. J Am Coll Cardiol. 2008;51:210-47.
Terkelsen CJ, Sorensen JT, Maeng M, Jensen Lo, Tilsted HH, Trautner S, et al. System delay and mortality among patients with STEMI treated with primary percutaneous coronary intervention. JAMA. 2010;304(7):763-71.