Stated and actual management of acute myocardial infarction among different specialties

Objectives: To examine the variation in stated management of acute myocardial infarction (AMI) among clinicians of different specialties, and to compare stated with actual practice. Design: Mail survey using a hypothetical case history, and review of medical records. Setting: 47 public hospitals in New South Wales. Subjects: 224 cardiologists, general/other physicians and general practitioners (GPs) who manage patients with AMI; 390 patients admitted for AMI between February and June 1996. Outcome measures: Stated and actual use of treatments and investigations for AMI. Results: Stated use of aspirin, thrombolysis and beta-blockers (95%-100%, 95%-100% and 80%-86%, respectively) was high in all three specialties. Cardiologists were significantly more likely than GPs to state use of heparin (87% v 57%; P<0.001), ACE inhibitors (84% v 49%; P<0.001) and echocardiography or gated pool heart scan (79% v 26%; P<0.001). Stated use of nitrates by cardiologists was significantly lower compared with the other specialties (29% v 50% and 44%; P=0.027). Actual use of aspirin was high (>80%) in all specialties. Actual use of thrombolysis was similar to stated use after adjusting for factors such as time to hospital arrival and ST-segment elevation. There were substantial differences between stated and actual use. Conclusions: There were differences in practice patterns between and among clinicians of different specialties in NSW, consistent with findings from other countries. The high stated and actual use of aspirin and thrombolysis is encouraging.