Therapy for management of acute myocardial infarction (AMI) varies according to patient, prescriber, and geographical characteristics. This study described the in-hospital use of reperfusion therapy for ST-elevation AMI, and discharge use of aspirin, beta-blockers, angiotensin converting enzyme inhibitors (ACEI), and statins in patients presenting with AMI in Canada from 1999 – 2002.
Four Canadian registries (FASTRAK II, CACS, EFFECT, and ICONS) were used to identify AMI patients in Canada and to measure in-hospital reperfusion and medication utilization. Utilization rates were compared by age, sex, time period, and geographical area, according to available data. Utilization rates for reperfusion in ST-elevation MI patients ranged from 60-70%, primarily representing fibrinolytic therapy. Delay in presentation to hospital after symptom onset represents an impediment to timely therapy, which is particularly pronounced for women and the elderly. Overall, less than 50% of patients met the door-to-needle targets of <30 minutes. Medication utilization rates at discharge increased from 1999/00 to 2000/01 to: aspirin 83-88%, beta-blockers 74-89%, ACEI 54-67%, statins 41-53%, and calcium antagonists 21-32% across the different data sources.
Canadian and provincial rates of use of evidence-based medications for the treatment of AMI have increased over time, although there remains room for improvement. A single, comprehensive data source would supply better insights into the management of AMI in Canada.
