Secondary prevention of coronary heart disease in patients after acute myocardial infarction at the Soroka medical center

The records of 214 patients with acute myocardial infarction (AMI) admitted to Soroka Medical Center in 1989 were reviewed to assess the quality of medical treatment after AMI. Medical treatment was reviewed with respect to administration, indications, and contraindications of specific drugs. Sixty-nine percent of patients received suboptimal treatment with respect to aspirin and beta blockers, which was almost always due to undertreatment rather than overprescription. Only 23% of patients with mural thrombi, as shown by echocardiography and without contraindications to anticoagulants, received coumadin. Patients hospitalized in the Intensive Coronary Care Unit received somewhat better medical care with regard to aspirin, beta blockers and coumadin. Appropriate decisions whether to give or withhold thrombolytic therapy were made in 81% of the cases and it was given to 29% of the patients. We conclude that during the period of this study there was a considerable gap between: a) recommendations in the medical literature, and b) the quality of care provided to AMI patients with regard to medications prescribed by physicians for preventive medical therapy.