The care of patients with acute myocardial infarction (AMI) has undergone significant change over the past several decades, in part due to the introduction and use of bedside hemodynamic monitoring. The flow-directed pulmonary artery (PA) catheter was introduced by Swan and associates in 1970 and has been widely used in scores of critically ill patients since that time. It has been estimated that approximately 100,000 patients with AMI undergo PA catheterization annually in the United States. Use of the PA catheter provides hemodynamic information that may be of benefit in selecting therapeutic options and monitoring outcomes in patients with various complications of AMI. Furthermore, PA catheterization provides data that can be utilized to stratify patients at differential risk of dying during the short-term hospitalization. buy tavist online
Despite its widespread use, however, recent controversy has surrounded the PA catheter because a lack of benefit on selected outcomes has been demonstrated in two large nonrandomized population-based studies of patients hospitalized with AMI. While PA catheterization is typically employed in patients with AMI complicated by left ventricular failure, limited data exist, particularly from a multihospital community-wide perspective, of patient-related factors associated with PA catheterization. Using data from an ongoing population-based study of patients hospitalized with AMI in 16 hospitals in the Worcester, Mass, Standard Metropolitan Statistical Area, we examined the sociodemographic and clinical characteristics of patients with AMI receiving PA catheters in order to provide a profile of patients who undergo this invasive procedure. In addition, we examined changes over time (1975 to 1990) in the utilization of PA catheterization.
The Worcester Heart Attack Study is an ongoing community-wide study examining time trends in the incidence rates as well as in-hospital and long-term case-fatality rates of patients hospitalized with AMI in 16 general hospitals in the Worcester, Mass, Standard Metropolitan Statistical Area (1980 census population= 373,000), during calendar years 1975, 1978, 1981, 1984, 1986, 1988, and 1990.