Skip to main content
NCBI home page
Canadian Family Physician logoLink to Canadian Family Physician
. 1984 Nov;30:2362–2366.

The Rural Physician and Myocardial Infarction: Part 2: The Hospital Phase of Treatment

Douglas P Black
PMCID: PMC2154103  PMID: 21279063

Abstract

A critical review of the literature reveals several facts which are important in helping the rural physician decide where and how patients with myocardial infarction should be treated. The effectiveness of coronary care units has not been well established, even for patients admitted during the early phase of the disease; they do not benefit the majority of patients admitted five or more hours after the onset of symptoms. Transporting patients over relatively long distances during the early phase results in increased mortality. The survival rates for patients treated in small hospitals is quite comparable to that of patients treated in coronary care units. The majority of rural patients with myocardial infarction are therefore more appropriately treated in a small local hospital than by being transferred to a coronary care unit. Those coronary care units which have been established in small hospitals do not appear to have reduced mortality. Patients with myocardial infarction who are being treated in small hospitals should be observed carefully, but electronic monitoring should be used only when there is a specific indication.

Full text

PDF
2362

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Armstrong A., Duncan B., Oliver M. F., Julian D. G., Donald K. W., Fulton M., Lutz W., Morrison S. L. Natural history of acute coronary heart attacks. A community study. Br Heart J. 1972 Jan;34(1):67–80. doi: 10.1136/hrt.34.1.67. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Black D. P. Management of myocardial infarction in a rural area. Can Med Assoc J. 1973 Nov 3;109(9):863–867. [PMC free article] [PubMed] [Google Scholar]
  3. Black D. P. The rural physician and myocardial infarction: part 1: pre-hospital management. Can Fam Physician. 1984 Nov;30:2355–2358. [PMC free article] [PubMed] [Google Scholar]
  4. Christiansen I., Iversen K., Skouby A. P. Benefits obtained by the introduction of a coronary-care unit. A comparative study. Acta Med Scand. 1971 Apr;189(4):285–291. doi: 10.1111/j.0954-6820.1971.tb04377.x. [DOI] [PubMed] [Google Scholar]
  5. Curtis P. Family practice grand rounds: myocardial infarction--home or hospital care. J Fam Pract. 1978 Mar;6(3):643–648. [PubMed] [Google Scholar]
  6. Davies A. Coronary care in a general practitioner hospital. Br Med J (Clin Res Ed) 1982 Nov 20;285(6353):1469–1470. doi: 10.1136/bmj.285.6353.1469. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Falk R. H. Medication in acute myocardial infarction -- does it do as much harm as good? Med Hypotheses. 1979 Oct;5(10):1123–1127. doi: 10.1016/0306-9877(79)90028-8. [DOI] [PubMed] [Google Scholar]
  8. Geyman J. P. A coronary care unit in a 25-bed rural hospital. Calif Med. 1970 Jan;112(1):74–77. [PMC free article] [PubMed] [Google Scholar]
  9. Headley R. N., Woodruff L. F., Jr, Nelson L. H., 3rd Is coronary care really feasible in small rural hospitals? South Med J. 1973 Aug;66(8):929–933. doi: 10.1097/00007611-197308000-00019. [DOI] [PubMed] [Google Scholar]
  10. Levenstein J. H. Myocardial infarction and the evolution of the intensive coronary care unit. S Afr Med J. 1976 Jun 5;50(24):918–926. [PubMed] [Google Scholar]
  11. Lown B., Selzer A. The coronary care unit. Am J Cardiol. 1968 Oct;22(4):597–602. doi: 10.1016/0002-9149(68)90167-7. [DOI] [PubMed] [Google Scholar]
  12. MacMillan R. L., Brown K. W. Comparison of the effects of treatment of acute myocardial infarction in a coronary unit and on a general medical ward. Can Med Assoc J. 1971 Nov 20;105(10):1037–1040. [PMC free article] [PubMed] [Google Scholar]
  13. Mather H. G., Morgan D. C., Pearson N. G., Read K. L., Shaw D. B., Steed G. R., Thorne M. G., Lawrence C. J., Riley I. S. Myocardial infarction: a comparison between home and hospital care for patients. Br Med J. 1976 Apr 17;1(6015):925–929. doi: 10.1136/bmj.1.6015.925. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. Mather H. G., Pearson N. G., Read K. L., Shaw D. B., Steed G. R., Thorne M. G., Jones S., Guerrier C. J., Eraut C. D., McHugh P. M. Acute myocardial infarction: home and hospital treatment. Br Med J. 1971 Aug 7;3(5770):334–338. doi: 10.1136/bmj.3.5770.334. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Mitchell J. R. "But will it help my patients with myocardial infarction?" The implications of recent trials for everyday country folk. Br Med J (Clin Res Ed) 1982 Oct 23;285(6349):1140–1148. doi: 10.1136/bmj.285.6349.1140. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Morris A. L., Nernberg V., Roos N. P., Henteleff P., Roos L., Jr Acute myocardial infarction: survey of urban and rural hospital mortality. Am Heart J. 1983 Jan;105(1):44–53. doi: 10.1016/0002-8703(83)90277-6. [DOI] [PubMed] [Google Scholar]
  17. Mulholland H. C., Pantridge J. F. Heart-rate changes during movement of patients with acute myocardial infarction. Lancet. 1974 Jun 22;1(7869):1244–1247. doi: 10.1016/s0140-6736(74)90002-6. [DOI] [PubMed] [Google Scholar]
  18. Naney A. P. Coronary care in a small rural hospital. J Natl Med Assoc. 1970 May;62(3):204–207. [PMC free article] [PubMed] [Google Scholar]
  19. Rawlins D. C. Study of the management of suspected cardiac infarction by British immediate care doctors. Br Med J (Clin Res Ed) 1981 May 23;282(6277):1677–1679. doi: 10.1136/bmj.282.6277.1677. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Sackett D. L. Bias in analytic research. J Chronic Dis. 1979;32(1-2):51–63. doi: 10.1016/0021-9681(79)90012-2. [DOI] [PubMed] [Google Scholar]
  21. Sucsy R. W. Myocardial infarction in a rural Maine hospital. J Maine Med Assoc. 1979 Jul;70(7):263–264. [PubMed] [Google Scholar]

Articles from Canadian Family Physician are provided here courtesy of College of Family Physicians of Canada

RESOURCES