This Week in BMJ
BMJ No 7050 Volume 313
Saturday 20 July 1996
Despite the established view that women have a poor prognosis after acute myocardial infarction compared with men, results so far are conflicting. To clarify this issue Galatius-Jensen et al (p.137) examined the short and long term prognosis in 3,073 conservatively treated patients with acute myocardial infarction. The patients were recruited consecutively from 16 coronary care units covering a fifth of the total Danish population and were followed for 10 years. After adjustment for the higher age in women with acute myocardial infarction, the sexes had similar early mortality, 10 year mortality, 10 year reinfarction rate, and 10 year mortality after reinfarction. No difference in cause of death was found between the sexes. The authors conclude that sex by itself is not an indicator of risk after acute myocardia] infarction, suggesting that differences in treatment of the sexes after acute myocardial infarction may be one possible reason for the higher mortality among women found in other studies.
The use of steroids for hospitalised children with croup has been controversial in the past but there has been increasing acceptance of their use - firstly in intensive care units and now on general wards. Geelhoed et al (p.140) report extending this work by asking whether steroids might benefit most children who present to emergency departments but are not admitted. They enrolled 100 children and found that whereas 16% of children not treated returned to medical care with croup no child given a small (0.15 mg/kg) oral dose of dexamethasone returned. Though it has always been acknowledged that some children with croup will return to medical care, there has never before been evidence that steroids might help. The findings have positive implications for reducing health care costs in a common condition but, more importantly, for reducing both parental and childhood anxiety associated with croup.
Studies of cognitive function after cardiac arrest outside hospital have been limited by the scarcity of long term survivors. Since the start of Heartstart Scotland, a scheme for defibrillation outside hospital, survival rates have increased dramatically in Edinburgh. Grubb et al (p.143) compared memory function in 35 survivors of cardiac arrest outside hospital with that in 35 survivors of myocardial infarction without cardiac arrest. Nearly 40% of the survivors of cardiac arrest had chronic deficits in their long term memory of a severity likely to affect daily activity. None of the controls had such severe deficits. The severity of memory impairment correlated with the duration of the cardiac arrest. The authors conclude that improving the response times of emergency services may improve cognitive outcome in survivors. With increasing numbers of survivors, the authors advocate cognitive assessment of such patients when they are discharged and propose investigation of specific rehabilitation strategies.
Little is known about the underdiagnosis and undertreatment of asthma among ethnic groups in Britain, although being diagnosed as having asthma increases the chance of having the condition managed. On p.148 Duran-Tauleria et al report the variation in treatment of asthma among different ethnic groups while taking into account sociodemographic factors in a large sample of English and Scottish children. They confirmed the importance of appropriate diagnosis and management of asthma and found that both varied according to ethnic group. For example, children of Afro-Caribbean and Indian subcontinent origin were less likely to be prescribed Beta-2 agonists for their asthma, and those from the Indian subcontinent were less likely to be prescribed anti-inflammatory drugs. Serious efforts should be made to monitor variations in the treatment of asthma among ethnic groups as this may be translated into tangible health gains.