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Early management of myocardial infarction

BMJ 1994; 308 doi: (Published 30 April 1994) Cite this as: BMJ 1994;308:1159
  1. Alastair D Short,
  2. West Barbara
  1. Former chairman, Chairman, Community/Primary Care Audit Committee, c/o GP Subcommittee, Glasgow G9 9JT.

    The challenge for GPs is to change

    EDITOR,--At the same time as Hazel Wyllie and Francis Dunn were doing their study on use of aspirin in cases of chest pain in the north sector of Glasgow,1 the first part of an audit was carried out among general practitioners in all of Glasgow over a period of a year. Half of those involved in 156 incidents of chest pain carried aspirin routinely, a fifth gave aspirin to patients with chest pain suspected of being myocardial infarction. The preliminary results were shown at the Scottish National GP Audit Symposium. Since then (and since Wyllie and Dunn's study) the results have been presented at meetings attended by Glasgow general practitioners and the need for aspirin discussed and emphasised. More meetings are planned.

    Chest pain at home can be difficult to diagnose and manage. Most chest pain is not cardiac in origin, and the presentation of myocardial infarction may not be classical. General practitioners tend to be concerned with assessing the patient, relieving symptoms, handling anxious relatives, and arranging for patients to be transferred to hospital and given thrombolysis as soon as possible. Doubts over diagnosis may have inhibited use of aspirin in the past, and it is not long since aspirin was being pilloried for its side effects. Intravenous analgesia in the patient's home is not always without hazard. In a city like Glasgow with “immediate” ambulances patient transfer is quick.

    Wyllie and Dunn's study depended on the recollections of patients who were unwell. Our study depended on the general practitioners accurately recording their actions. Both these methods may lead to some bias.

    The challenge is to change. Publishing papers in academic journals seems to be of limited effect; implementing change is more likely to work if the difficulties perceived by general practitioners are addressed. General practitioners in Glasgow have already taken action to improve management of this situation. There is no room for complacency, but future audits should show a rise in the administration of aspirin and appropriate drug therapy.


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