[Pilot register of acute myocardial infarction--a 5-year evaluation of quality of care in non-PCI hospitals]. / Pilotní registr akutního infarktu myokardu--hodnocení kvality péce v non-PCI nemocnicích v prubehu 5 let.

INTRODUCTION: The aim of this research was to describe (demographic data and cardiovascular disease risk factors) a non-selected patient population with acute myocardial infarction and to evaluate the applied diagnostic and therapeutic approaches. PATIENTS AND METHODS: Data on 3,184 cases of acute myocardial infarction from non-PCI hospitals in Cáslav, Chrudim, Jindrichuv Hradec, Kutná Hora, Písek and Znojmo were entered in a pilot register between 2003 and 2007. RESULTS: ST elevation myocardial infarctions represented 28.5% of registered cases; primary reperfusion was indicated in 68.3% of these cases. Coronarography was indicated in 43.8% of patients in the non-ST elevation myocardial infarction subgroup. When evaluating pharmacotherapy administered during the first 24 hours following admission, a statistically significant increase in pharmacotherapy administration over the 5 years of register existence was observed (the most apparent for clopidrogel--increase from 24.6% to 63.3%). Analysis of medication recommended for use at discharge also revealed significant increase in administration of the recommended medication over the 5 years in all evaluated drug groups--the most significant, once again, for thienopyridines (increase from 34.9% to 49.6%). In-hospital mortality decreased over the 5 years from 15.2% in 2003 to 8.0% in 2007. CONCLUSION: The 5-year evaluation of diagnostic and therapeutic approaches applied in patients with acute myocardial infarction in non-PCI hospitals confirmed improvement in care provided, specifically improved adherence to pharmacotherapy as well as interventional treatment guidelines pertinent to this patient group. Together with increased quality of care, we observed a decline in in-hospital mortality of patients with acute myocardial infarction.

Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine.

Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.

[Therapy of acute myocardial infarction in unspecialised medical centres--evaluation of diagnostic and therapeutic practice]. / Terapie akutního infarktu myokardu mimo kardiocentrum--zhodnocení diagnostických a lécebných postupu.

BACKGROUND: No general register of patients with acute coronary syndrome is available in the Czech Republic. That is why the everyday clinical practice remains indeterminate. The aim of the study was to compare patients' characteristics, diagnostic and therapeutic procedures in patients with acute myocardial infarction admitted to three municipal hospitals (Caslav, Kutna Hora, Znojmo) and to assess the correspondence of the local clinical practice with the current guidelines. METHODS AND RESULTS: A total of 564 patients (300 men, 264 women) mean age 71 +/- 11.9 years) admitted for acute myocardial infarction was included into the study. No significant difference was found in the demographic data among the hospitals. Higher proportion of smokers was observed in the hospital of Kutna Hora (p < 0.01). In the studied sample, the proportion of myocardial infarctions without ST elevation was larger than that without it (311 pts. - 73%). In the subgroup of patients with myocardial infarction and ST elevation 67% received some form of reperfusion therapy (primary angioplasty in 63 % and fibrinolytic therapy in 4%). Most patients received aspirin and heparin (78% a 82% respectively) within the first 24 hours; the treatment with beta-blockers was less common (34%). The most frequent in-hospital complication was the heart failure (23%). In-hospital mortality for all patients was 15%. At the discharge from hospital, patients received flowing treatment: aspirin (76%), beta-blockers (63%), ACE inhibitors (58%), statins (54%). A significant difference was found only in the use of clopidogrel and ticlopidin (p < 0.001). CONCLUSIONS: This study reveals only minor differences in the management of patients among hospitals and demonstrates some differences between existing guidelines and current clinical practice. The vast majority of patients with acute myocardial infarction with ST elevation was treated by primary angioplasty.