Disparity in the process and outcome of the treatment for acute myocardial infarction in Japan: CAMPAIGN Study in the National Hospital Network.

ABSTRACT

BACKGROUND: A nationwide survey of the process and outcome of treatment for acute myocardial infarction (AMI) has not been conducted in Japan. METHODS AND RESULTS: In the present study 2,007 patients with AMI admitted to 22 national hospitals were registered between July 1999 and January 2002 for CAMPAIGN Study 1; an additional 206 and 238 cases were registered between October and December 2002 (CAMPAIGN 2) and between October and December 2003 (CAMPAIGN 3), respectively. In CAMPAIGN 1, the length of stay varied from 15 to 35 days among hospitals (mean 24.8 days), and was mainly determined by the schedule of follow-up examinations rather than clinical course. Of the prescriptions at discharge, beta-blockers and angiotensin-converting enzyme inhibitors varied widely; the use of beta-blockers was very low (25%). Nitrates were frequently used (68%) although there is no evidence for secondary prevention. In CAMPAIGNs 2 and 3, the use of beta-blockers increased (36%, 47%) and that of nitrates decreased (24%, 21%). CONCLUSION: CAMPAIGN Study 1 revealed considerable variation in the treatment of AMI during the acute phase among the hospitals. The use of beta-blocker and nitrates as discharge medication was inappropriate. CAMPAIGNs 2 and 3 showed some improvement in the problems revealed by CAMPAIGN 1.