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Treatment of Patients with Myocardial Infarction Who Present with a Paced Rhythm

Saif S. Rathore, MPH; Kevin P. Weinfurt, PhD; Bernard J. Gersh, MB, ChB, DPhil; William J. Oetgen, MD, MBA; Kevin A. Schulman, MD, MBA; and Allen J. Solomon, MD
[+] Article and Author Information

From Georgetown University Medical Center, Washington, D.C.; Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina; Mayo Clinic and Foundation, Rochester, Minnesota; Maryland HealthCare Associates, Clinton, Maryland; and Delmarva Foundation for Medical Care, Easton, Maryland.


Disclaimer: The analyses on which this publication is based were performed under contract numbers 500-96-P623 and 500-96-P624, titled “Utilization and Quality Control Peer Review Organization for the State of Maryland and the District of Columbia,” sponsored by the Delmarva Foundation for Medical Care, Inc., and the Health Care Financing Administration, U.S. Department of Health and Human Services. The contents of this publication do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products, or organizations imply endorsement by the U.S. government. The authors assume full responsibility for the accuracy and completeness of the ideas presented. The article is a direct result of the Health Care Quality Improvement Program initiated by the Health Care Financing Administration, which has encouraged identification of quality improvement projects derived from analysis of patterns of care.

Requests for Single Reprints: Allen J. Solomon, MD, Division of Cardiology, Georgetown University Medical Center, Room M4222, 3800 Reservoir Road NW, Washington, DC 20007; e-mail, solomona@gunet.georgetown.edu.

Current Author Addresses: Mr. Rathore: Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, Room IE-61 SHM, Box 208025, New Haven, CT 06520-8025.

Drs. Weinfurt and Schulman: Center for Clinical and Genetic Economics, Duke Clinical Research Institute, Box 17969, Duke University Medical Center, Durham, NC 27715.

Dr. Gersh: Division of Internal Medicine and Cardiovascular Diseases, Mayo Clinic, Suite 1643, 2001 First Street SW, Rochester, MN 55902.

Dr. Oetgen: Maryland HealthCare Associates, Suite 600, 9131 Piscataway Road, Clinton, MD 20735.

Dr. Solomon: Division of Cardiology, Georgetown University Medical Center, Room M4222, 3800 Reservoir Road NW, Washington, DC 20007.

Author Contributions: Conception and design: S.S. Rathore, A.J. Solomon.

Analysis and interpretation of the data: S.S. Rathore.

Drafting of the article: S.S. Rathore, B.J. Gersh, W.J. Oetgen, A.J. Solomon.

Critical revision of the article for important intellectual content: S.S. Rathore, K.P. Weinfurt, B.J. Gersh, W.J. Oetgen, K.A. Schulman, A.J. Solomon.

Final approval of the article: S.S. Rathore, K.P. Weinfurt, B.J. Gersh, W.J. Oetgen, K.A. Schulman, A.J. Solomon.

Provision of study materials or patients: W.J. Oetgen, K.A. Schulman, A.J. Solomon.

Statistical expertise: S.S. Rathore, K.P. Weinfurt.

Obtaining of funding: B.J. Gersh, W.J. Oetgen, K.A. Schulman, A.J. Solomon.

Administrative, technical, or logistic support: S.S. Rathore, W.J. Oetgen, A.J. Solomon.


Ann Intern Med. 2001;134(8):644-651. doi:10.7326/0003-4819-134-8-200104170-00009
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As the U.S. population ages, use of cardiac pacemakers continues to increase at a rate of 6% annually. Recent estimates suggest that in the United States, more than 112 000 pacemakers are implanted per year (1). Because of advanced age and coronary risk factors, patients with pacemakers are likely to be at increased risk for coronary events (including acute myocardial infarction) and death. Current protocols emphasize rapid and accurate diagnosis in the management of such acute coronary events (2). However, evaluation of an electrocardiogram during a myocardial infarction may be hampered by cardiac pacing (36). This can have deleterious consequences, such as delays in diagnosis and treatment. Previous studies have documented missed treatment opportunities and poorer outcomes among patients with myocardial infarction for whom electrocardiographic evaluation is limited or not feasible (78). While this heterogeneous group of patients with nondiagnostic electrocardiograms has been evaluated in the aggregate, little is known about the subset of patients experiencing a myocardial infarction who present with paced rhythms. It is unclear what proportion of patients with acute myocardial infarction currently present with paced rhythms, whether patients with myocardial infarction and paced rhythms are appropriately managed, and whether mortality rates differ among patients with paced rhythms and those without. To address these issues, we evaluated patients from the Cooperative Cardiovascular Project (CCP), a data set of 234 769 Medicare beneficiaries treated for acute myocardial infarction, to determine the characteristics, treatment, and outcomes of a cohort of patients experiencing myocardial infarction who presented with paced rhythms.

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Figures

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Figure.
Crude use of therapies for acute myocardial infarction among the respective cohorts classified as ideal for each therapy.P

White bars indicate patients with paced rhythms; gray bars indicate patients with no paced rhythms.  = 0.001 for all comparisons.

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Summary for Patients

Treatment and Outcomes of Heart Attacks in People with Pacemakers

The summary below is from the full report titled “Treatment of Patients with Myocardial Infarction Who Present with a Paced Rhythm.” It is in the 17 April 2001 issue of Annals of Internal Medicine (volume 134, pages 644-651). The authors are SS Rathore, KP Weinfurt, BJ Gersh, WJ Oetgen, KA Schulman, and AJ Solomon.

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