Management of acute coronary syndromes, a questionnaire survey of the clinical practice of cardiologists and other medical physicians belonging to west midland hospitals

Objective: To assess the management of acute coronary syndromes by cardiologists and other medical physicians in a clinical setting. Design: Questionnaire survey consisting of 10 hypothetical clinical scenarios and four possible therapeutic options for each scenario. Setting: Consultants and specialist registrars in Cardiology (with or without access to interventional facilities) and consultant physicians belonging to various hospitals in the west midland region of United Kingdom. Main outcome measures: Respondentsʹ ability to recognise high risk patients and their management of the hypothetical clinical cases. To establish any differences in management strategy between cardiologists and general physicians, and whether these differences, if any, relate to access to interventional cardiac facilities. Results: Overall no significant differences were found in the responses between cardiologists and general physicians with or without access to cardiac interventional facilities. However, cardiologists were more inclined to use percutaneous transluminal coronary angioplasty (PTCA) compared to other physicians (scenario 8, 18.4% vs. 6.7%, p=0.05 and scenario 9, 44.9% vs. 26.7%, p=0.01). In two other situations, physicians from institutions with access to interventional facilities were more inclined to use ‘other’ treatment strategies (intravenous nitrates, antiplatelet treatment, inotropes, Intra-aortic balloon pump) compared to their colleagues from non-tertiary hospitals with no interventional facility on site (scenario 3, 21.7% vs. 2.4%, p=0.04) and more use of PTCA ( scenario 6, 52.2% vs. 26.8%, p=0.04). Conclusions: The management of acute coronary syndromes in this questionnaire survey was satisfactory and evidence based. No real differences were found between the management strategies adopted by cardiologists or non-cardiologists. Physicians working in centres with interventional facilities were no more inclined towards using primary PTCA or rescue angioplasty than those working in centres without such facilities.