Purpose To determine compliance with the 2004 ACC/AHA Class I recommendations for right-sided electrocardiographic leads in patients with inferior wall ST elevation myocardial infarction. Such screening is advised to exclude coexisting right ventricular infarction.
Methods Lectures regarding the above recommendations were provided by cardiovascular fellows to housestaff at a large university-affiliated community hospital and at a Veterans Affairs Medical Center. Additionally, the ACC/AHA class I recommendations that nitrates not be administered to patients with right ventricular infarction was emphasized. Following such lectures, a prospective study was undertaken to determine compliance with the guidelines.
Results During a 21-month period, 62 patients with inferior wall ST elevation myocardial infarction were identified at the community hospital and 12 at the Veterans Affairs Medical Center. When the frequency of right ventricular leads at the community hospital and Veterans Affairs Medical Center were compared there was a highly significant difference (community hospital 95% CI: 0.004-0.112; Veterans Affairs Medical Center 95% CI: 0.779-1.00; p < .0001).
Conclusion Despite instructions regarding right ventricular leads to housestaff at both institutions, there was minimal application of right-sided leads at the community hospital compared with the Veterans Affairs Medical Center. Reasons for the difference appear to be greater use of early echocardiography and percutaneous coronary intervention at the community hospital and aggressive cardiovascular fellow-driven guideline implementation at the Veterans Affairs Medical Center.
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