The impact of clinical trials on medical practice remains controversial, in part because of weak study designs and nonrepresentative study samples.
To assess changes in trends in medication use in the setting of acute myocardial infarction (AMI) before and after publication of two large clinical trials : the Second Intemational Study of Infarct Survival (ISIS-2) trial that supported the use of aspirin after AMI and the Multi-center Diltiazem Postinfarction Trial that reported no overall benefit from the use of calcium antagonists after AMI.
Study patients consisted of 2114 patients hospitalized with AMI in 16 hospitals in metropolitan Worcester, Mass, during 1986,1988, and 1990.
We used multivariable logistic regression models to examine the rate of change in the use of selected medications before and after trial publication, controlling for medical history, characteristics and complications of AMI, medications taken, and procedures performed during hospitalization.
The dependent variable was receipt of the specific medication under investigation.
Before publication of ISIS-2,26% of patients with AMI received aspirin while hospitalized compared with 66% after its publication.
However, in-hospital aspirin use began to rise before ISIS-2 with an immediate increase in the level of use occurring after trial publication but with no significant change in the rate of increase.
Mots-clés Pascal : Infarctus, Myocarde, Aigu, Information thérapeutique, Essai clinique, Effet consécutif, Protocole thérapeutique, Utilisation, Antagoniste calcium, Acétylsalicylique acide, Attitude, Adulte, Homme, Appareil circulatoire pathologie, Cardiopathie coronaire, Myocarde pathologie
Mots-clés Pascal anglais : Infarct, Myocardium, Acute, Therapeutic information, Clinical trial, After effect, Therapeutic protocol, Use, Calcium antagonist, Attitude, Adult, Human, Cardiovascular disease, Coronary heart disease, Myocardial disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 96-0143075
Code Inist : 002B30A09. Création : 199608.