Comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding drug therapy for acute myocardial infarction

Chest. 1998 Feb;113(2):297-305. doi: 10.1378/chest.113.2.297.


Objectives: This study assesses the knowledge and practice of emergency physicians regarding the treatment of acute myocardial infarction (AMI) and compares the results with previously published data on cardiologists and primary care practitioners.

Background: Debate surrounding the respective roles of emergency physicians, primary care practitioners, and specialists figures prominently in discussions regarding the nation's evolving health-care system. Data are lacking about the comparative knowledge and practice of emergency physicians, cardiologists, and primary care practitioners regarding conditions commonly treated by all three groups, eg, AMI.

Methods: A survey of 1,045 emergency physicians, nationally, was conducted in 1995 regarding five short-term pharmacologic interventions employed for many years in the standard treatment of AMI. The emergency physicians were questioned about the effect on survival of each intervention and the likelihood that they would prescribe each intervention. The findings were then compared with previously published data on the knowledge and practice of cardiologists and primary care practitioners obtained in New York and Texas in 1993. Identical clinical queries and eligibility criteria were employed in all groups.

Results: The responding emergency physicians' knowledge was similar or significantly greater than that of responding cardiologists for the effect on survival of most of the short-term interventions, and their practice patterns were similar or significantly better than responding cardiologists for all interventions studied. Emergency physicians and cardiologists had significantly better knowledge and practice in this area compared with responding primary care practitioners.

Conclusions: For the management of AMI, emergency physicians, on average, have a similar or greater awareness of the effects on survival and similar or better practice patterns regarding most acute pharmacologic interventions when compared with those of cardiologists; both groups, on average, have a superior knowledge and practice when compared with primary care practitioners. These results illustrate the importance of emergency medicine and support further consideration of an expanding role for the emergency physician in the nation's evolving health-care system.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / therapeutic use
  • Adult
  • Aspirin / therapeutic use
  • Cardiology* / education
  • Chi-Square Distribution
  • Clinical Competence*
  • Delivery of Health Care
  • Emergency Medicine* / education
  • Faculty, Medical
  • Family Practice* / education
  • Female
  • Fibrinolytic Agents / therapeutic use
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Internship and Residency
  • Logistic Models
  • Male
  • Middle Aged
  • Myocardial Infarction / drug therapy*
  • New York
  • Physician's Role
  • Platelet Aggregation Inhibitors / therapeutic use
  • Practice Patterns, Physicians'
  • Professional Practice
  • Survival Rate
  • Texas
  • Thrombolytic Therapy
  • United States


  • Adrenergic beta-Antagonists
  • Fibrinolytic Agents
  • Platelet Aggregation Inhibitors
  • Aspirin