Management of acute myocardial infarction in the public sector in the Bahamas

In 1996 and 1997, 52 patients were admitted to the Princess Margaret Hospital, Nassau, Bahamas, with a confirmed diagnosis of acute myocardial infarction (AMI). The average time to presentation after the onset of symptoms was 18 hours, with 56% of patients presenting within 12 hours. Risk factors identified for ischaemic heart disease were hypertension (77%), obesity (62%), diabetes mellitus (35%), tobacco smoking (25%), a family history of coronary artery disease (17%) and hypercholesterolaemia (8%). Medications administered in the treatment of AMI included oral nitrates (96%), intravenous heparin (90%), beta-blockers (65%), morphine (15%), thrombolytic agents (8%) and lignocaine (4%). In hospital post myocardial infarction complications were angina (23%), arrhythmias (12%) and cardiac failure (10%). The average hospital stay was eight days, with a mortality rate of 19%. These results show that there is considerable room for improvement, particularly in the use of thrombolytic therapy, to ensure that all patients receive optimal acute and post myocardial infarction care.