This article looks at the results of four studies which examined the delivery of early thrombolysis by general practitioners and ambulance paramedics to patients suffering an acute myocardial infarction. The studies found that they could provide early thrombolysis safely.
One study in an isolated rural area in Scotland found general practitioners would have very limited experience of thrombolysis – one case per general practitioner per year – and that use of thrombolysis by local general practitioners fell off sharply after the study. A second study carried out in 15 European countries and Canada, found that there was no significant improvement in mortality and morbidity in the pre-hospital group given thrombolysis at home. This was also found by a Dutch study. An American study using computer-assisted diagnostic ECGs relayed to a physician at the base hospital, found little difference in the pre-hospital and hospital treatment arms but a dramatic improvement in the speed of treatment of both groups. Pre-hospital thrombolysis was also reduced. Two studies found ambulances became ‘tied up’ when thrombolysis was delivered at home.
These studies were used as part of a submission on behalf of the Primary Care Cardiovascular Society to the National Institute for Clinical Excellence. The rest of the submission is discussed in part two of this article next month.
For UK healthcare professionals only