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[Utilization of thrombolytic drugs in Barcelona. Study Group on Secondary Prevention of Myocardial Infarction]
1Servicio de Farmacología Clínica, Ciutat Sanitària i Universitària Vall d'Hebron, Barcelona.
Insights
Thrombolytic therapy effectively treats acute myocardial infarction (AMI), but only one-third of AMI patients in Barcelona hospitals received it. A significant portion of eligible AMI patients did not receive this life-saving treatment.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Clinical trials demonstrate thrombolytic therapy's efficacy in reducing acute myocardial infarction (AMI) mortality.
- Recent studies indicate suboptimal thrombolytic treatment rates in AMI patients, with only about one-third receiving it.
- This study aimed to assess thrombolytic drug utilization in AMI patients within Barcelona hospitals.
Purpose of the Study:
- To quantify and characterize thrombolytic drug use in patients diagnosed with AMI.
- To identify factors influencing thrombolytic therapy prescription in AMI cases.
- To determine the proportion of AMI patients who could benefit from thrombolysis but did not receive it.
Main Methods:
- Retrospective analysis of clinical data and drug prescriptions for AMI patients.
- Study conducted across three hospitals in Barcelona between January and June 1994.
- Multivariate analysis to identify variables associated with thrombolytic therapy use.
Main Results:
- 364 AMI patients (mean age 68 years) were included; 28% received thrombolytic drugs, primarily streptokinase (62% of those treated).
- Factors negatively associated with thrombolytic use included age >75, symptom-to-admission time >3 hours, and specific EKG findings.
- 18% of AMI patients who could have benefited from thrombolysis did not receive it.
Conclusions:
- Thrombolytic treatment rates for AMI in the studied Barcelona hospitals were low (one-third of patients).
- A notable proportion (one-fifth) of AMI patients eligible for thrombolysis did not receive the therapy.
- Findings highlight potential gaps in the implementation of evidence-based AMI treatment.
Background:
A number of clinical trials including more than 50,000 patients have shown the efficacy of thrombolytic therapy in reducing mortality associated with acute myocardial infarction (AMI). However, the results of some recently published drug utilization studies have shown that only one third of admitted patients with a diagnosis of AMI receive thrombolytic treatment. The aim of the present study was to quantify and characterize the use of thrombolytic drugs in three hospitals in Barcelona, Spain.
Patients And Methods:
We collected retrospective information about some clinical variables and drug prescription of patients discharged with a diagnosis of AMI from three hospitals in Barcelona between January and June 1994.
Results:
Three hundred and sixty-four patients (247 men, 68%) with a mean age of 68 years (SD 13) were included in the study. The median time from the beginning of clinical symptoms to hospital admission was 3 h (range 1 to 96). One hundred and two patients (28%) were prescribed thrombolytic drugs, and of these, 62%, received streptokinase. No one patient received any thrombolytic treatment before hospital admission. In a multivariate analysis the following variables were negatively associated with thrombolytic use: age over 75 years, more than three hours from the beginning of symptoms to hospital admission and an EKG with bundle-branch block, ST depression or normal. After excluding patients with limitations to thrombolytic use, 18% of all patients could be identified who did not receive any thrombolytic treatment they could have benefited from.
Conclusions:
Only one third of admitted patients with a diagnosis of AMI in the three study hospitals receive thrombolytic treatment. One fifth of the study population with AMI does not receive any thrombolytic therapy but could have benefited from it.