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Published on: November 27, 2013
Thrombolytic eligibility in acute myocardial infarction patients admitted to Norwegian hospitals
Insights
This study analyzed acute myocardial infarction patients in Norway, finding thrombolytic therapy use was limited by patient characteristics and late presentation. Actual use was 32%, though 50% were eligible, highlighting treatment gaps.
Area of Science:
- Cardiology
- Public Health
Background:
- Acute myocardial infarction (AMI) management guidelines recommend thrombolytic therapy.
- Clinical trials often enroll highly selected patient populations.
Purpose of the Study:
- To characterize the AMI patient population in Norwegian hospitals.
- To quantify the use and potential maximal use of thrombolytic therapy in a real-world setting.
Main Methods:
- Medical record review of AMI patients discharged from Health region 1 in April-May 1993.
- Comparison of clinical population characteristics with those in thrombolytic trials.
Main Results:
- The clinical AMI population differed significantly from trial participants, with more elderly patients (>74 years) and ST depression on admission.
- Thrombolytic therapy was administered to 32% of patients, primarily streptokinase.
- Late presentation (>12h) and diagnostic challenges were key reasons for non-administration.
- Approximately 50% of patients were eligible for thrombolysis, but eligibility was restricted by patient characteristics.
Conclusions:
- Real-world AMI patient characteristics limit thrombolytic therapy eligibility and use compared to clinical trial populations.
- Substantial patient subgroups with equivocal thrombolysis benefits were under-represented in trials, raising questions about evidence extrapolation.
Abstract:
We characterised the population of acute myocardial infarction patients admitted to Norwegian hospitals and quantified the actual use and potential maximal use of thrombolytic therapy. Data were collected by medical record review of all acute myocardial infarction patients discharged from hospital in April and May 1993 in Health region 1. The clinical population differed significantly from the patients recruited to the thrombolytic clinical trials. Patients were more likely to have ST depression on admission (23% vs. 7%) and to be over 74 years (42% vs. 10%) than in the trials. A fifth of patients presented more than 12 h after symptom onset (or time indeterminate). Thrombolysis was given to 32% of patients, mainly utilising streptokinase. Late presentation or diagnostic difficulty appeared to be the main reasons for non- thrombolysis. Approximately 50% of the clinical population were eligible for thrombolysis. Eligibility for thrombolytic therapy was therefore severely restricted by the presenting characteristics of the clinical population. Substantial numbers of patients belonged to subgroups where the reported benefit from thrombolysis is equivocal. Uncertainty remains on the extrapolation of the trials evidence to those subgroups who were under-represented in the clinical trials.
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