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. 1993 Dec;70(6):503–506. doi: 10.1136/hrt.70.6.503

Assessment by general practitioners of suitability of thrombolysis in patients with suspected acute myocardial infarction.

J D Gemmill 1, W K Lifson 1, A P Rae 1, W S Hillis 1, F G Dunn 1
PMCID: PMC1025379  PMID: 8280513

Abstract

OBJECTIVE--To assess the clinical ability of general practitioners to decide to give thrombolytic therapy to patients with suspected myocardial infarction and to assess the contribution of the electrocardiograph (ECG) to this decision-making process. SETTING--7 practices on the North side of Glasgow and the coronary care unit of Stobhill General Hospital. SUBJECTS--137 patients presenting with chest pain who required direct admission to the coronary care unit. MAIN OUTCOME MEASURES--Agreement between the general practitioner's clinical decision to give thrombolytic therapy with or without reference to the ECG and the prescription of thrombolytic therapy in the coronary care unit. RESULTS--The predictive accuracy of the general practitioner's assessment of the necessity for thrombolytic therapy was 71.5%. The ECG had no impact on the accuracy of this decision and there were problems with the recording and interpretation of the ECG. Clinical decision making was altered in six cases by the ECG--wrongly in four. CONCLUSION--The diagnostic accuracy among general practitioners would result in some patients who did not have acute myocardial infarction being given thrombolytic therapy. In this study the ECG did not contribute towards diagnostic accuracy. Substantial improvement in both the recording and interpretation of ECGs is needed before thrombolytic agents can be routinely prescribed at home.

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Selected References

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  1. Bradley N., Watkins S. Survey of equipment in general practice. BMJ. 1989 Aug 12;299(6696):435–436. doi: 10.1136/bmj.299.6696.435. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Burns J. M., Hogg K. J., Rae A. P., Hillis W. S., Dunn F. G. Impact of a policy of direct admission to a coronary care unit on use of thrombolytic treatment. Br Heart J. 1989 Apr;61(4):322–325. doi: 10.1136/hrt.61.4.322. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Butler J., Davies A. H., Westaby S. Streptokinase in acute aortic dissection. BMJ. 1990 Feb 24;300(6723):517–519. doi: 10.1136/bmj.300.6723.517. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Colquhoun M. C. General practitioners' use of electrocardiography: relevance to early thrombolytic treatment. BMJ. 1989 Aug 12;299(6696):433–433. doi: 10.1136/bmj.299.6696.433. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Curzen N. P., Clarke B., Gray H. H. Intravenous thrombolysis for suspected myocardial infarction: a cautionary note. BMJ. 1990 Feb 24;300(6723):513–513. doi: 10.1136/bmj.300.6723.513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Davies A. Electrocardiographs in general practice. BMJ. 1989 Aug 12;299(6696):408–409. doi: 10.1136/bmj.299.6696.408. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Fox K. A. Thrombolysis and the general practitioner. 1. Practicable only under certain circumstances. BMJ. 1990 Mar 31;300(6728):867–868. doi: 10.1136/bmj.300.6728.867. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Muller D. W., Topol E. J. Selection of patients with acute myocardial infarction for thrombolytic therapy. Ann Intern Med. 1990 Dec 15;113(12):949–960. doi: 10.7326/0003-4819-113-12-949. [DOI] [PubMed] [Google Scholar]
  9. Pell A. C., Miller H. C. Delays in admission of patients with acute myocardial infarction to coronary care: implications for thrombolysis. Health Bull (Edinb) 1990 Sep;48(5):225–231. [PubMed] [Google Scholar]
  10. Pell A. C., Miller H. C., Robertson C. E., Fox K. A. Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis. BMJ. 1992 Jan 11;304(6819):83–87. doi: 10.1136/bmj.304.6819.83. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Petch M. C. Dangers of thrombolysis. BMJ. 1990 Feb 24;300(6723):483–484. doi: 10.1136/bmj.300.6723.483. [DOI] [PMC free article] [PubMed] [Google Scholar]
  12. Rule S., Brooksby P., Sanderson J. Use of thrombolysis for acute myocardial infarction by general practitioners. Postgrad Med J. 1993 Mar;69(809):190–193. doi: 10.1136/pgmj.69.809.190. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Simoons M. L., Serruys P. W., van den Brand M., Res J., Verheugt F. W., Krauss X. H., Remme W. J., Bär F., de Zwaan C., van der Laarse A. Early thrombolysis in acute myocardial infarction: limitation of infarct size and improved survival. J Am Coll Cardiol. 1986 Apr;7(4):717–728. doi: 10.1016/s0735-1097(86)80329-1. [DOI] [PubMed] [Google Scholar]
  14. Timmis A. D. Early diagnosis of acute myocardial infarction. BMJ. 1990 Oct 27;301(6758):941–942. doi: 10.1136/bmj.301.6758.941. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Wilcox R. G. Thrombolysis with tissue plasminogen activator in suspected acute myocardial infarction. The ASSET Study. Chest. 1989 May;95(5 Suppl):270S–275S. [PubMed] [Google Scholar]
  16. Wilcox R. G., von der Lippe G., Olsson C. G., Jensen G., Skene A. M., Hampton J. R. Trial of tissue plasminogen activator for mortality reduction in acute myocardial infarction. Anglo-Scandinavian Study of Early Thrombolysis (ASSET). Lancet. 1988 Sep 3;2(8610):525–530. doi: 10.1016/s0140-6736(88)92656-6. [DOI] [PubMed] [Google Scholar]

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