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. 1994 Mar 19;308(6931):767–771. doi: 10.1136/bmj.308.6931.767

Guidelines for the early management of patients with myocardial infarction. British Heart Foundation Working Group.

C F Weston 1, W J Penny 1, D G Julian 1
PMCID: PMC2539628  PMID: 8142834

Abstract

In light of recent publications relating to resuscitation and pre-hospital treatment of patients suffering acute myocardial infarction of British Heart Foundation convened a working group to prepare guidelines outlining the responsibilities of general practitioners, ambulance services, and admitting hospitals. The guidelines emphasise the importance of the rapid provision of basic and advanced life support; adequate analgesia; accurate diagnosis; and, when indicted, thrombolytic treatment. The working group developed a standard whereby patients with acute myocardial infarction should receive thrombolysis, when appropriate, within 90 minutes of alerting the medical or ambulance service--the call to needle time. Depending on local circumstances, achieving this standard may involve direct admissions to coronary care units, "fast track" assessments in emergency departments, or pre-hospital thrombolytic treatment started by properly equipped and trained general practitioners.

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Selected References

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  1. Ahmad R. A., Bond S., Burke J., Singh S. P., Watson R. D. Patients with suspected myocardial infarction: effect of mode of referral on admission time to a coronary care unit. Br J Gen Pract. 1992 Apr;42(357):145–147. [PMC free article] [PubMed] [Google Scholar]
  2. Basinski A., Naylor C. D. Aspirin and fibrinolysis in acute myocardial infarction: meta-analytic evidence for synergy. J Clin Epidemiol. 1991;44(10):1085–1096. doi: 10.1016/0895-4356(91)90011-w. [DOI] [PubMed] [Google Scholar]
  3. Birkhead J. S. Time delays in provision of thrombolytic treatment in six district hospitals. Joint Audit Committee of the British Cardiac Society and a Cardiology Committee of Royal College of Physicians of London. BMJ. 1992 Aug 22;305(6851):445–448. doi: 10.1136/bmj.305.6851.445. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Bouten M. J., Simoons M. L., Hartman J. A., van Miltenburg A. J., van der Does E., Pool J. Prehospital thrombolysis with alteplase (rt-PA) in acute myocardial infarction. Eur Heart J. 1992 Jul;13(7):925–931. doi: 10.1093/oxfordjournals.eurheartj.a060294. [DOI] [PubMed] [Google Scholar]
  5. 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]
  6. Chesebro J. H., Knatterud G., Roberts R., Borer J., Cohen L. S., Dalen J., Dodge H. T., Francis C. K., Hillis D., Ludbrook P. Thrombolysis in Myocardial Infarction (TIMI) Trial, Phase I: A comparison between intravenous tissue plasminogen activator and intravenous streptokinase. Clinical findings through hospital discharge. Circulation. 1987 Jul;76(1):142–154. doi: 10.1161/01.cir.76.1.142. [DOI] [PubMed] [Google Scholar]
  7. Cobbe S. M., Redmond M. J., Watson J. M., Hollingworth J., Carrington D. J. "Heartstart Scotland"--initial experience of a national scheme for out of hospital defibrillation. BMJ. 1991 Jun 22;302(6791):1517–1520. doi: 10.1136/bmj.302.6791.1517. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. 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]
  9. Colquhoun M. C., Julian D. G. Treatable arrhythmias in cardiac arrests seen outside hospital. Lancet. 1992 May 9;339(8802):1167–1167. doi: 10.1016/0140-6736(92)90765-u. [DOI] [PubMed] [Google Scholar]
  10. Fillmore S. J., Shapiro M., Killip T. Arterial oxygen tension in acute myocardial infarction. Serial analysis of clinical state and blood gas changes. Am Heart J. 1970 May;79(5):620–629. doi: 10.1016/0002-8703(70)90281-4. [DOI] [PubMed] [Google Scholar]
  11. Gersh B. J., Anderson J. L. Thrombolysis and myocardial salvage. Results of clinical trials and the animal paradigm--paradoxic or predictable? Circulation. 1993 Jul;88(1):296–306. doi: 10.1161/01.cir.88.1.296. [DOI] [PubMed] [Google Scholar]
  12. Gray D., Keating N. A., Murdock J., Skene A. M., Hampton J. R. Impact of hospital thrombolysis policy on out-of-hospital response to suspected myocardial infarction. Lancet. 1993 Mar 13;341(8846):654–657. doi: 10.1016/0140-6736(93)90420-l. [DOI] [PubMed] [Google Scholar]
  13. Greenberg H., Sherrid M. V., Lynn S., Dwyer E. M., Jr, O'Kelly J., Marsella R., Mathesen D. Out-of-hospital, paramedic administered streptokinase for acute myocardial infarction. Lancet. 1988 Nov 19;2(8621):1187–1187. doi: 10.1016/s0140-6736(88)90248-6. [DOI] [PubMed] [Google Scholar]
  14. Grines C. L., DeMaria A. N. Optimal utilization of thrombolytic therapy for acute myocardial infarction: concepts and controversies. J Am Coll Cardiol. 1990 Jul;16(1):223–231. doi: 10.1016/0735-1097(90)90482-5. [DOI] [PubMed] [Google Scholar]
  15. Kereiakes D. J., Weaver W. D., Anderson J. L., Feldman T., Gibler B., Aufderheide T., Williams D. O., Martin L. H., Anderson L. C., Martin J. S. Time delays in the diagnosis and treatment of acute myocardial infarction: a tale of eight cities. Report from the Pre-hospital Study Group and the Cincinnati Heart Project. Am Heart J. 1990 Oct;120(4):773–780. doi: 10.1016/0002-8703(90)90192-z. [DOI] [PubMed] [Google Scholar]
  16. MacCallum A. G., Stafford P. J., Jones C., Vincent R., Perez-Avila C., Chamberlain D. A. Reduction in hospital time to thrombolytic therapy by audit of policy guidelines. Eur Heart J. 1990 Aug;11 (Suppl F):48–52. doi: 10.1093/eurheartj/11.suppl_f.48. [DOI] [PubMed] [Google Scholar]
  17. McLauchlan C. A., Ward A., Murphy N. M., Griffith M. J., Skinner D. V., Camm A. J. Resuscitation training for cardiac patients and their relatives--its effect on anxiety. Resuscitation. 1992 Aug-Sep;24(1):7–11. doi: 10.1016/0300-9572(92)90168-c. [DOI] [PubMed] [Google Scholar]
  18. McNeill A. J., Cunningham S. R., Flannery D. J., Dalzell G. W., Wilson C. M., Campbell N. P., Khan M. M., Patterson G. C., Webb S. W., Adgey A. A. A double blind placebo controlled study of early and late administration of recombinant tissue plasminogen activator in acute myocardial infarction. Br Heart J. 1989 Apr;61(4):316–321. doi: 10.1136/hrt.61.4.316. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Norris R. M., White H. D., Cross D. B., Woo K. S., Maslowski A. H., Caruana M. P., Hart H. H., Williams B. Aspirin does not improve early arterial patency after streptokinase treatment for acute myocardial infarction. Br Heart J. 1993 Jun;69(6):492–495. doi: 10.1136/hrt.69.6.492. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Parry G., Wrightson W. N., Hood L., Adams P. C., Reid D. S. Delays to thrombolysis in the treatment of myocardial infarction. J R Coll Physicians Lond. 1993 Jan;27(1):19–23. [PMC free article] [PubMed] [Google Scholar]
  21. 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]
  22. Rawles J. M., Haites N. E. Patient and general practitioner delays in acute myocardial infarction. Br Med J (Clin Res Ed) 1988 Mar 26;296(6626):882–884. doi: 10.1136/bmj.296.6626.882. [DOI] [PMC free article] [PubMed] [Google Scholar]
  23. Rowley J. M., Hill J. D., Hampton J. R., Mitchell J. R. Early reporting of myocardial infarction: impact of an experiment in patient education. Br Med J (Clin Res Ed) 1982 Jun 12;284(6331):1741–1746. doi: 10.1136/bmj.284.6331.1741. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Rowley J. M., Mounser P., Harrison E. A., Skene A. M., Hampton J. R. Management of myocardial infarction: implications for current policy derived from the Nottingham Heart Attack Register. Br Heart J. 1992 Mar;67(3):255–262. doi: 10.1136/hrt.67.3.255. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Stene J. K., Stofberg L., MacDonald G., Myers R. A., Ramzy A., Burns B. Nalbuphine analgesia in the prehospital setting. Am J Emerg Med. 1988 Nov;6(6):634–639. doi: 10.1016/0735-6757(88)90109-x. [DOI] [PubMed] [Google Scholar]
  26. Walters G., Glucksman E. Planning a pre-hospital cardiac resuscitation programme: an analysis of community and system factors in London. J R Coll Physicians Lond. 1989 Apr;23(2):107–110. [PMC free article] [PubMed] [Google Scholar]
  27. Weaver W. D., Cerqueira M., Hallstrom A. P., Litwin P. E., Martin J. S., Kudenchuk P. J., Eisenberg M. Prehospital-initiated vs hospital-initiated thrombolytic therapy. The Myocardial Infarction Triage and Intervention Trial. JAMA. 1993 Sep 8;270(10):1211–1216. [PubMed] [Google Scholar]
  28. Weston C. F., McCabe M. J. Audit of an emergency ambulance service: impact of a paramedic system. J R Coll Physicians Lond. 1992 Jan;26(1):86–89. [PMC free article] [PubMed] [Google Scholar]
  29. Weston C. Delay in admitting patients with chest pain. Br J Gen Pract. 1991 Nov;41(352):476–477. [PMC free article] [PubMed] [Google Scholar]
  30. Weston C., Fox K. A. Pre-hospital thrombolysis: current status and future prospects. J R Coll Physicians Lond. 1991 Oct;25(4):312–320. [PMC free article] [PubMed] [Google Scholar]
  31. 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]
  32. Zelis R., Mansour E. J., Capone R. J., Mason D. T. The cardiovascular effects of morphine. The peripheral capacitance and resistance vessels in human subjects. J Clin Invest. 1974 Dec;54(6):1247–1258. doi: 10.1172/JCI107869. [DOI] [PMC free article] [PubMed] [Google Scholar]

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