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- W2185156764 abstract "Objectives-To identify andrankthefactorsthatcurrently limit theuseofthrombolytic treatment inpatients admitted to hospital withacutemyocardial infarction. Design-Weighted samplingstudywith retrospective dataretrieval fromclinical records. Setting--All hospitals withintheTrent regionproviding acutegeneral medical services. Patients-Random sampleof420patients admittedduringFebruary-April 1993 who hadacutemyocardial infarction as themaindischarge diagnosis. Main outcome measures-Treatment oddsratios (and95%confidence intervals (CI))fortheuse ofthrombolysis in patient groupsdefined byrelevant clinicalcharacteristics. Results-Thepatientpopulation was olderandlesslikely tohaveST segment elevation ontheinitial electrocardiogram thanpatients entered intotherandomisedtrials ofthrombolysis. Thrombolytic treatment wasgivento49%ofpatients (SE2.4%). Aftercontrolling fornegative associations witha historyof stroke (treatment oddsratio 0-18(95%CI0-04to 0.53)) andpeptic ulcer(oddsratio052 (95%CI0-26to1.01)) useofthrombolysis decreased withincreasing patient age. Thiswasparticularly noticeable forthose aged>74years(oddsratio0-17(95%CI 005to0.51)) relative tothoseaged<65 years.Thrombolysis was lesslikely to beusedinpatients withST depression (oddsratio0-22(95%CI0-11to0.41)) or bundlebranchblock(oddsratio0-18 (95%CI0-07to0.44)) thaninthosewith ST elevation ontheinitial electrocardiogram.Delayfrom symptom onsetto admission wasmorethan12h in15%of patients. Conclusions-Thepatientpopulation admitted tohospital withacutemyocardialinfarction differs inseveral respects fromthesamples thathavebeenincluded inthetrials ofthrombolysis. Themain factors limiting wideruseofthrombolysis arediagnostic uncertainty atadmission and delayedpresentation. Perceived clinical contraindications to treatment areoflesser importance. Thereisevidentreluctance to use thrombolytic treatmentinolderpatients, who were substantially under-represented in the clinical trials. (BrHeart J1995;74:224-228)" @default.
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- W2185156764 date "1995-01-01" @default.
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- W2185156764 title "Selection factors fortheuse ofthrombolytic treatmentinacutemyocardial infarction: a population basedstudy ofcurrentpractice inthe United Kingdom" @default.
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