Candidates for thrombolysis among emergency room patients with acute chest pain

Article Abstract:

During a myocardial infarction (heart attack), the blood vessels supplying the heart muscle can become blocked with blood clots. Drugs that dissolve blood clots, thrombolytic agents, can be given to reopen blocked blood vessels, improve heart functioning and reduce mortality. Patients brought into the emergency room are given thrombolytic therapy if they meet three eligibility criteria: they must be under 75 year of age, have arrived in the emergency room within four hours from the onset of pain and have evidence of a myocardial infarction on an electrocardiogram, which is a record of the heart's activity. Although thrombolytic therapy is currently widely accepted, its impact on the total population of patients who have myocardial infarctions is not clear. The number of emergency room patients meeting the criteria for thrombolytic therapy was determined for three university hospitals. Of the 7,734 patients coming to the emergency room with chest pain, 1,118 patients were determined to be experiencing a myocardial infarction. Of these patients, 261 (23 percent) were eligible for thrombolytic therapy. Of the 6,616 patients without infarction, 60 (0.9 percent) also met the criteria. The criteria correctly predicted a myocardial infarction in 86 percent of the patients. The proportion of patients eligible for thrombolytic therapy would be increased if less definitive electrocardiogram readings were used and if the four-hour time limit was increased. For every eight patients with true-positive results who receive thrombolytic therapy, one to two other patients who currently do not meet the criteria could benefit from therapy if decisions were based on less strict electrocardiographic recordings. (Consumer Summary produced by Reliance Medical Information, Inc.)

Health aspects, Usage, Drug therapy, Emergency medical services, Electrocardiography, Fibrinolytic agents, Infarction, Cardiovascular emergencies, Thrombolytic drugs

---

Effect of race on the presentation and management of patients with acute chest pain

Article Abstract:

African Americans appear less likely than whites with similarly diagnosed heart disease to undergo coronary artery bypass surgery. Nationally, the death rate from coronary heart disease has dropped more in whites than in African Americans, but the reasons for this are not clear. Of 3,031 patients who came to the emergency department with acute chest pain, 1,374 were African-American and 1,657 were white. After adjusting for age and sex, there were no significant differences between the two groups in the diagnosis of heart attack or in the incidence of complications or in-hospital death. African-Americans were more likely to delay seeking treatment more than six hours after the onset of pain, which is significant because anti-thrombolytic therapy is considered effective only within the first six hours. After hospital admission, there were no differences between groups in admissions to to the coronary care unit and cardiac catheterization. However, African-Americans were significantly less likely to undergo coronary artery bypass surgery.

Demographic aspects, African Americans, Coronary artery bypass, Discrimination in medical care, Medical care discrimination

---

Failure of information as an intervention to modify clinical management: a time-series trial in patients with acute chest pain

Article Abstract:

Conveying patient risk information and treatment guidelines without using person-to-person communication may fail to increase efficiency or change the decision-making processes of physicians. Researchers followed 1,921 patients aged 30 years or older who were admitted to a hospital because of chest pain. Information on each patient's risk of a heart attack and treatment recommendations were provided to doctors in the emergency department and hospital using flowsheets and stickers. All personal communication was avoided. Much of the information came from treatment guidelines published in medical journals. This practice failed to reduce admission rates, inpatient costs, and lengths of stay. Person-to-person communication may influence physicians' decision making better than information alone.

Medical protocols

Similar abstracts:

• Abstracts: Has sclerotherapy altered the management of patients with variceal bleeding? Management of variceal hemorrhage in the potential liver transplant candidate
• Abstracts: Haemostatic factors associated with vascular thrombosis in patients with systemic lupus erythematosus and the lupus anticoagulant
• Abstracts: Human immunodeficiency virus infection among members of the Reserve Components of the US Army: prevalence, incidence and demographic characteristics
• Abstracts: Breast vasculitis in association with breast gigantism in a pregnant patient with systemic lupus erythematosus
• Abstracts: Brain-reactive antibodies and the AIDS dementia complex. Norepinephrine response in early HIV infection. Abnormal pituitary-adrenocortical response in early HIV-1 infection

This website is not affiliated with document authors or copyright owners. This page is provided for informational purposes only. Unintentional errors are possible.