4 CURRENT ISSUES
International Research and Opinion
Underuse of thrombolytics for acute MI in Europe
Only about one-third of patients admitted to European hospitals with acute myocardial infarction (MI) receive thrombolytic therapy; 20% of eligible patients do not receive such therapy, according to researchers for the European Secondary Prevention Study Group.
In order to determine whether the results of clinical trials of thrombolytics are translated into practice, the researchers analysed the medical records of a represen-tative sample of 4035 patients with acute MI admitted to hospitals in 11 European countries between January 1993 and June 1994. Patients in this analysis tended to be older (mean age 68 years) than those who participated in randomised trials of thrombolytics; 33% of patients in the analysis were aged > 74 years, compared with 10% in the clinical trials.
20% shortfall in thrombolytic use The observed rate of thrombolytic drug use ranged
from 13 to 52% in the geographical regions studied, and of the 4035 patients involved in the analysis, only 1397 (35%) received such therapy. Factors limiting use of thrombolytics included:
hospital admission after the generally accepted limit of 12 hours from onset of MI symptoms (21 % of patients)
diagnosis of acute MI not supported by ECG changes to warrant thrombolytic drug use (15%)
diagnosis of acute MI not considered at admission (7%)
the presence of contraindications to thrombolytics (2%).
The remaining 20% of patients did not receive tlrrombo-lytic therapy when there was no documented contra-indication to such treatment. By eliminating this shortfall, the researchers estimate that the proportion of patients with acute MI receiving thrombolytic therapy could be increased to 55%.Interestingly, the researchers also found that women and older patients were less likely to receive thrombolytics for the treatment of acute MI.
European Secondary Prevention Study Group. Translation of clinical trials into practice: a European populationbased study of the use of thrombolysis for acute myocardial infarction. Lancet 347: 12031207, 4 May 1996 8004311'"
PharmacoEconomics & Ou1Comes News 25 May 1996 No. 63 1173-550319610063-0004l$01.00 Adl. International Limitec:l1996. All rlghte reHrvec:t