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[Compensation to a patient with cerebral hemorrhage. He was injured after thrombolysis in suspected myocardial infarction]

https://arctichealth.org/en/permalink/ahliterature54646
Source
Lakartidningen. 1996 Jun 19;93(25):2444
Publication Type
Article
Date
Jun-19-1996

Consequences of overutilization and underutilization of thrombolytic therapy in clinical practice. TRACE Study Group. TRAndolapril Cardiac Evaluation.

https://arctichealth.org/en/permalink/ahliterature53930
Source
J Am Coll Cardiol. 2001 May;37(6):1581-7
Publication Type
Article
Date
May-2001
Author
M M Ottesen
L. Køber
S. Jørgensen
C. Torp-Pedersen
Author Affiliation
Department of Cardiology, Gentofte University Hospital of Copenhagen, Denmark. otte@heart.dk
Source
J Am Coll Cardiol. 2001 May;37(6):1581-7
Date
May-2001
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Cerebrovascular Accident - etiology
Denmark - epidemiology
Drug Utilization - statistics & numerical data
Female
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Myocardial Infarction - complications - drug therapy - mortality
Patient Selection
Physician's Practice Patterns - utilization
Proportional Hazards Models
Prospective Studies
Research Support, Non-U.S. Gov't
Risk factors
Survival Analysis
Thrombolytic Therapy - adverse effects - contraindications - utilization
Treatment Outcome
Abstract
OBJECTIVES: The aim of this study was to evaluate the consequences, measured as mortality and in-hospital stroke, of the use of thrombolytic therapy among patients with acute myocardial infarction (AMI), who do not fulfill accepted criteria or who have contraindications to thrombolytic therapy (i.e., overutilization) and among patients who are withheld thrombolytic treatment despite fulfilling indications and having no contraindications (i.e., underutilization). BACKGROUND: The implementation of treatment with thrombolysis in clinical practice is not in accordance with the accepted criteria from randomized studies. The consequence has been over- and underutilization of thrombolytic therapy among patients with AMI in clinical practice. The outcome of overutilization of thrombolytic therapy has not been described previously. METHODS: We examined 6,676 consecutive patients admitted to the hospital with an AMI and recorded characteristics, in-hospital complications and long-term mortality. RESULTS: Overall, 41% of the patients received thrombolytic therapy. Thrombolytic therapy was underutilized in 14.3% and overutilized in 12.9% of the patients. The use of thrombolytic therapy was associated with reduced mortality in every subgroup examined, including patients without an accepted indication, with an accepted indication and in patients with prior stroke. The risk ratio of in-hospital stroke was not increased in connection with thrombolytic therapy, not even in patients with prior stroke (relative risk = 0.237, 95% confidence interval: 0.031 to 1.810, p = 0.17). CONCLUSIONS: With the large benefit known to be associated with thrombolytic therapy and the favorable result of thrombolytic therapy in patients with contraindications observed in this study, we conclude that a formal evaluation of thrombolytic therapy in wider patient categories is warranted.
Notes
Comment In: J Am Coll Cardiol. 2001 May;37(6):1588-911345369
PubMed ID
11345368 View in PubMed
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[The RECORD registry. Treatment of patients with acute coronary syndromes in hospitals with and without possibilities to perform invasive coronary procedures].

https://arctichealth.org/en/permalink/ahliterature141935
Source
Kardiologiia. 2010;50(7):8-14
Publication Type
Article
Date
2010
Author
A D Érlikh
N A Gratsianskii
Source
Kardiologiia. 2010;50(7):8-14
Date
2010
Language
Russian
Publication Type
Article
Keywords
Acute Coronary Syndrome - diagnosis - epidemiology - physiopathology - therapy
Aged
Angioplasty, Balloon, Coronary - adverse effects - contraindications - mortality
Coronary Angiography
Coronary Artery Bypass - adverse effects - contraindications - mortality
Electrocardiography
Hospital Mortality
Hospital records
Humans
Middle Aged
Outcome and Process Assessment (Health Care) - statistics & numerical data
Patient Acceptance of Health Care
Registries
Risk assessment
Russia
Thrombolytic Therapy - adverse effects - contraindications - mortality
Abstract
The participants initiated RECORD registry in Russia recruited 796 patients (pts) with ST elevation (STE, n=256) and non ST elevation (NSTE, n=550) acute coronary syndrome (ACS) between 11.2007 and 02.2008. Ten of 18 participating hospitals (H) had facilities for coronary angiography and revascularization (invasive H-IH). STEACS. Percentages of pts with history of heart failure (HF) and with high GRACE score were significantly higher among pts in noninvasive (N) H. Pts in NH also had numerically although insignificantly higher mean age, portions of pts aged 75 years, with history of myocardial infarction (MI), and with Killip class II. In IH 60.9% of pts were subjected to reperfusion therapy (but only 30.4% - to primary PCI). In NH thrombolytic therapy was used in 34.1% of pts. Inhospital mortality was 14.3% in IH and 21.2% in NH. Within IH among pts subjected to PCI (n=49) proportion of persons aged 75 years and mean age were significantly lower compared with nonPCI pts, portion of subjects with high admission GRACE score ( 150) was numerically although insignificantly (p=0.07) smaller. There were no differences in clinical characteristics between nonPCI pts in IH and pts in NH. Therapy of nonPCI pts in IH was closer to guidelines with higher rate of thrombolytic therapy (42 vs 34.1%) and especially of clopidogrel use (42 vs 18.8%). However inhospital mortality of nonPCI pts in IH was closer to that in NH (18.9 vs 21.2%). NSTEACS. Pts in NH had significantly higher age. Portions of pts aged 75 years, with history of MI and of HF, with Killip class II, and high GRACE score in NH were significantly larger than in IH. Treatment of pts in IH was closer to guidelines with significantly higher use of clopidogrel and low molecular weight heparin, 54.3% of pts were subjected to angiography, 24.8% - to PCI, 9.4% - to coronary bypass surgery. Mortality was equal and relatively low in IH and NH (2.8 and 2.7%, respectively) despite differences in clinical characteristics of pts. Within IH invasively compared with noninvasively treated pts had significantly lower mean age and lower portion of pts 75 years, lower portions of pts with history of MI and HF, with Killip class II. Mortality was equal but rate of MI was significantly higher in invasively treated pts. Comparison of results of invasive treatment in IH and treatment in NH: mortality was equally relatively low (2.5 and 2.7%, respectively) despite higher proportions of pts with old age, history of HF, high GRACE score in NH; development of inhospital MI was significantly more frequent among invasively treated pts (7.9 vs 1.7%). Conclusion. Lower risk pts were admitted to IH and within IH lower risk pts were actually subjected to invasive treatment. Results of invasive reperfusion in STEACS were better than results of noninvasive treatment but effect of selection of lower risk pts can not be excluded. No positive effect of either invasive treatment or treatment in advanced H was revealed in NSTEACS.
PubMed ID
20659038 View in PubMed
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