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Diffusion of thrombolysis for acute myocardial infarction from 1981 to 2000 in England: Trend analysis and comparison with need

Published online by Cambridge University Press:  01 November 2004

Claire Packer
Affiliation:
The University of Birmingham
Andrew Stevens
Affiliation:
The University of Birmingham
Alison Cook
Affiliation:
The University of Birmingham
James Raftery
Affiliation:
The University of Birmingham

Abstract

Objectives: To describe the adoption and take up of thrombolytic agents for acute myocardial infarction since 1980 in England and compare use with the estimated ceiling of need.

Methods: Data on national sales and use of thrombolysis since 1980 (supplied by IMS Health) was used to draw an adoption and diffusion curve. The epidemiological ceiling of acute myocardial infarction, from hospital activity statistics, was modified to an estimated clinical need by accounting for diagnostic difficulty and contraindications using information from published surveys of thrombolysis use in the United Kingdom.

Results: There was a rapid uptake of thrombolytic agents in the first 2 years after availability in 1987, then a plateau, followed by a rise to a peak use in 1995. The shortfall in doses resulting from the difference between estimated ceiling of clinical need and doses purchased and provided in the 14 years since availability is estimated as 167,800 (95 percent confidence range 94,000 to 241,700).

Conclusions: Although there was a rapid initial uptake of thrombolysis in England, usage took 8 years to reach the ceiling of clinical need of 65 percent of patients with acute myocardial infarction, with many patients missing the opportunity to benefit. Monitoring of uptake of innovations known to be cost-effective is required to identify those developments that need additional stimulus for change to ensure that patients do not miss out on the opportunity to benefit.

Type
GENERAL ESSAYS
Copyright
© 2004 Cambridge University Press

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References

Antman EM, Lau J, Kupelnick B, Mosteller F. 1992 A comparison of results of meta-analyses of randomised control trials and recommendations of clinical experts. JAMA. 268: 240248.Google Scholar
Birkhead J. 2003 Where are we today? Early results from MINAP, the national audit of myocardial infarction project. Heart. 89 (Suppl II): ii13ii15.Google Scholar
Birkhead JS on behalf of the Myocardial Infraction Audit Group. 1997 Thrombolytic treatment for myocardial infarction: An examination of practice in 39 UK hospitals. Heart. 78: 2833.
British Heart Foundation Working Group. 1989 Role of the general practitioner in managing patients with myocardial infarction: Impact of thrombolysis. BMJ. 299: 555557.
British National Formulary. 2002. British Medical Association and the Royal Pharmaceutical Society of Great Britain
Brown N, Young T, Gray D, Skene AM, Hampton JR. 1997 Inpatient deaths from acute myocardial infarction, 1982–92: Analysis of data in the Nottingham heart attack register. BMJ. 315: 159164.Google Scholar
Brown N, Melville M, Gray D, et al. 1999 Relevance of clinical trial results in myocardial infarction to medical practice: Comparison of four year outcome in participants of a thrombolytic trial, patients receiving routine thrombolysis, and those deemed ineligible for thrombolysis. Heart. 81: 598602.Google Scholar
De Bono DP, Hopkins A. 1994 The management of acute myocardial infarction: Guidelines and audit standards. Report of a workshop of the Joint Audit Committee of the British Cardiac Society and the Royal College of Physicians. J R Coll Physicians Lond. 28: 312317.Google Scholar
Department of Health and Social Security Office of Population Censuses and Surveys. 1986. Hospital in-patient enquiry: In-patient and day case trends 1979–1985. England: Series MB4 No. 29.
Department of Health. 2000. National service framework for coronary heart disease. London: Department of Health
el Gaylani N, Weston CF, Griffith K, et al. 1998 Acute myocardial infarction: Are there missed opportunities for reperfusion? Coron Artery Dis. 9: 753758.Google Scholar
European Secondary Prevention Study Group. 1996 Translation of clinical trials into practice: A European population-based study on the use of thrombolysis for acute myocardial infarction. Lancet. 347: 12031207.
Farnsworth TA. 1993 Varying thrombolytic administration rates in elderly patients with acute myocardial infarction. Br J Clin Pharmacol. 47: 305307.Google Scholar
Fibrinolytic Therapy Trialists' (FTT) Collaborative Group. 1994 Indications for fibrinolytic therapy in suspected acute myocardial infarction: Collaborative overview or early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet. 343: 311322.
Hannaford P, Kay CR, Ferry S. 1994 Agism as explanation for sexism in provision of thrombolysis. BMJ. 309: 573.Google Scholar
Hendra TJ, Marshall AJ. 1992 Increased prescription of thrombolytic treatment to elderly patients with suspected acute myocardial infarction associated with audit. BMJ. 304: 423425.Google Scholar
Ketley D, Woods K. 1993 Impact of clinical trials on clinical practice: Example of thrombolysis for acute myocardial infarction. Lancet. 342: 89194.Google Scholar
Ketley D. 1996. Beyond clinical trials:Translation of evidence into practice in the treatment of acute myocardial infarction. PhD thesis. University of Leicester
Lawson-Matthew P, Wilson AT, Woodmansey PA, Channer KS. 2003 Thrombolysis and myocardial infarction. Letter. Lancet. 341: 1096.Google Scholar
Myocardial Infarction National Audit Project Team. 2001. Myocardial Infarction National Audit Project (MINAP): Trial study report May–September 2000. London: Royal College of Physicians
Norris RM, Roy S, Dixon G. 1994 What proportion of patients with acute myocardial infarction should receive thrombolytic therapy? Br Heart J. 71: 40.Google Scholar
Pell ACH, Miller HC, Robertson CE, Fox KAA. 1992 Effect of ‘fast track’ admission for acute myocardial infarction on delay to thrombolysis. BMJ. 304: 8387.Google Scholar
Secretary of State for Health. 1992. The Health of the Nation: A strategy for health in England. London: HMSO
Timmis AD. 1996 Data on eligibility for thrombolytic treatment cannot be generalized. Letter. BMJ. 313: 941.Google Scholar
Woodmansey PA, Caldicott LD, Channer KS. 1993 Thrombolysis in acute myocardial infarction: An audit of practice. J R Coll Physicians Lond. 27: 4044.Google Scholar
Yusef S, Collins R, Peto R, et al. 1985 Intravenous and intracoronary fibrinolytic therapy in acute myocardial infarction: Overview of results on mortality, reinfarction and side-effects from 33 randomized controlled trials. Eur Heart J. 6: 556585.Google Scholar