JRSM > Volume 97, Number 5 > Pp. 230-234

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Prehospital thrombolysis—calculated health benefit for catchment population of one hospital

Mark Kroese MRCGP MFPHM  ¹ David Kanka MRCGP FFPH  ² Peter Weissberg MD FRCP  ³ Barbara Arch MSc  ⁴   John Scott MBChB FIMCRCS(Ed)  ⁵

¹ Public Health Genetics Unit, Strangeways Research Laboratory, Worts Causeway, Cambridge CB1 8RN
² South Cambridgeshire Primary Care Trust, Fulbourn, Cambridge CB1 5EE
³ Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge Addenbrooke's NHS Trust, Cambridge CB2 2QQ
⁴ Centre for Applied Statistics, Institute of Public Health, Cambridge CB2 2SR
⁵ East Anglian Ambulance NHS Trust, Norwich NR6 5NA, UK

Correspondence to: Mark Kroese
E-mail: mark.kroese{at}srl.cam.ac.uk

The health benefit of thrombolysis in acute myocardial infarction is greatest when patients are treated soon after onset of symptoms. One approach to reducing treatment delay is to give thrombolysis before the patient reaches hospital. When an ambulance trust proposed a prehospital thrombolysis service, local commissioners requested an estimate of its possible health impact. Clinical audit and ambulance trust data were obtained for 165 patients who received thrombolysis for acute myocardial infarction in the coronary care unit of a local hospital in one year. This information was then used to estimate the health impact of prehospital thrombolysis in the local population in a mathematical model derived from the results of trials comparing prehospital and hospital thrombolysis.

The best predicted local health benefit from the proposed prehospital thrombolysis service is that, if 45 minutes can be cut off the call-to-needle time, 61 cases of acute myocardial infarction need to be treated to save one additional life at 35 days.

By use of published research data, the health benefits of prehospital thrombolysis can be estimated for a local population. Variables in the treatment population and ambulance service will influence the size of the health benefit that can be achieved.

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