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004 MEASURING THE IMPACT OF A PREHOSPITAL THROMBOLYSIS PROGRAMME USING THE NATIONAL AMBULANCE OUTCOMES DATABASE: THE STAFFORDSHIRE EXPERIENCE
T. Quinn1,2, D. Minard1, I. Snelling3, C. Wright4, R. Thayne1, C. Thomas1, A. Van Dellen1.1Staffordshire Ambulance Service NHS Trust, Stafford, UK; 2Coventry University, Coventry, UK; 3Shropshire and Staffordshire Cardiac Network, Stafford, UK; 4University of Birmingham, Birmingham, UK
Background: Prehospital administration (PHT) of thrombolytic treatment has been shown to reduce all-cause mortality compared with hospital thrombolysis in acute myocardial infarction, and has been introduced in England after publication of the National Service Framework for coronary heart disease.
Objective: To compare the clinical course and outcome of patients receiving PHT and hospital thrombolysis, using data from the National Ambulance Outcomes Database, part of the national audit of myocardial infarction.
Methods: Prospective observational study during the period March 2003 to January 2006.
Results: Results are described in the table.
Limitations: Patients with hospital thrombolysis were older and a higher proportion was women; more patients with hospital thrombolysis had left bundle branch block—all indicators of higher mortality risk. Data on baseline characteristics, such as prior myocardial infarction, smoking or medication, and use of adjunctive treatments including rescue angioplasty, were unavailable.
Conclusion: These data suggest that PHT in routine practice seems to be as safe (diagnostic accuracy and intracranial haemorrhage rate) as hospital thrombolysis, and there is significantly lower unadjusted hospital mortality in the PHT group—but baseline characteristics differ. Access to a more comprehensive dataset than currently available to ambulance services is required to facilitate detailed analysis.
005 PUBLIC PERCEPTIONS AND EXPERIENCES OF HEART ATTACK, CARDIAC ARREST AND CARDIOPULMONARY RESUSCITATION IN LONDON
R. T. Donohoe, K. Haefeli, F. Moore.Clinical Audit and Research Unit, London Ambulance Service NHS Trust, London, UK
Background: Coronary heart disease (CHD) is a leading cause of mortality and a common cause of out-of-hospital cardiac …