IMPROVED HEALTH BENEFITS OF INCREASED USE OF THROMBOLYTIC THERAPY

Background: To quantify population health consequences of increased us e of thrombolytic therapy for acute myocardial infarction in the Unite d States. Methods: A decision analytic model was constructed to evalua te treatment-related outcomes for two myocardial infarction treatment strategies: standard therapy and standard therapy plus combination asp irin-thrombolytic therapy. Patients were entered into the model by age , electrocardiographic presentation, and time to medical evaluation. E stimated mortality changes associated with increased use of thrombolyt ic therapy were calculated both for populations for which thrombolytic therapy is recommended and for specific patient populations for which thrombolytic therapy is not recommended under current guidelines. Sen sitivity analyses tested the robustness of results when input variable s were altered. Results: If every patient with acute myocardial infarc tion for whom thrombolytic therapy is recommended under current guidel ines were treated with aspirin and a thrombolytic agent, more than 400 0 additional lives would be saved annually in the United States. The m odel projected that approximately 8000 additional lives could be saved if use of thrombolytic therapy were expanded to include the following patient groups: age greater than 75 years (approximately 4500 lives s aved), left bundle-branch block on electrocardiogram (approximately 25 00 lives saved), and presentation 6 to 12 hours after the onset of che st pain (approximately 2000 lives saved). Sensitivity analysis demonst rated a mortality advantage attributable to the use of thrombolytic th erapy in each clinical scenario tested. Conclusions: Providing thrombo lytic therapy more aggressively could prevent over 12000 deaths from a cute myocardial infarction each year in the United States.