ASSESSMENT BY GENERAL-PRACTITIONERS OF SUITABILITY OF THROMBOLYSIS INPATIENTS WITH SUSPECTED ACUTE MYOCARDIAL-INFARCTION

Objective-To assess the clinical ability of general practitioners to d ecide to give thrombolytic therapy to patients with suspected myocardi al infarction and to assess the contribution of the electrocardiograph (ECG) to this decision-making process. Setting-7 practices on the Nor th side of Glasgow and the coronary care unit of Stobhill General Hosp ital. Subjects-137 patients presenting with chest pain who required di rect admission to the coronary care unit. Main outcome measures-Agreem ent between the general practitioner's clinical decision to give throm bolytic therapy with or without reference to the ECG and the prescript ion of thrombolytic therapy in the coronary care unit. Results-The pre dictive accuracy of the general practitioner's assessment of the neces sity for thrombolytic therapy was 71 5%. The ECG had no impact on the accuracy of this decision and there were problems with the recording a nd interpretation of the ECG. Clinical decision making was altered in six cases by the ECG-wrongly in four. Conclusion-The diagnostic accura cy among general practitioners would result in some patients who did n ot have acute myocardial infarction being given thrombolytic therapy. In this study the ECG did not contribute towards diagnostic accuracy. Substantial improvement in both the recording and interpretation of EC Gs is needed before thrombolytic tic agents can be routinely prescribe d at home.