Jd. Gemmill et al., ASSESSMENT BY GENERAL-PRACTITIONERS OF SUITABILITY OF THROMBOLYSIS INPATIENTS WITH SUSPECTED ACUTE MYOCARDIAL-INFARCTION, British Heart Journal, 70(6), 1993, pp. 503-506
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.