THROMBOLYTIC THERAPY GUIDED BY A DECISION-ANALYSIS MODEL - ARE THERE POTENTIAL BENEFITS FOR PATIENT-MANAGEMENT

Background: Although thrombolytic therapy improves t he outcome of myo cardial infarction, it is associated with increased risks of stroke an d bleeding; these risks may outweigh the benefits of therapy. The risk s and benefits of thrombolysis, for any individual clinical situation, can be explicitly estimated by means of decision analysis. Hypothesis : The aim of this study was to compare the actual use of thrombolytic agents for suspected acute myocardial infarction (AMT) with the manage ment preferred by a decision analysis model. Methods: Admission data p rospectively obtained in 262 consecutive patients admitted to a rural community hospital's coronary care unit with suspected AMI, as well as clinical decisions and outcomes, were reviewed and analyzed. Results: Seventeen deaths from AMI and no major strokes were observed, compare d with 18.30 deaths and 0.85 major strokes predicted by a decision ana lysis model. Forty-seven of 84 patients with confirmed AMI and 3 of 17 8 without AMI were given a thrombolytic agent, compared with 65 patien ts with and 7 without AMI who had decision analysis-guided therapy. De cision analysis-guided therapy could have saved 3.7 additional lives a nd gained 29.6 life years, but produced 0.4 extra strokes. Changing th e quality adjustment for stroke or heart failure would not have altere d the treatment preferred by decision analysis in any of the 262 cases studied. Some patients were predicted to benefit considerably from th rombolysis sis with little extra risk of stroke and vice versa: all ca ses must, therefore, be assessed individually. Conclusions: A decision analysis model can guide thrombolytic therapy by promptly defining it s risks and benefits.