Heart 1998;80:231-234 ( September )
Audit of prehospital thrombolysis by general practitioners in peripheral practices in Grampian
a Medicines Assessment
Research Unit, Aberdeen Royal Infirmary, Aberdeen, UK, b Department of Cardiology,
Aberdeen Royal Infirmary, c Department of General Practice and Primary Care,
University of Aberdeen, Aberdeen, UK, d Grampian
Health Board, Aberdeen, UK
Correspondence to: Dr J Rawles, Medicines Assessment Research Unit, Aberdeen Royal Infirmary, Foresterhill, Aberdeen AB25 2ZN, UK.
Accepted for publication 27 May 1998
Background
In
the Grampian region early anistreplase trial (GREAT), domiciliary
thrombolysis by general practitioners was associated with a halving of
one year mortality compared with hospital administration. However,
after completion of the trial and publication of the results, the use
of this treatment by general practitioners declined sharply.
ObjectiveTo
increase the proportion of eligible patients receiving timely
thrombolytic treatment from their general practitioners.
SettingPractices
in Grampian located 
30 minutes' travelling time from Aberdeen
Royal Infirmary, where patients with suspected acute myocardial
infarction were referred after being seen by general practitioners.
Audit standardA
call-to-needle time of 90 minutes, as proposed by the British Heart
Foundation (BHF).
MethodsFindings of
this audit of prehospital management of acute myocardial infarction
were periodically fed back to the participating doctors, when practice
case reviews were also conducted.
ResultsOf 414 administrations of thrombolytic treatment, 146 (35%) were given by
general practitioners and 268 (65%) were deferred until after hospital
admission. Median call-to-needle times were 45 (94% 
90) and 145 (7% 90) minutes, respectively. Survival at one year was improved
with prehospital compared with hospital thrombolysis (83%
v 73%; p < 0.05). The proportion of
patients receiving thrombolytic treatment from their general
practitioners did not increase during the audit.
ConclusionsIn
practices 30 minutes from hospital, the BHF audit standard was
readily achieved if general practitioners gave thrombolytic treatment,
but not otherwise. Knowledge of the benefits of early thrombolysis, and
feedback of audit results, did not lead to increased prehospital
thrombolytic use. Additional incentives are required if general
practitioners are to give thrombolytic treatment.
© 1998 by Heart
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