Impact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction

doi:10.1016/0140-6736(93)91945-I

The Lancet

Volume 342, Issue 8876, 9 October 1993, Pages 891-894

https://doi.org/10.1016/0140-6736(93)91945-I Get rights and content

Abstract

Little is known about incorporation of new knowledge from randomised clinical trials into clinical practice. Thrombolytic therapy was shown to reduce the mortality of acute myocardial infarction in several large trials published during 1986-88. To examine the effect of these data on clinical practice, we analysed the supply of thrombolytic drugs in a representative English region (population 4·7 million) in 1987-92. During the study period there were over 10 000 hospital admissions per year in the region for acute myocardial infarction. From a very low initial level, thrombolytic drug use rose slowly for several years after publication of the trial results and reached a plateau in 1991-92. Rates of use per 1000 patients admitted with myocardial infarction varied almost six-fold between districts in 1989-90 and over two-fold in 1991-92. Level of use attained by districts in the latter period was strongly associated with the extent of their previous participation in multicentre trials of thrombolysis (p=0·003); we estimate that 35-50% of patients admitted with acute myocardial infarction were receiving thrombolytics. The full potential of thrombolytic treatment has still not been achieved in routine care and the limiting factors need to be defined.

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Population-based surveillance study monitoring trends in clinical epidemiology among residents of the Worcester, Massachusetts, metropolitan statistical area (WMSA) diagnosed with an acute VTE in all 12 WMSA hospitals. Patients were followed for up to 3 years after their index event. Total of 2334 WMSA residents diagnosed with first-time community-presenting VTE (occurring in an ambulatory setting or diagnosed within 24 hours of hospitalization) from 1999 through 2009.
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ARTICLESImpact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction

Abstract

Lancet

Lancet

Am J Cardiol

Control Clin Trials

Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction

Lancet

Long-term effects of intravenous thrombolysis in acute myocardial infarction: final report of the GISSI study

Lancet

Effect of intravenous APSAC on mortality after acute myocardial infarction: preliminary report of a placebo- controlled clinical trial

Lancet

Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17 187 cases of suspected acute myocardial infarction: ISIS-2

Lancet

British Heart Foundation surveys (1987 and 1989) of United Kingdom treatment policies for acute myocardial infarction

Br Heart J

La prescription médicamenteuse dans le postinfarctus: résults de l'EPPI (étude de prescription postinfarctus)

Arch Mal Coeur

ARTICLES
Impact of clinical trials on clinical practice: example of thrombolysis for acute myocardial infarction