Panel urges prompt use of clot-dissolving drugs to save heart attack patients

February 08, 1994|By New York Times News Service

BETHESDA -- Federal health officials recommended yesterday that all heart attack patients who need clot-dissolving drugs receive them within 30 minutes of arrival at an emergency room. They issued a set of specific guidelines aimed at reducing the deaths from the leading killer of American adults.

The aim is to reduce death and disability by administering timely injections of clot-dissolving drugs such as streptokinase and tpa, which are also known as thrombolytics. The benefit of such therapy has been proven conclusively in several trials involving tens of thousands of heart attack victims in many countries.

Currently, the study said, "many eligible patients do not actually receive this therapy" and many others do not get it in time. One recent national study, cited in yesterday's report, found that only 39 percent of heart attack patients received a clot-buster drug.

The report from a panel representing 39 scientific, professional, governmental and voluntary organizations is being published in the February issue of the Annals of Emergency Medicine.

Of the estimated 1.25 million people who suffer a heart attack in the United States each year, nearly 500,000 die. More than half the deaths occur within an hour of the onset of symptoms and outside a hospital.

Time is a critical factor in the effectiveness of clot-dissolving drugs in preventing sudden death from a heart attack and in the later development of complications like heart failure. The drugs have the greatest benefit if they are injected in the first hour or two after a heart attack, and the results can be striking. The benefit continues if the drugs are given up to about 12 hours after a heart attack, but it declines rapidly as time passes after the first hour.

The study specifically includes a recommendation for administering such drugs to older patients, assuming that there are no complicating factors. Doctors have withheld clot-buster drugs from many older heart attack patients because of concerns about safety, as some early studies did not include older people.

But recent studies have shown the drugs to be safe in all age groups. The drugs may not be as safe for some people who also have other medical problems that pose a risk of bleeding. The decision to use clot busters among such patients is decided case by case.

A heart attack patient "should be treated in the emergency department with the same sense of urgency as a victim of major trauma," said Dr. Claude Lenfant, the head of the National Heart, Lung and Blood Institute, a federal agency in Bethesda.

The report cites a number of specific emergency-room barriers to prompt treatment. Among the steps the panel recommended were these:

* Update emergency room plans to rapidly identify and treat heart attack patients and to reduce the long intervals between registering a patient and examining the individual.

* Allow nurses to order an electrocardiogram and set five minutes as a deadline for getting one after it is ordered.

* Give nurses standing orders to order certain diagnostic tests and start certain therapies for heart attack patients.

* Eliminate jurisdictional battles and disputes among emergency doctors, cardiologists, internists, family doctors and other medical specialists who compete to care for heart attack patients.

* Establish plans to authorize emergency room doctors to give clot-buster drugs without having to wait for approval from the patient's personal doctor.

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