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Media Advisory: September 30, 1997
Busy emergency room doctors now have a new ally in their
fight to save heart attack victims from dying. The ally is a
computerized decision-making aid built into the standard
electrocardiograph (EKG) machine that instantly prints
predictions, based on the patient's EKG and other clinical
information, of whether that individual is likely to benefit from
potentially lifesaving treatment with thrombolytic (clot-dissolving) drugs.
The new real-time predictive instrument was developed and
tested by a team of researchers under a grant from the federal
government's Agency for Health Care Policy and Research (AHCPR).
The description of the instrument and all necessary details to
calculate its predictions for any patient with a heart attack are
published in the October 1 issue of Annals of Internal Medicine.
"This marks an important step forward in the fight to cut
deaths from heart attack," said AHCPR Administrator John M.
Eisenberg, M.D. "It's also a prime example of how health
services research aids everyday medical care." Dr. Eisenberg
said physicians currently base thrombolytic therapy decisions
mostly on the same kinds of information the instrument uses, but
that the new tool can make the process more systematic, precise
Thrombolytic drugs help many patients survive a heart attack
if administered in time. However, if the drugs are administered
too late, or given to patients unlikely to benefit, they are of
little or no help, may cause serious complications, and waste
Other than timing (AHCPR-funded and other research shows
that heart attack victims often delay seeking care) the main
reasons more patients do not receive thrombolytic care is failure
to recognize suitable candidates and fear of complications.
According to the research team leader, Harry P. Selker,
M.D., of Boston's New England Medical Center, the new instrument
estimates the patient's probabilities (from zero to 100 percent)
of suffering cardiac arrest within 48 hours, of dying within 30
days or of dying within one year, if the patient is, or is not,
treated with thrombolytic therapy in the emergency room. The
instrument also calculates the patient's likelihood of developing
serious complications, such as hemorrhagic stroke or major
bleeding, if given thrombolytic therapy.
The study involved researchers from Tufts University School
of Medicine, Duke University Medical Center, University of
Washington School of Medicine, Boston University Department of
Mathematics, Harbor-UCLA Medical Center and the University of
Southern California Department of Medicine.
Dr. Selker's study is one of a series of research projects
supported by AHCPR to improve the quality and effectiveness of
clinical care. AHCPR is currently funding a follow-up,
randomized controlled trial in a diverse group of 28 hospitals
across the country to test the clinical impact of making this
thrombolytic predictive instrument available in emergency rooms.
To arrange an interview of Dr. Selker,
please contact Melissa McPherson of New England Medical Center's
External Affairs Office, (617) 636-3265.
For additional information, contact AHCPR Public Affairs: Salina Prasad, (301) 427-1864 (SPrasad@ahrq.gov).