Heart attack patients who receive anti-clotting drugs before arriving at hospital will be more likely to survive or have fewer complications than patients whose initial treatment is delayed.
New research funded by the Queensland Ambulance Service (QAS) has shown early administration of thrombolytic therapy by paramedics attending emergency calls not only saved lives but was also good value for money.
Health economist Professor Paul Scuffham, from Griffith’s School of Medicine1, said waiting for doctors to administer the potentially life-saving therapy when patients were transferred to hospitals could incur critical delays.
“QAS data on almost 30,000 patients with chest pain showed that thrombolytics could be administered almost an hour earlier if given by paramedics at the scene.”
Simulation modelling also found that earlier administration could avert 65 deaths over the first 30 days, a 10.5 per cent reduction in mortality, and reduce the incidence of heart failure by up to 40 per cent in these patients.
“Highly trained paramedics with the ECG skills to diagnose ST-elevated myocardial infarction are certainly capable of administering thrombolytics such as tenecteplase in a safe, timely and cost-effective manner,” he said.
QAS intensive care paramedics will be the first in Australia to deliver on a new statewide reperfusion strategy to deliver these drugs to patients as early as possible.
Only a minority of patients, where the diagnosis was not clear-cut, may still require transfer to hospital before therapy.
Professor Scuffham said increased survival rates resulted in slightly higher health care costs associated with hospital stays for patients and their ongoing medical or surgical management.
“Compared to the cost-effectiveness ratios used to evaluate new drugs, the costs of paramedics administering thrombolytic therapy represents a sound investment to improve health outcomes.”
QAS Commissioner David Melville said “emphasis on cost effective clinical best practice is a priority for QAS. This report has provided a valuable evidence base for our operational practice.”
QAS medical director Dr Stephen Rashford said the research vindicated their decision to undertake this critical enhancement in pre-hospital care.
“This is a crucial piece of academic research which has assisted the development of a vital new health care strategy,” he said.
Professor Scuffham said the health benefits may be even greater in areas where the time to hospital was typically longer than in the Queensland model.
(Source: Current Medical Research and Opinion: Griffith’s School of Medicine: July 2008)