Guidelines for the early management of patients with myocardial infarction

In light of recent publications relating to resuscitation and pre-hospital treatment of patients suffering acute myocardial infarction the British Heart Foundation convened a working group to prepare guidelines outlining the responsibilities of general practitioners, ambulance services, and admitting hospitals. The guidelines emphasise the importance of the rapid provision of basic and advanced life support; adequate analgesia; accurate diagnosis; and, when indicted, thrombolytic treatment. The working group developed a standard whereby patients with acute myocardial infarction should receive thrombolysis, when appropriate, within 90 minutes of alerting the medical or ambulance service - the call to needle time. Depending on local circumstances, achieving this standard may involve direct admissions to coronary care units, “fast track” assessments in emergency departments, or pre-hospital thrombolytic treatment started by properly equipped and trained general practitioners.

In 1989 a working group of the British Heart Foundation published recommendations for the early management of patients with suspected acute myocardial infarction.1 These were felt to be necessary because of the high incidence of coronary events in the population,2 the recognition that most of those dying do so soon after the onset of symptoms (before arriving in cardiac care units),3 and because many lives could be saved by the prompt provision of resuscitation skills and equipment and, where appropriate, by early thrombolytic treatment.4

The 1989 report needed revision for two reasons: because of the subsequent publication of relevant studies and to address continued uncertainty, not so much about the aim of treatment, but about the role of the various components of the health service (general practitioners, ancillary staff, ambulance services, admitting hospitals) in achieving these aims. A rapid and effective response to heart attack has been targeted as a major health gain area by the Department of Health,5 and health districts have been recommended to …