title: The effect of early prehospital transtelephonic coronary intervention on morbidity and mortality: experience with 284 postmyocardial infarction patients in a pilot program.
abstract: We have evaluated, in a pilot study, the effects of subsequent mortality and morbidity of a prehospital program for postmyocardial infarction patients experiencing recurrent chest pain. Two hundred eighty-four patients were enrolled during their late hospital period: 161 in a program incorporating patient education, routine transtelephonic follow-up, and emergency prehospital CCU-controlled intervention; 124 in a control group receiving usual medical care. Cardiac mortality over a median of 13 months of follow-up was significantly reduced in the treatment group (5.8%) vs control (12.9%), p = 0.036, although the incidence of acute events (nonfatal infarction plus cardiac death) was similar in both groups. This suggests that the program does not affect the acute incident but rather the mortality subsequent to it. Prehospital ventricular arrhythmias present in 7 of 54 treatment patients with recurrent chest pain did not recur following self-injection by a prefilled lidocaine syringe; only one patient who was initially arrhythmia-free had ventricular ectopic beats after lidocaine injection. Delay from onset of symptoms to hospital arrival was 1.9 hours. Routine telephone follow-up uncovered ventricular arrhythmias in 30% of treatment patients and, despite the program's patient educational efforts, unreported angina in 20% of the treatment group. In the treatment group there were 99 emergency calls placed by 62 patients, 50% within 12 weeks after discharge and 80% by 35 weeks, resulting in 74 Emergency Department evaluations and 57 hospital admissions. Overuse of the emergency system occurred with only one patient, and physician acceptance was high.(ABSTRACT TRUNCATED AT 250 WORDS)
mesh_terms: D001145:Arrhythmias, Cardiac / Q000209:etiology; D002300:Cardiac Care Facilities; D003402:Creatine Kinase / Q000097:blood; D005260:Female; D006801:Humans; D007527:Isoenzymes; D008012:Lidocaine / Q000008:administration & dosage; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D009518:New York; D010865:Pilot Projects; D012237:Rhode Island; D012646:Self Administration; D013689:Telephone
chemical_list: D007527:Isoenzymes; D008012:Lidocaine; D003402:Creatine Kinase