Pre-hospital treatment of patients with suspected acute myocardial using a beta-blocking agent: a double-blind feasibility study. EMIP-BB Pilot Study Group.
The efficacy of intravenous beta-blocker treatment in hospital patients with acute myocardial infarction (AMI) in reducing short-term mortality and morbidity has been demonstrated; the efficacy seems to be higher the earlier the treatment is administered. We assessed the feasibility of pre-hospital treatment of patients in a randomised, double-blind, controlled pilot study. Eligible patients (symptoms suggestive of AMI for less than 2 h) were randomised by mobile emergency unit staff to receive either pre-hospital beta-blocker treatment (intravenous injection of atenolol) immediately, followed by placebo in hospital, or the opposite. All patients received a 7-day course of oral atenolol at the discretion of the hospital physician. A total of 77 patients were included (41 in the pre-hospital beta-blocker group and 36 in the pre-hospital placebo group). Sixteen patients in each group received active treatment, but only 9 and 11 patients, respectively, received full treatment. The reasons for the non-administration of the second injection included the occurrence of adverse events after the first injection, and a certain reserve on the part of the hospital physicians to administer beta-blocker treatment in patients with suspected myocardial infarction. Three patients in each group died; the minor adverse event rate was similar in the two groups. The findings of the study suggest that this approach would be feasible in terms of safety. However, a large number of patients did not receive any hospital treatment for a number of reasons which must be considered if a large-scale trial is to be undertaken.
D001262:Atenolol / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004632:Emergency Medical Services; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D010343:Patient Admission; D010865:Pilot Projects; D010919:Placebos; D015996:Survival Rate; D016896:Treatment Outcome