How EBM has saved lives: the golden hour

How EBM has saved lives: the golden hour A few weeks ago, ‪@juliaoftoronto posted a tweet asking evidence nerd’s about favourite EBM that has saved lives.

Evidence nerds – what’s your fave ex. of how EBM has saved lives? @peterjgill @hildabast @cebmblog @trished @trishgreenhalgh I can’t pick — Julia Belluz (@juliaoftoronto) August 15, 2014

An interesting issue, one I am answering a few weeks later, having thought about it, my favourite EBM for saving lives – the golden hour. Early treatment with thrombolysis has a huge effect on mortality: for every 1000 patients treated 65 more will be alive at 1 month if treatment is administered in the first hour – the ‘golden hour’ – after symptom onset, compared with not giving thrombolysis.

Look what happens if you delay treatment a little:

• 37 lives are saved for every 1000 patients treated in the 1–2 hour interval;

• 26 lives are saved for every 1000 patients treated in the 2–3 hour interval;

• 29 lives are saved for every 1000 patients treated in the 3–6 hour interval;

• 20 lives are saved for every 1000 patients treated in the 7–12 hour interval after symptom onset.

Mortality is therefore increased  by about 2 lives per 100 infarct for every hour delay.

I’ve posted the references below for this great piece of  important EBM that definitely saves lives.

References

Lancet. 1994 Feb 5;343(8893):311-22. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients.

Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Boersma E, Maas AC, Deckers JW, Simoons ML. Lancet. 1996 Sep 21;348(9030):771-5.