Response to an optimistic viewpoint

Abstract

We appreciate the interests in our work and observe that we agree that earlier thrombolysis for AMI can reduce the AMI case fatality. The question is how much and at what price. There are no data available to directly address this issue, and we developed a simulation model to quantify costs and health consequences of less thrombolytic delay by using public awareness campaigns, telemedicine, or a combination of the two. Inevitably, such a model needs to be based on several uncertain parameter values. We performed a range of sensitivity analyses so readers of the analysis could see the effect of replacing our base case values with others that the reader might consider more appropriate. Due to space restrictions, we had to omit a table with sensitivity analyses that would have addressed several of the concerns Terkelsen and coworkers have.