Nunn C, Scott M, Lennane J
Department of Cardiology, Waikato Hospital, Hamilton.
N Z Med J. 2001 Feb 9;114(1125):41-3.
To assess treatment delays incurred by Coromandel patients requiring thrombolytic therapy for acute myocardial infarction at Thames Hospital.
A chart search was undertaken at Thames Hospital to identify all patients admitted from July 1993 to July 1998 with a diagnosis of acute myocardial infarction who were treated with thrombolytic therapy. Times of pain onset, general practitioner (GP) assessment, transportation, hospital arrival and thrombolytic administration were noted. Additional information, when required, was obtained from the patient's GP or the St Johns Ambulance service.
153 patients were thrombolysed at Thames Hospital over this period, mean age 65.1 years, 36.6% in heart failure. The mean time from pain onset to GP contact was 157.2 minutes and varied from 63.2 minutes in Coromandel Township to 272.5 minutes in Pauanui. Delays from GP contact to thrombolysis were longer for patients living in outlying areas versus Thames and its environs, 169.4 +/- 45.9 versus 125.2 +/- 50.4 minutes (mean +/-SD) respectively, p<0.001. This contributed to a total delay from pain onset to thrombolysis of 316.7 +/- 145.8 minutes for patients in outlying areas versus 269.1 +/- 185.8 minutes for local patients (p=0.014).
Delays in providing thrombolytic therapy for acute infarct patients reflect not only transport times but also delays in seeking initial medical assessment and hospital triage times. Transport times become particularly significant for those outside of Thames and its environs. Only with improved patient education and local delivery of thrombolytic therapy will these delays be adequately addressed.
