Rural Alberta thrombolysis study. Survey of practice patterns for managing acute myocardial infarction.

OBJECTIVE

To determine current practice patterns for managing acute myocardial infarction in rural Alberta, particularly to examine the availability of thrombolytic therapy.

DESIGN

Mailed questionnaire based on a clinical vignette.

SETTING

All 104 acute care hospitals in rural Alberta with fewer than 100 beds.

PARTICIPANTS

The Chief of Staff at each hospital.

MAIN OUTCOME MEASURES

Proportion of hospitals providing thrombolytic therapy, choice of thrombolytic agent, rates of elective transfer after thrombolysis, and barriers preventing universal use of thrombolytic therapy.

RESULTS

Questionnaires were completed by 101 physicians. Three hospitals had no medical staff. Thrombolytic therapy was available in 80.8% of the hospitals. Hospitals that did not offer thrombolysis were smaller (average bed capacity 21.9 versus 37.7, P < 0.001), had fewer medical staff (average number 2.4 versus 5.5, P < 0.001), and had fewer nurses holding Advanced Cardiac Life Support certification (P = 0.015) than hospitals providing thrombolysis. Physicians identified inadequate nursing resources as the greatest barrier to providing thrombolysis. Of physicians using thrombolysis, 71.4% chose streptokinase. Half of the physicians preferred elective transfer after the procedure.

CONCLUSIONS

Thrombolytic therapy for acute myocardial infarction is standard practice in small hospitals in Alberta.