Copyright © 1998 by the European Society of Cardiology.
Delays in thrombolytic therapy for acute myocardial infarction in Finland. Results of a national thrombolytic therapy delay study
a Department of Internal Medicine, Kuopio University Hospital, Kuopio, Finland
b Department of Accident and Emergency, Kuopio University Hospital, Kuopio, Finland
c Department of Internal Medicine, Maria Hospital, Helsinki, Finland
d Finnish Heart Association, Helsinki, Finland
accepted November 21, 1997
Objective
To determine lengths and causes of pre- and in-hospital delays in thrombolytic treatment.
Design
A prospective national survey covering 48 of the 51 Finnish university, central and general hospitals to obtain basic data before the start of a public campaign to shorten patient-related delay in acute myocardial infarction.
Subjects
One thousand and twelve consecutive patients with acute myocardial infarction who received thrombolytic therapy over 3 months in 1995 and who represent 40% of all patients with confirmed acute myocardial infarction.
Results
The median interval between onset of infarction symptoms and initiation of thrombolytic therapy was 160min (30–647). Only 13% of the patients received thrombolysis within 60min and 38% within 120min. The median time from the onset of symptoms to the call for help was 60min (5–491), and no difference was found in patients with or without a history of previous myocardial infarction (60 and 64min, respectively). Only 52% of the patients called to the dispatch centre. The median delay from calling for help to hospital arrival was 40min (10–170). The median in-hospital door-to-needle thrombolysis delay was 40min (12–196). In 13% of hospitals the median delay was more than 60min. The emergency physician encountered difficulties in decision making in 33% of cases.
Conclusions
Only 38% of the patients received thrombolysis within 2h of onset of symptoms. Patient-related delay before they sought help accounted for the major portion of the total treatment delay. Thus the findings emphasize the importance of prompt action when people are confronted with an acute heart attack. Reorganizing the emergency medical service and emergency department routines is also a necessary target to shorten thrombolysis delays. The delay attributable to transporting patients could be shortened by initiating thrombolytic treatment in the pre-hospital setting. In Finnish hospitals, door-to-needle delay was acceptable in cases with clear indications for thrombolysis. However, emergency physicians often had diagnostic difficulties, which led to remarkably longer in-hospital delays.
Key Words: acute myocardial infarction • delay • thrombolytic therapy
f1 Correspondence: Dr Timo Hirvonen, Department of Internal Medicine, Kuopio University Hospital, P.O.B. 1777, FIN-70211 Kuopio, Finland.
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