A Provincial Hospital C.C.U. After ISIS 2

Summary

A prospective study of admissions to an Irish provincial coronary care unit in the light of reported benefits of streptokinase and oral aspirin as reported in the Isis study was carried out. of 115 patients admitted with suspected myocardial infarction (M.I.), the diagnosis was confirmed in 41. The average delay from onset of chest pain to admission to C.C.U. was 6.65 hours (0.3 – 18 hours, median 6 hours). Twenty-six of the 41 patients were given streptokinase after a median time lapse of six hours from the onset of pain. 88% of the M.I. patients were on oral aspirin at discharge but only 12% were on oral beta blockers. These findings are compared with the findings of the Isis 2 study worldwide and in Ireland. The presence of risk factors in the patients with M.I. is analysed, 16 of the 41 had serum cholesterol levels greater than 6 mmols/1. As an index of community risk factor screening, an enquiry was made of the patients and of their family doctor as to whether serum cholesterol had previously been checked, this had been done in only 12 of 41 and in only 2 had it been carried out by the family doctor. Pre-hospital analgesic use was also examined and 36 of the 41 patients had chest pain and were seen by their G.P.s but only 18 were given analgesics of whom 13 received morphine. We conclude that greater public education is necessary to reduce the delay in summoning help after an M.I., greater efforts are needed by hospitals to streamline admissions to the C.C.U. and to provide mobile C.C.U. in rural areas and greater efforts are required by family doctors to provide risk factor screening and to provide adequate analgesia in patients with M.I. prior to hospital admission.