Abstract
Background
Patients with an acute myocardial infarction require a rapid response to their symptoms and the earlier fibrinolysis is given (where indicated), the better the outcome.
Aims
The aim of this study is to compare’door to needle times’for fibrinolysis in Acute Myocardial Infarction (AMI) in three phases of one year each, at Letterkenny General Hospital.
Methods
In the PREINTERVENTION year all fibrinolysis was performed in the Coronary Care Unit (CCU). In the INTERVENTION year Emergency Department (ED) fast track fibrinolysis was introduced and in the POST INTERVENTION year most fibrinolysis was performed on fast track in the ED.
Results
The time saved by the introduction of ED fibrinolysis was significant, 41 minutes on average per patient. Elderly, female patients were more likely to bypass ED fast track fibrinolysis and to be brought to CCU for fibrinolysis, with attendant delays. This has educational implications in relation to the variation in clinical presentation of AMI with age and sex.
Conclusion
The ED fast track fibrinolysis system is recommended as an effective, safe, achievable and worthwhile intervention towards improving ‘door to needle times’ for fibrinolysis in AMI.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Building Healthier Hearts, The Report of the Cardiovascular Health Strategy Group, Department of Health and Children, March 1999.
Gordon T and Kannel WB. Premature mortality from coronary heart disease. The Framingham Study. JAMA 1971;125:1617–25.
White NM, Parker WS, Binning RA et al. Mobile coronary care provided by ambulance personnel. BMJ 1973; 111: 618–22.
Fibrinolytic Therapy Trialists’ Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Lancet 1994; 343; 311–22.
Boersma E, Maas ACP, Simoons ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996; 348:771–5
The Task Force on the Management of Acute Myocardial Infarction of the European Society of Cardiology. Acute Myocardial Infarction: pre-hospital and in-hospital management. Eur Heart J 1996; 17: 43–63.
McGee HM, Browne C, Horgan JH: Presentation and management of acute myocardial infarction in Irish hospitals: a national census. Dublin:The Council on Acute Coronary Care of the Irish Heart Foundation; 1996.
Doyle F, De La Harpe D, McGee H et al. CCU 2003; National Survey of the Presentation and Management of Acute Myocardial Infarction (AMI) and other Acute Coronary Syndromes (ACS) in Irish Hospitals. 2004. Royal College of Surgeons in Ireland, Dublin.
How Hospitals Manage Heart Attacks. Second Public Report of the Myocardial Infarction National Audit Project. June 2003. Clinical Effectiveness and Evaluation Unit, Royal College of Physicians, London.
Boland A, Dundar Y, Bagust A et al. Early thrombolysis for the treatment of acute myocardial infarction: a systemic review and economic evaluation. Health Technology Assessment 2003; 7 (15): 1–136.
Moore R, Moore K, Quinn E et al. Delay times in the administration of thrombolytic therapy: the Brighton experience. Int J Cardiol. 1995 Aug; 49 Suppl:S39–46.
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Lane, G., Cuddihy, J., Wright, P. et al. Efficacy of fibrinolysis in the emergency department for acute myocardial infarction. Ir J Med Sci 174, 9–12 (2005). https://doi.org/10.1007/BF03169140
Issue Date:
DOI: https://doi.org/10.1007/BF03169140