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[Improved routines for thrombolytic treatment of acute myocardial infarction]
J O Hessen1, M A Schei, P C Valle
1Institutt for samfunnsmedisin Universitetet i Tromsø.
Insights
Improved hospital routines increased thrombolytic treatment for acute myocardial infarction (AMI) patients, reducing in-hospital delays. Further reductions in treatment times may be achieved by addressing pre-hospital delays.
Area of Science:
- Cardiology
- Emergency Medicine
- Healthcare Quality Improvement
Background:
- A 1995 study identified suboptimal thrombolytic treatment rates and prolonged in-hospital delays for acute myocardial infarction (AMI) patients.
- Inadequate and delayed treatment of AMI can lead to increased morbidity and mortality.
Purpose of the Study:
- To evaluate the impact of enhanced medical and nursing routines on AMI treatment protocols.
- To assess changes in thrombolytic treatment administration and in-hospital delays post-intervention.
Main Methods:
- Prospective analysis of 122 AMI patients treated between October 1996 and October 1997.
- Comparison of treatment data with a baseline 1995 study cohort.
- Evaluation of key performance indicators: thrombolytic treatment rates, in-hospital delay, and mortality.
Main Results:
- The proportion of AMI patients receiving thrombolytic therapy increased significantly from 24% to 37% (p = 0.02).
- In-hospital delay was substantially reduced, with 67% of patients treated within 60 minutes of arrival, compared to 20% previously (p < 0.001).
- In-hospital mortality decreased from 25% to 16% (p = 0.06).
Conclusions:
- Implementation of improved hospital routines effectively increased the utilization of thrombolytic treatment for AMI.
- Significant reductions in in-hospital delays were achieved, potentially contributing to decreased mortality.
- Future improvements may involve reducing pre-hospital delays or initiating treatment prior to hospital arrival.
Abstract:
A study in 1995 at Harstad District Hospital concluded that too few patients with acute myocardial infarction had received thrombolytic treatment and that the in-hospital delay before administration of thrombolytics had been too long. To evaluate the effect of improvements in medical and nursing routines, data on all patients with acute myocardial infarction treated between October 1996 and October 1997 (n = 122) were analysed prospectively and compared with data from the 1995 study. The proportion of patients who received thrombolytic treatment increased from 24% in 1995 to 37% (p = 0.02). All patients received thrombolytics when indicated. The proportion of patients who died in hospital decreased from 25% in 1995 to 16% (p = 0.06). The proportion of patients who were treated within 60 minutes after arrival at the hospital increased from 20% to 67% (p < 0.001). For patients with typical ECG changes at arrival the mean door-to-needle time was 37 minutes. Mean delay from onset of symptoms to treatment was 4.5 hours. The results indicate that improved routines may have increased the proportion of patients receiving thrombolytic treatment and reduced the in-hospital delay. It is possible that a further reduction of delay may be achieved by reducing the pre-hospital delay, or by starting thrombolytic treatment before arrival to hospital.