Time delay to thrombolytic therapy--a Sri Lankan perspective

Area of Science:

• Cardiology
• Emergency Medicine
• Public Health

Background:

• Timely thrombolytic therapy is essential for improving outcomes in acute myocardial infarction (AMI).
• Delays in treatment initiation can significantly reduce functional recovery and survival benefits.
• Understanding the sources of delay is key to developing effective interventions.

Purpose of the Study:

• To analyze the time delays in initiating thrombolytic therapy for acute myocardial infarction.
• To identify specific stages contributing to the overall treatment delay.
• To propose strategies for minimizing these delays in Sri Lanka.

Main Methods:

• Analysis of 120 consecutive admissions for thrombolytic therapy to a Coronary Care Unit.
• Categorization of total delay into prehospital, in-hospital, and Coronary Care Unit (CCU) stages.
• Statistical analysis to identify factors associated with longer delays.

Main Results:

• Median delays were 130 minutes (prehospital), 70 minutes (in-hospital), and 15 minutes (CCU).
• Delays were significantly longer when patients sought prehospital medical advice.
• Diagnosis delays at the emergency treatment unit also contributed to longer overall treatment times.

Conclusions:

• Significant delays occur in prehospital and in-hospital phases of thrombolytic therapy for AMI.
• Patient-seeking behavior and diagnostic efficiency in emergency units are critical factors.
• Public education, system modifications, and enhanced emergency medical services are recommended to reduce delays and improve AMI prognosis in Sri Lanka.