Delays in thrombolytic therapy for acute myocardial infarction in Finland. Results of a national thrombolytic therapy delay study

Objective To determine lengths and causes of pre- and in-hospital delaysin thrombolytic treatment. Design A prospective national survey covering 48 of the 51 Finnishuniversity, central and general hospitals to obtain basic databefore the start of a public campaign to shorten patient-relateddelay in acute myocardial infarction. Subjects One thousand and twelve consecutive patients with acute myocardialinfarction who received thrombolytic therapy over 3 months in1995 and who represent 40% of all patients with confirmed acutemyocardial infarction. Results The median interval between onset of infarction symptoms andinitiation of thrombolytic therapy was 160min (30–647).Only 13% of the patients received thrombolysis within 60minand 38% within 120min. The median time from the onset of symptomsto the call for help was 60min (5–491), and no differencewas found in patients with or without a history of previousmyocardial infarction (60 and 64min, respectively). Only 52%of the patients called to the dispatch centre. The median delayfrom calling for help to hospital arrival was 40min (10–170).The median in-hospital door-to-needle thrombolysis delay was40min (12–196). In 13% of hospitals the median delay wasmore than 60min. The emergency physician encountered difficultiesin decision making in 33% of cases. Conclusions Only 38% of the patients received thrombolysis within 2h ofonset of symptoms. Patient-related delay before they soughthelp accounted for the major portion of the total treatmentdelay. Thus the findings emphasize the importance of promptaction when people are confronted with an acute heart attack.Reorganizing the emergency medical service and emergency departmentroutines is also a necessary target to shorten thrombolysisdelays. The delay attributable to transporting patients couldbe shortened by initiating thrombolytic treatment in the pre-hospitalsetting. In Finnish hospitals, door-to-needle delay was acceptablein cases with clear indications for thrombolysis. However, emergencyphysicians often had diagnostic difficulties, which led to remarkablylonger in-hospital delays.