Delays in thrombolytic therapy for acute myocardial infarction in Finland

Objective To determine lengths and causes of pre- and in-hospital delays in thrombolytic treatment. Design A prospective national survey covering 48 of the 51 Finnish university, central and general hospitals to obtain basic data before the start of a public campaign to shorten patient-related delay in acute myocardial infarction. Subjects One thousand and twelve consecutive patients with acute myocardial infarction who received thrombolytic therapy over 3 months in 1995 and who represent 40% of all patients with confirmed acute myocardial infarction. Results The median interval between onset of infarction symptoms and initiation of thrombolytic therapy was 160 min (30–647). Only 13% of the patients received thrombolysis within 60 min and 38% within 120 min. The median time from the onset of symptoms to the call for help was 60 min (5–491), and no difference was found in patients with or without a history of previous myocardial infarction (60 and 64 min, respectively). Only 52% of the patients called to the dispatch centre. The median delay from calling for help to hospital arrival was 40 min (10–170). The median in-hospital door-to-needle thrombolysis delay was 40 min (12–196). In 13% of hospitals the median delay was more than 60 min. The emergency physician encountered difficulties in decision making in 33% of cases. Conclusions Only 38% of the patients received thrombolysis within 2 h of onset of symptoms. Patient-related delay before they sought help accounted for the major portion of the total treatment delay. Thus the findings emphasize the importance of prompt action when people are confronted with an acute heart attack. Reorganizing the emergency medical service and emergency department routines is also a necessary target to shorten thrombolysis delays. The delay attributable to transporting patients could be shortened by initiating thrombolytic treatment in the pre-hospital setting. In Finnish hospitals, door-toneedle delay was acceptable in cases with clear indications for thrombolysis. However, emergency physicians often had diagnostic difficulties, which led to remarkably longer in-hospital delays.