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Fibrinolytic administration for acute myocardial infarction in a tertiary ED: factors associated with an increased door-to-needle time

  • Peter J. Zed
    Correspondence
    Address reprint requests to Peter J. Zed, BSc, BSc(Pharm), PharmD, CSU Pharmaceutical Sciences, Vancouver General Hospital, 855 West 12th Ave., Vancouver, BC, Canada V5Z 1M9
    Affiliations
    Clinical Service Unit Pharmaceutical Sciences, Vancouver General Hospital, Vancouver, British Columbia, Canada

    Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada

    Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada
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  • Riyad B. Abu-Laban
    Affiliations
    Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Travis M. Cadieu
    Affiliations
    Emergency Medicine, University of Manitoba, Winnipeg, Canada
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  • Roy A. Purssell
    Affiliations
    Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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  • Lyne Filiatrault
    Affiliations
    Division of Emergency Medicine, Department of Surgery, University of British Columbia, Vancouver, British Columbia, Canada

    Department of Emergency Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
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      Abstract

      The purpose of this study was to evaluate the door-to-needle time for fibrinolytic administration for acute myocardial infarction (AMI) at Vancouver General Hospital (VGH) and identify factors associated with time prolongation. A retrospective chart review of all patients fibrinolysed for AMI in the ED at VGH was performed from January 1, 1998, to December 31, 1999, to determine door-to-needle time. A mixed-effects linear regression model was fit to the fibrinolytic data with the door-to-needle time to identify factors associated with prolonged times. One hundred forty patients were included in the final analysis. The mean and median door-to-needle times were 58 and 43 minutes, respectively. A door-to-needle time of under 30 minutes was achieved in 24.3% of patients, 30 to 40 minutes in 24.3%, 40 to 60 minutes in 22.1%, and over 60 minutes in 29.3%. EP prescribers without prior cardiologist consultation resulted in a significantly shorter door-to-needle time compared with requesting a cardiology consult before administration (mean [median] 41 [35] minutes vs. 108 [90] minutes respectively; P < .001). Patients who arrived by ambulance had shorter door-to-needle times than those who did not (mean [median] 50 [38] minutes vs. 71 [57] minutes, respectively; P = .008). Patients who arrived during the night shift (2300–0700 hrs) had significantly shorter door-to-needle times than those patients who arrived during the day (0700–1500 hrs) or afternoon (1500–2300) shifts (P = 0481); and patients who had a longer time from chest pain onset to ED arrival also had longer door-to-needle times (P = .0233). A significant number of AMI patients fibrinolysed at VGH do not meet the national guideline for door-to-needle time less than 30 minutes. Factors associated with this should be addressed to improve the care of patients with AMI.

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