CHANGES IN PREHOSPITAL PHASE AND THROMBOL YSIS RATE WITHIN 7 YEARS INAN URBAN EMERGENCY HOSPITAL

Early thrombolysis in acute myocardial infarction (MI) reduces infarct ion mortality remarkably. The preclinical behavior of infarction patie nts of our department was analyzed from 1986 to October 31, 1993: preh ospital phase (PHP), mode of admission, transport, thrombolysis rate. Within approx. 7.5 years, the diagnosis of MI was substantiated in 708 patients Mean PHP was reduced from 9.4 h in 1986 to 3.3 h in 1993. PH P differed considerably by the mode of admission: family doctor and me dical emergency service (1988 vs. 1993): 14 vs. 9.3 h; emergency physi cian: 2.4 vs. 2.8 h; self-referral: 5.5 vs. 3.5 h. The PH during dayti me (8-19 h) was 6.4 vs. 3.9 h in the night (19-8 h). 58 and 69%, respe ctively, were hospitalized within 3 and 6 h after the onset of symptom s, 81 and 89% within 12 and 24 h, respectively. We observed, however, an encouraging trend (PHP < 6 h): 1986 62%, 1993 86% While 55% of the self-referrers underwent thrombolysis, this was the case in only 24% o f the patients referred by a family doctor or medical emergency servic e. In 1986, 23% of the overall population were treated by thrombolysis vs. 73% in 1993. 12.5% died. Since extensive patient information camp aigns are only transiently able to modify the prehospital patient beha vior, patients at particular risk as well as their doctors should be t rained selectively.