NATIONAL PERSPECTIVE OF ACUTE CORONARY-CARE IN THE REPUBLIC-OF-IRELAND

Objective-To assess the use of acute coronary care facilities in the R epublic of Ireland with regard to case mix, patient characteristics, m ortality and factors associated with mortality, time intervals to admi ssion, utilisation of thrombolysis, and risk factor profiles. Design-A 1 week prospective census of all hospitals admitting acute coronary c ases. These comprised 23 coronary care units (CCU) and 17 combined cor onary care/intensive care units (CCU/ICU). Data were collected by stan dardised methods on each new patient ''upon whom a cardiac monitor was placed''. Results-Acute coronary heart disease was confirmed in 185 ( 44 . 9%) of 412 patients. Of these 109 (26 . 4%) had a confirmed myoca rdial infarction and 76 (18 . 4%) unstable angina. Women were signific antly older than men in all groups. Of those with proven acute coronar y heart disease, 42 . 6% were current smokers, 23 . 1% were aware of h aving a raised cholesterol concentration, and 42 . 3% gave a history o f prior hypertension. Only 44% were transported by ambulance. Median d elay time from the onset of symptoms to admission was 6 h in Dublin an d 4 h elsewhere. 34 . 9% of patients with a confirmed myocardial infar ction received thrombolysis. Mortality of patients with myocardial inf arction in CCU/ICU at 7 days was 10 . 9%. Conclusions-There is potenti al for considerable improvement in the management of coronary heart di sease in the Republic of Ireland through a reduction in delay times to admission to hospital, increased use of thrombolytic treatment, and i ntensification of advice on primary and secondary risk factors.