Treatment delays for patients with acute myocardial infarction within the Coromandel region of New Zealand

Aim. To assess treatment delays incurred by Coromandel patients requiring t hrombolytic therapy for acute myocardial infarction at Thames Hospital. Methods. A chart search was undertaken at Thames Hospital to identify all p atients admitted from July 1993 to July 1998 with a diagnosis of acute myoc ardial infarction who were treated with thrombolytic therapy, Times of pain onset, general practitioner (GP) assessment, transportation, hospital arri val and thrombolytic administration were noted, Additional information, whe n required, was obtained from the patient's GP or the St Johns Ambulance se rvice. Results. 153 patients were thrombolysed at Thames Hospital over this period , mean age 65.1 years, 36.6% in heart failure, The mean time from pain onse t to GP contact was 157.2 minutes and varied from 63.2 minutes in Coromande l Township to 272.5 minutes in Pauanui. Delays from GP contact to thromboly sis were longer for patients living in outlying areas versus Thames and its environs, 169.4 +/- 45.3 versus 125.2 +/- 50.4 minutes (mean +/- SD) respe ctively, p<0.001. This contributed to a total delay from pain onset to thro mbolysis of 316.7 +/- 145.8 minutes for patients in outlying areas versus 2 69.1 +/- 185.8 minutes for local patients (p=0.014). Conclusions. Delays in providing thrombolytic therapy for acute infarct pat ients reflect not only transport times but also delays in seeking initial m edical assessment and hospital triage times. Transport times become particu larly significant for those outside of Thames and its environs. Only with i mproved patient education and local delivery of thrombolytic therapy will t hese delays be adequately addressed.