Nine-year comparison of presentation and management of acute coronary syndromes in Ireland: a national cross-sectional survey

BMC Cardiovasc Disord. 2005 Feb 11;5(1):5. doi: 10.1186/1471-2261-5-5.

Abstract

Background: Shorter time to treatment is associated with lower mortality in acute coronary syndromes (ACS). A previous (1994) survey showed substantial delays for acute myocardial infarction (AMI) in Ireland. The present study compared current practice with 1994 and surveyed acute coronary syndromes as a more complete contemporary evaluation of critical cardiac care than assessing AMI alone.

Methods: Following ethics committee approval, all centres (N = 39) admitting acute cardiac patients to intensive/coronary care unit provided information on 1365 episodes. A cross-sectional survey design was employed.

Results: Since 1994, median hospital arrival to thrombolysis time was reduced by 41% (76 to 45 minutes). Thrombolysis was delivered more often in the emergency department in 2003 (48% vs 2%). Thrombolysis when delivered in the emergency department was achieved faster than thrombolysis delivered in intensive/coronary care (35 mins v 60 mins; z = 5.62, p < .0001). Suspected AMI patients who did not subsequently receive thrombolysis took longer to present to hospital (5 h vs 2 h 34 mins; z = 7.33, p < .0001) and had longer transfer times to the intensive/coronary care unit following arrival (2 h 17 mins vs 1 h 10 mins; z = 8.92, p < .0001). Fewer confirmed AMI cases received thrombolysis in 2003 (43% vs 58%). There was an increase in confirmed cases of AMI from 1994 (70% to 87%).

Conclusions: Substantial improvements in time to thrombolysis have occurred since 1994, probably relating to treatment provision in emergency departments. Patient delay pre-hospital is still the principal impediment to effective treatment of ACS. A recent change of definition of AMI may have precluded an exact comparison between 1994 and 2003 data.

Publication types

  • Comparative Study
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease
  • Adult
  • Aged
  • Aged, 80 and over
  • Angina, Unstable / diagnosis
  • Angina, Unstable / epidemiology
  • Coronary Disease / diagnosis
  • Coronary Disease / drug therapy*
  • Coronary Disease / epidemiology
  • Cross-Sectional Studies
  • Emergency Medical Services
  • Female
  • Humans
  • Intensive Care Units
  • Ireland / epidemiology
  • Male
  • Middle Aged
  • Myocardial Infarction / diagnosis
  • Myocardial Infarction / drug therapy
  • Myocardial Infarction / epidemiology
  • Patient Acceptance of Health Care
  • Patient Discharge
  • Patient Transfer
  • Syndrome
  • Thrombolytic Therapy*
  • Time Factors
  • Time Management