Call to needle times after acute myocardial infarction in urban and rural areas in northeast Scotland: prospective observational study

BMJ 1998;317:576-578 ( 29 August )

General Practice

Call to needle times after acute myocardial infarction in urban and rural areas in northeast Scotland: prospective observational study

John Rawles, honorary senior lecturer in medicine, ^a Catherine Sinclair, audit nurse, ^a Kevin Jennings, consultant cardiologist, ^b Lewis Ritchie, Mackenzie professor, ^c Norman Waugh, consultant in public health medicine. ^d

^a Medicines Assessment Research Unit, University of Aberdeen, Aberdeen Royal Infirmary, Aberdeen AB25 2ZN, ^b Department of Cardiology, Aberdeen Royal Infirmary, ^c Department of General Practice and Primary Care, University of Aberdeen, ^d Grampian Health Board, Aberdeen AB15 6RE

Correspondence to: Dr J Rawles john.rawles{at}btinternet.com

Objective: To determine call to needle times and consider how best to provide timely thrombolytic treatment for patientswith acute myocardialinfarction.
Design: Prospective observationalstudy.
Setting: City, suburban, and country practices referring patients to a single district general hospital in northeast Scotland.
Subjects: 1046 patients with suspected acute myocardial infarction given thrombolytictreatment.
Main outcome measures: Time from patients' calls for medical help until receipt of opiate or thrombolytic treatment,measured against a call to needle time of 90 minutes or less,as proposed by the British HeartFoundation.
Results: General practitioners were the first medical contact in 97% (528/544) of calls by country patients and 68%(340/502) of city and suburban patients. When opiate was givenby general practitioners, median call to opiate time was about30 minutes (95% within 90 minutes) in city, suburbs, and country;call to opiate delay was about 60 minutes in city and suburbanpatients calling "999" for an ambulance. One third of countrypatients received thrombolytic treatment from their general practitionerswith a median call to thrombolysis time of 45 minutes (93% within90 minutes); this compares with 150 minutes (5% within 90 minutes)when this treatment was deferred until after hospital admission.In the city and suburbs, no thrombolytic treatment was given outsidehospital, and only a minority of patients received it within 90minutes of calling; median call to thrombolysis time was 95 (46%within 90 minutes)minutes.
Conclusions: The first medical contact after acute myocardial infarction is most commonly with a general practitioner.This contact provides the optimum opportunity to give thrombolytictreatment within the British Heart Foundation'sguideline.

Key messages

A British Heart Foundation guideline recommends that patients with acute myocardial infarction should receive thrombolytic treatment within 90 minutes of calling for medical assistance
In urban and rural areas in Grampian, only a minority of patients received treatment within the guideline
Median call to needle times were shortest when thrombolytic treatment was given by general practitioners
The first medical contact after acute myocardial infarction was most commonly with a general practitioner in both urban and rural areas
First contact with a general practitioner provides a matchless opportunity to give thrombolytic treatment within the British Heart Foundation guideline

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Rapid Responses:

Read all Rapid Responses

Resouces for national response: Mike Causer
bmj.com, 1 Sep 1998 [Full text]
Insufficient evidence of benefit to support pre-hospital thrombolysis in acute myocardial infarction: Brendon Smith
bmj.com, 8 Sep 1998 [Full text]
Thrombolysis in remote locations: John Knighton
bmj.com, 11 Sep 1998 [Full text]
Thrombolysis in remote locations: Matthew Hough, et al.
bmj.com, 11 Sep 1998 [Full text]
The Sheffield experience: June Edhouse
bmj.com, 16 Sep 1998 [Full text]
Call to needle times after acute myocardial infarction: John Rawles
bmj.com, 30 Oct 1998 [Full text]