Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town

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dc.contributor.authorMaharaj, Roshen C
dc.contributor.authorGeduld, Heike
dc.contributor.authorWallis, Lee A
dc.date.accessioned2021-10-08T07:17:59Z
dc.date.available2021-10-08T07:17:59Z
dc.date.issued2012
dc.description.abstractOBJECTIVES: To determine the current door-to-needle time for the administration of fibrinolytics for acute myocardial infarction (AMI) in emergency centres (ECs) at three hospitals in Cape Town, and to compare it with the American Heart Association/American College of Cardiology (AHA/ACC) recommendation of 30 minutes as a marker of quality of care. METHODS: A retrospective review of case notes from January 2008 to July 2010 of all patients receiving thrombolytics for AMI in the ECs of three Cape Town hospitals. The total door-to-needle time was calculated and patient demographics and presentation, physician qualification, clinical symptomology and reasons for delays in thromobolytic administration were analysed. RESULTS: A total of 372 patients with acute ST elevation myocardial infarction (STEMI) were identified; 161 patients were eligible for the study. The median door-to-needle time achieved was 54 minutes (range 13 - 553 mins). A door-to-needle time of 30 minutes or less was achieved in 33 (20.5%) patients; 51.3% of the patients arrived by ambulance; 34% of patients had a pre-hospital 12-lead ECG; and 88.8% had typical symptoms of myocardial infarction. Medical officers administered thrombolytics to 44.7% of the patients. The predominant infarct location on ECG was inferior (55.9%). CONCLUSION: A significant number of patients were not thrombolysed within 30 minutes of presentation. The lack of senior doctors, difficulty interpreting ECGs, atypical presentations and EC system delays prolonged the door-to-needle time in this study.
dc.identifier.apacitationMaharaj, R. C., Geduld, H., & Wallis, L. A. (2012). Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town. <i>South African Medical Journal</i>, 102(4), 241 - 244. http://hdl.handle.net/11427/34876en_ZA
dc.identifier.chicagocitationMaharaj, Roshen C, Heike Geduld, and Lee A Wallis "Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town." <i>South African Medical Journal</i> 102, 4. (2012): 241 - 244. http://hdl.handle.net/11427/34876en_ZA
dc.identifier.citationMaharaj, R.C., Geduld, H. & Wallis, L.A. 2012. Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town. <i>South African Medical Journal.</i> 102(4):241 - 244. http://hdl.handle.net/11427/34876en_ZA
dc.identifier.issn0038-2469
dc.identifier.ris TY - Journal Article AU - Maharaj, Roshen C AU - Geduld, Heike AU - Wallis, Lee A AB - OBJECTIVES: To determine the current door-to-needle time for the administration of fibrinolytics for acute myocardial infarction (AMI) in emergency centres (ECs) at three hospitals in Cape Town, and to compare it with the American Heart Association/American College of Cardiology (AHA/ACC) recommendation of 30 minutes as a marker of quality of care. METHODS: A retrospective review of case notes from January 2008 to July 2010 of all patients receiving thrombolytics for AMI in the ECs of three Cape Town hospitals. The total door-to-needle time was calculated and patient demographics and presentation, physician qualification, clinical symptomology and reasons for delays in thromobolytic administration were analysed. RESULTS: A total of 372 patients with acute ST elevation myocardial infarction (STEMI) were identified; 161 patients were eligible for the study. The median door-to-needle time achieved was 54 minutes (range 13 - 553 mins). A door-to-needle time of 30 minutes or less was achieved in 33 (20.5%) patients; 51.3% of the patients arrived by ambulance; 34% of patients had a pre-hospital 12-lead ECG; and 88.8% had typical symptoms of myocardial infarction. Medical officers administered thrombolytics to 44.7% of the patients. The predominant infarct location on ECG was inferior (55.9%). CONCLUSION: A significant number of patients were not thrombolysed within 30 minutes of presentation. The lack of senior doctors, difficulty interpreting ECGs, atypical presentations and EC system delays prolonged the door-to-needle time in this study. DA - 2012 DB - OpenUCT DP - University of Cape Town IS - 4 J1 - South African Medical Journal LK - https://open.uct.ac.za PY - 2012 SM - 0038-2469 T1 - Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town TI - Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town UR - http://hdl.handle.net/11427/34876 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/34876
dc.identifier.vancouvercitationMaharaj RC, Geduld H, Wallis LA. Door-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town. South African Medical Journal. 2012;102(4):241 - 244. http://hdl.handle.net/11427/34876.en_ZA
dc.language.isoeng
dc.publisher.departmentDivision of Emergency Medicine
dc.publisher.facultyFaculty of Health Sciences
dc.sourceSouth African Medical Journal
dc.source.journalissue4
dc.source.journalvolume102
dc.source.pagination241 - 244
dc.source.urihttps://dx.doi.org/10.7196/SAMJ.5188
dc.subject.otherAdult
dc.subject.otherAged
dc.subject.otherAged, 80 and over
dc.subject.otherClinical Competence
dc.subject.otherDelayed Diagnosis
dc.subject.otherEmergency Service, Hospital
dc.subject.otherFemale
dc.subject.otherFibrinolytic Agents
dc.subject.otherHumans
dc.subject.otherMale
dc.subject.otherMedical Audit
dc.subject.otherMiddle Aged
dc.subject.otherMyocardial Infarction
dc.subject.otherQuality Indicators, Health Care
dc.subject.otherReferral and Consultation
dc.subject.otherRetrospective Studies
dc.subject.otherSouth Africa
dc.titleDoor-to-needle time for administration of fibrinolytics in acute myocardial infarction in Cape Town
dc.typeJournal Article
uct.type.publicationResearch
uct.type.resourceJournal Article
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