PMID- 22681194
OWN - NLM
STAT- MEDLINE
DCOM- 20120808
LR  - 20191210
IS  - 1445-6354 (Electronic)
IS  - 1445-6354 (Linking)
VI  - 12
DP  - 2012
TI  - Thrombolysis for acute ST elevation myocardial infarction: a pilot study 
      comparing results from GP led small rural health emergency departments with 
      results from a physician led sub-regional emergency department.
PG  - 2013
AB  - INTRODUCTION: Urgent angiogram is best treatment for patients presenting with ST 
      elevation myocardial infarction (STEMI) in the first 90 min after contacting 
      medical help. For Australian residents of inner and outer regional areas and 
      remote or very remote areas, quick access to angiograms is not available. 
      Numerous approaches have been developed to maximize reperfusion but delays due to 
      systematic and patient factors persist. Diminishing confidence of some GPs in 
      small rural health services to administer thrombolytics was one barrier to timely 
      reperfusion identified in northeast Victoria, Australia. The aim of this study 
      was to compare the frequency and outcomes of STEMI patients treated with 
      thrombolysis by GPs in small rural emergency departments (EDs) with the outcomes 
      from thrombolysis for STEMI in the physician-led, sub-regional ED in northeast 
      Victoria. METHODS: Data were gathered by a medical file audit. Outcome measures 
      were the frequency of STEMI, symptom to presentation times, mode of transport to 
      hospital, ambulance call to presentation at ED times, door to needle (DTN) times, 
      subsequent percutanous intervention (PCI) or coronary artery bypass grafts 
      (CABG), physician follow up and death. RESULTS: In total 68 cases were audited. 
      Univariate analysis showed no significant differences between the GP-led or 
      physician-led EDs in time from onset of symptoms to presentation, DTN times, 
      thrombolysis related complications or subsequent access to PCI or CABG. Follow-up 
      care was similar in both groups. Transport to hospital differed between the 
      groups with only half of all cases arriving at the ED by ambulance, almost all of 
      which went to the sub-regional hospital. CONCLUSIONS: Thrombolysis for STEMI in 
      the small GP-led EDs had similar results to thrombolysis administered by the 
      physician-led ED. There is substantial time benefit to be gained by encouraging 
      GP-led EDs to provide thrombolysis treatment, thereby improving patient prognosis 
      and survival.
FAU - Krones, Robert
AU  - Krones R
AD  - Rural Health Academic Centre, The University of Melbourne, Wangaratta, Victoria, 
      Australia. robert@krones.com.au
FAU - Radford, Peter
AU  - Radford P
FAU - Cunningham, Chris
AU  - Cunningham C
FAU - Krones, David
AU  - Krones D
FAU - Haines, Helen M
AU  - Haines HM
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20120608
PL  - Australia
TA  - Rural Remote Health
JT  - Rural and remote health
JID - 101174860
SB  - IM
CIN - Rural Remote Health. 2012;12:2262. PMID: 22946935
MH  - Emergency Medical Services/*statistics & numerical data
MH  - General Practice
MH  - Humans
MH  - Myocardial Infarction/*therapy
MH  - *Outcome and Process Assessment, Health Care
MH  - Pilot Projects
MH  - Regional Medical Programs
MH  - Rural Health Services/*statistics & numerical data
MH  - *Thrombolytic Therapy
MH  - Victoria
EDAT- 2012/06/12 06:00
MHDA- 2012/08/09 06:00
CRDT- 2012/06/12 06:00
PHST- 2012/06/12 06:00 [entrez]
PHST- 2012/06/12 06:00 [pubmed]
PHST- 2012/08/09 06:00 [medline]
AID - 2013 [pii]
PST - ppublish
SO  - Rural Remote Health. 2012;12:2013. Epub 2012 Jun 8.