Abstract
The aim of this prospective study was to determine the delay between the onset of symptoms and arrival in the coronary care unit of patients with suspected acute myocardial infarction, and the relative contribution to the total delay of patient delay, method of referral (self referral or general practitioner referral) and delay in the hospital before reaching the coronary care unit. All patients admitted with chest pain to the coronary care unit at Dudley Road Hospital, Birmingham, over the six month period April-September 1989 were included in the study. Ninety five patients were referred by their general practitioner and 107 patients attended the accident and emergency department directly or arrived by ambulance without contacting their general practitioner. The proportion of self referred and general practitioner referred patients with acute myocardial infarction, angina and non-cardiac chest pain were not significantly different. The total delay was significantly longer for patients who had been referred by their general practitioner (median 5.3 hours) than for self referrals (3.2 hours, P less than 0.001), with a significantly higher proportion of self referrals arriving at the coronary care unit within six hours of the onset of symptoms (77% versus 54%, P less than 0.01). Among general practitioner referrals, initial patient delay accounted for a median of 2.5 hours and the general practitioner's response time for a median of 1.1 hours. The delay in hospital was similar for both groups of patients. In inner city areas, self referral may result in considerably less delay than general practitioner referral allowing a greater proportion of patients to receive effective thrombolytic therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Selected References
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- Burns J. M., Hogg K. J., Rae A. P., Hillis W. S., Dunn F. G. Impact of a policy of direct admission to a coronary care unit on use of thrombolytic treatment. Br Heart J. 1989 Apr;61(4):322–325. doi: 10.1136/hrt.61.4.322. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pai G. R., Haites N. E., Rawles J. M. One thousand heart attacks in Grampian: the place of cardiopulmonary resuscitation in general practice. Br Med J (Clin Res Ed) 1987 Feb 7;294(6568):352–354. doi: 10.1136/bmj.294.6568.352. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Rawles J. M., Haites N. E. Patient and general practitioner delays in acute myocardial infarction. Br Med J (Clin Res Ed) 1988 Mar 26;296(6626):882–884. doi: 10.1136/bmj.296.6626.882. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Smyllie H. C., Taylor M. P., Cuninghame-Green R. A. Acute myocardial infarction in Doncaster. II. Delays in admission and survival. Br Med J. 1972 Jan 1;1(5791):34–36. doi: 10.1136/bmj.1.5791.34. [DOI] [PMC free article] [PubMed] [Google Scholar]