Rural Alberta thrombolysis study. Survey of practice patterns for managing acute myocardial infarction.
OBJECTIVE
To determine current practice patterns for managing acute myocardial infarction in rural Alberta, particularly to examine the availability of thrombolytic therapy.


METHODS
Mailed questionnaire based on a clinical vignette.


METHODS
All 104 acute care hospitals in rural Alberta with fewer than 100 beds.


METHODS
The Chief of Staff at each hospital.


METHODS
Proportion of hospitals providing thrombolytic therapy, choice of thrombolytic agent, rates of elective transfer after thrombolysis, and barriers preventing universal use of thrombolytic therapy.


RESULTS
Questionnaires were completed by 101 physicians. Three hospitals had no medical staff. Thrombolytic therapy was available in 80.8% of the hospitals. Hospitals that did not offer thrombolysis were smaller (average bed capacity 21.9 versus 37.7, P < 0.001), had fewer medical staff (average number 2.4 versus 5.5, P < 0.001), and had fewer nurses holding Advanced Cardiac Life Support certification (P = 0.015) than hospitals providing thrombolysis. Physicians identified inadequate nursing resources as the greatest barrier to providing thrombolysis. Of physicians using thrombolysis, 71.4% chose streptokinase. Half of the physicians preferred elective transfer after the procedure.


CONCLUSIONS
Thrombolytic therapy for acute myocardial infarction is standard practice in small hospitals in Alberta.
Hindle
H
H
Department of Family Medicine, University of Alberta.
Norheim
J K
JK
Renger
R
R
D000416:Alberta; D002568:Certification; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006297:Health Services Accessibility; D006743:Hospital Bed Capacity, under 100; D006801:Humans; D008020:Life Support Care; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy*; D009741:Nursing Staff, Hospital / Q000193:education; D010360:Patient Transfer; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D012423:Rural Health; D013300:Streptokinase / Q000627:therapeutic use; D011795:Surveys and Questionnaires; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D000078329:Workforce
D005343:Fibrinolytic Agents; D013300:Streptokinase; D010959:Tissue Plasminogen Activator