Community thrombolysis in the Coromandel region. Audit of the "Cardiac Events in the Coromandel-Assessment Strategy and Triage" (CE-COAST) pilot program.
OBJECTIVE
To audit the experience of a pilot program for  community thrombolysis undertaken within the Coromandel region.


METHODS
Community thrombolysis for patients suffering acute myocardial infarction (MI) was undertaken in areas within the Coromandel peninsula greater than half an hour by road from Thames Hospital. Thrombolytic therapy (Retelapse) was given following a discussion and review of a digitally transmitted ECG with the cardiology registrar. Treatment times and patients demographics were prospectively recorded. Subsequent clinical events were by chart review. Comparison of treatment times were made with an historical cohort for the same population which had received in-hospital thrombolysis between 1993 and 1998.


RESULTS
Between July 1998 and December 1999, nineteen patients received thrombolysis in the community. There were no arrhythmic events during transportation and no deaths or reinfarctions during hospital stay. Median time from pain onset to thrombolysis was 135 (mean 175.5 +/- 144.9 SD) minutes which equated to a reduction in median time delay of 135 minutes compared to that experienced by the historical cohort (median 270, mean 316.7 +/- 145.8 SD minutes), p=0.0003.


CONCLUSIONS
Community thrombolysis is logistically feasible within the New Zealand setting and results in major time reductions in the treatment of patients with acute MI.
Nunn
C
C
Department of Cardiology, Waikato Hospital, Hamilton.
Lennane
J
J
Marriott
G
G
Wilson
D
D
D000368:Aged; D003153:Community Health Services; D004562:Electrocardiography; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000188:drug therapy*; D009520:New Zealand; D010865:Pilot Projects; D012424:Rural Population; D015912:Thrombolytic Therapy; D013997:Time Factors