title: Impact of pre-hospital care in patients with acute myocardial infarction compared with those first managed in-hospital.
abstract: OBJECTIVE
  To compare prospectively the impact of pre-hospital care by a physician-staffed mobile coronary care unit with patients managed initially in-hospital, all with acute myocardial infarction.
  
  
  RESULTS
  This was a single centre registry of consecutive patients (n=750) admitted with acute myocardial infarction to the coronary care unit and cardiology wards of the Royal Victoria Hospital, Belfast between 1998 and 2001. For the 750 patients, in-hospital mortality was 11% and was significantly lower for those managed pre-hospital (8% vs 13%, P=0.04): patients who received fibrinolytic therapy (n=474), the in-hospital mortality was significantly lower in the pre-hospital group (7% vs 13%, P=0.02). Those managed pre-hospital had significant reduction in the median delay times (25th, 75th percentiles) from onset of symptoms to call for help 1.0 (0.5, 2.2) vs 2.0 (0.9, 6.0) h, P<0.001, from call for help to receiving fibrinolytic therapy 1.0 (0.8, 1.5) vs 1.8 (1.2, 2.5) h, P<0.001 resulting in a shorter pain-to-needle time for fibrinolytic therapy 2.3 (1.5, 3.8) vs 4.0 (2.6, 7.2) h, P<0.001. For all patients, older age, haemodynamic indicators on admission (hypotension, higher heart rate, heart failure) and managed by the in-hospital route were significant independent variables for an adverse in-hospital mortality. Although for patients aged >or=75 years no statistical significant reduction in mortality occurred for those managed pre-hospital (P=0.051), nevertheless patients in this age group first treated pre-hospital who received fibrinolytic therapy had a significantly lower mortality than those first treated in-hospital (21% vs 43%, P=0.02).
  
  
  CONCLUSIONS
  Consecutive patients with acute myocardial infarction seen and managed initially out-of-hospital by a physician-staffed mobile coronary care unit had significantly lower in-hospital mortality.
authors.affiliation: Regional Medical Cardiology Centre, Royal Victoria Hospital, Belfast, Northern Ireland, UK.
authors.forename: T P
authors.initials: TP
authors.lastname: Mathew
authors.forename: I B A
authors.initials: IB
authors.lastname: Menown
authors.forename: D
authors.initials: D
authors.lastname: McCarty
authors.forename: H
authors.initials: H
authors.lastname: Gracey
authors.forename: L
authors.initials: L
authors.lastname: Hill
authors.forename: A A J
authors.initials: AA
authors.lastname: Adgey
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004632:Emergency Medical Services / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006282:Health Personnel / Q000458:organization & administration; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D015912:Thrombolytic Therapy / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome