title: Time to fibrinolytics for acute myocardial infarction: Reasons for delays at Steve Biko Academic Hospital, Pretoria, South Africa.
abstract: BACKGROUND
  Fibrinolytic therapy is a time-critical intervention proven to reduce mortality and morbidity in patients with ST-elevation myocardial infarction (STEMI). Limited data exist in South Africa (SA) regarding time to fibrinolytic therapy for STEMI patients and reasons for delayed therapy.
  
  
  OBJECTIVE
  To establish the proportion of STEMI patients receiving fibrinolytic agents at Steve Biko Academic Hospital (SBAH), Pretoria, SA, identify any delays to receiving fibrinolytic agents, and uncover reasons for those delays. The number of lives lost as a result of these delays was calculated.
  
  
  METHODS
  This prospective, observational study included 100 consecutive patients presenting with a STEMI to SBAH. Using a researcher-administered questionnaire, the times from symptom onset to receipt of fibrinolytic therapy and the reasons for delays were documented. The number of lives lost was then calculated.
  
  
  RESULTS
  Only 37% of patients received fibrinolytic therapy and only 3% received the medication within 1 hour. The median total delay in receiving fibrinolytic therapy was 270 minutes (range 45-584). The median time delays from onset of symptoms to call for help, between calling for help and arriving at hospital, and from hospital arrival to fibrinolytic agent administration, were 35 minutes (5-1 185), 55 minutes (12.5-670) and 62.5 minutes (16.5-282), respectively. Numerous delays were identified at all stages, with patient and transport delays being most significant. Strikingly, an additional 32 patients per 1000 treated could have been saved if a fibrinolytic agent had been administered within 1 hour.
  
  
  CONCLUSIONS
  This study highlights the important problem of delayed or non-administration of fibrinolytic therapy at a tertiary hospital. The problems identified will contribute to the implementation of a robust STEMI management network in SA, similar to those in developed countries.
authors.affiliation: Department of Internal Medicine, School of Medicine, Faculty of Health Sciences, University of Pretoria, South Africa, and Steve Biko Academic Hospital, Pretoria. ruchikameel@gmail.com.
authors.forename: Ruchika
authors.initials: R
authors.lastname: Meel
authors.forename: Ricardo
authors.initials: R
authors.lastname: Gonçalves