Rural Alberta thrombolysis study. Survey of practice patterns for managing acute myocardial infarction

Abstract

Objective: To determine current practice patterns for managing acute myocardial infarction in rural Alberta, particularly to examine the availability of thrombolytic therapy.

Design: Mailed questionnaire based on a clinical vignette.

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

Participants: The Chief of Staff at each hospital.

Main outcome measures: 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.