Prehospital and interhospital delay in the treatment of patients with acute myocardial infarction with ST segment elevation and strategies to improve it from the perspective of the process owners: The importance of time

Fibrinolytic drugs are one of the important strategies for the treatment of patients with acute myocardial infarction with ST segment elevation, especially in small centers. This study was conducted with the aim of evaluating the distance with the global standard for fibrinolytic treatment and the viewpoints of experts in this regard. This cross-sectional study was performed on 384 patients with acute myocardial infarction in Imam Hossein Hospital in Shahroud, Iran during a 5-year period. Data were collected using a demographic and medical profile and a 13-item checklist on how and when access to treatment and services and interviewed by the treatment team was sought. Out of 384 patients, %76.3 was male and the mean age was 60.4 years. Prehospital delay, electrocardiography time, and first visit time respectively were 270, 6.59 and 8.45 minute, generally, the door-to- needle time was more than three times the global standard. Prehospital delay with gender, history of diabetes and high blood pressure, education level, and history of percutaneous coronary intervention(PCI) were significant (p <0.005). Considering the global standard time only 7% of patients had received the drug in the standard range and according to the opinions of the experts and the treatment team, the definition of the MI code in the hospital and the creation of conditions for the fibrinolytic therapy in the emergency room and conducting monthly meetings with all members of the team, from guard to doctor, as understanding the importance of time in treating heart patients can be effective in improving conditions.