The effect of patients’ time of arrival at the hospital on the rate of Thrombolytic therapy

The honorable editor-in-chief of the Journal of ARYA We read with interest the article of Dr. Maleki that has recently been published.۱ We conducted a similar study in Birjand Vali-e-Asr Hospital in ۲۰۰۹-۲۰۱۰. This study was done on ۱۲۵ patients with STEMI with a mean age of ۵۹.۲ ± ۱۱.۹ years. In this study, ۶۵.۶% of patients underwent thrombolytic therapy. This showed a crucial increase compared to the previous study in Birjand in ۲۰۰۳ that showed ۱۷.۳% of patients underwent thrombolytic therapy.۲ Mean door to needle time was ۷۴.۸ ± ۴۲.۷ minutes (median ۶۰ minutes). Thrombolytic therapy showed no difference for difference in sex (۶۹.۴% in males, and ۵۱.۹% in females, P = ۰.۰۸). However, in working staff (۸۶.۷% in employees, and ۵۱.۲% in farmers/workers, P = ۰.۰۰۳), in highly educated individuals (۹۲.۳% at university level, and ۴۵.۵% illiterate, P < ۰.۰۰۱), and in citizens (۷۳.۲% in urban, and ۵۱.۲% in rural citizens, P = ۰.۰۱) there was a higher percentage of thrombolytic therapy. The main reason for this difference between them is earlier arrival to the hospital since the onset of symptoms. The arrival time in the city's residents was ۱۶۶.۷ ± ۱۷۹.۶ minutes, but for villagers it was ۲۲۱.۶ ± ۱۱۲ minutes (P = ۰.۰۰۱). Furthermore, the rate of thrombolytic therapy during the night was not significantly different compared to the rest of the day (۷۳% during morning, ۶۲.۹% during afternoon, and ۶۲.۳% during night, P = ۰.۵۲). The patient's arrival time to the hospital at night was not different compared to the rest of the day (۱۶۶.۹ ± ۱۷۴.۷ minutes in the morning shift, and ۱۴۸.۲ ± ۸۵.۲ minutes during the night shift, P = ۰.۶۳). Visiting patients during the night shift was similar to other shifts; visit by intern was ۱۲.۳ ± ۹.۱ minutes during the morning shift, and ۱۴.۱ ± ۹.۳ minutes during the night shift (P = ۰.۷۳). The rate of thrombolytic therapy in our study was similar to the study by Dr. Maleki;۱ however, door to needle time was longer. In our hospital (Birjand Vali-e-Asr Hospital), due to lack of residents, it is necessary that patients should certainly be visited by a cardiologist (on call) before starting thrombolytic therapy and the cardiologist should himself/herself be present at the patient's bedsides. It is necessary that public awareness be increased through educational programs on television, and local journals. Providing telemedicine facilities, through which a patient’s ECG is observed by a cardiologist at home, is one of the necessities.