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Moving cardiology to the front of the hospital
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  • Published on:
    Move immediate coronary care out of the hospital into the community
    Dear Editor,

    The major factor influencing the outcome of thrombolytic therapy for acute myocardial infarction is not door-to-needle time, as Harvey White claims, but pain-to-needle time. The largest component of the overall delay from onset to thrombolytic treatment is attributable to the patient's delay in calling for medical help. There is then an appreciable delay between calling for an ambulance or a doctor and arr...

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    Conflict of Interest:
    None declared.
  • Published on:
    Move immediate coronary care out of the hospital into the community - Authors' response
    • Harvey White, Director of Coronary Care and Cardiovascular Research

    Dear Editor,

    I agree wholeheartedly with many of Dr Rawles' comments. There are five components of delay in the "pain-to-needle" time. My editorial focused on administration of thrombolytic therapy in the emergency department, and as such I did not discuss other important components of delay.

    Patient delays in summoning medical assistance have proven to be very difficult to influence. Delays in the arr...

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    Conflict of Interest:
    None declared.