Is the National Service Framework standard for thrombolytic therapy achievable in a rural area?

The National Service Framework (NSF) for coronary heart disease requires that patients with acute myocardial infarction should start thrombolytic therapy within 60 min of the patient making contact with the National Health Service. In an audit of 700 patients with suspected acute myocardial infarction, patients' first contact was most commonly with a general practitioner (GP) (505/700; 72 per cent), who attended on 88 per cent (446/505) of occasions when they were called. In 93 per cent (255/284) of cases where both GP and an ambulance attended, the GP arrived first, by 25 min (median). In the final audit period, median call-to-thrombolysis time was 90 min (26 per cent < or = 60). We conclude that with existing physical and personnel resources in this semi-rural area of Northern Ireland, the NSF standard for thrombolytic treatment is unlikely to be met in a majority of cases unless GPs adopt prehospital thrombolysis.