Medical practitioners’ Knowledge and Attitude on Prehospital ST Elevation Myocardial Infarction (STEMI) Thrombolysis
Prehospital Thrombolysis for STEMI
Abstract
This study explores the knowledge and attitudes of medical practitioners with prehospital care (PHC) experience toward prehospital thrombolytic therapy for ST-elevation myocardial infarction (STEMI) management in Malaysia. While prehospital thrombolytic therapy shortens the door-to-needle time and improves outcomes, its implementation is hindered by the lack of local guidelines and limited training for prehospital providers. A cross-sectional survey was conducted at Hospital Canselor Tuanku Muhriz (HCTM) between November 2023 and May 2024. The participants included 65 medical practitioners with PHC experience. A validated questionnaire assessed knowledge and attitudes related to prehospital thrombolytic therapy, covering theoretical knowledge, electrocardiogram (ECG) interpretation and attitude statements. Chi-square tests analysed the association between knowledge and attitudes. Majority (93.8%) achieved acceptable knowledge levels, with 13.8% classified as having high knowledge. High proficiency was observed in ECG interpretation for STEMI cases, although challenges persisted with STEMI mimics such as left ventricular hypertrophy. Most participants (89.2%) exhibited positive attitudes toward prehospital thrombolysis. However, statistical analysis revealed no significant association between knowledge and attitudes (p = 0.715). The findings indicated adequate knowledge among medical practitioners but highlight gaps in managing STEMI mimics and prehospital workflows. Positive attitudes suggest readiness for implementation, though factors like medico-legal concerns and training opportunities may influence attitudes more than knowledge. This study demonstrates the feasibility of integrating medical practitioners in performing prehospital thrombolysis as a standard practice in Malaysia, emphasising the need for targeted training, advanced ECG interpretation courses and standardised protocols. Future research should expand to diverse regions and include broader provider cohorts.
Keywords :
Attitude; knowledge; prehospital emergency care; STEMI; thrombolytic therapy,
Abstrak
Kajian ini meneroka pengetahuan dan sikap pegawai perubatan yang mempunyai pengalaman dalam penjagaan pra-hospital (PHC) terhadap terapi trombolitik pra-hospital bagi pengurusan 'ST-elevation myocardial infarction' (STEMI) di Malaysia. Walaupun terapi trombolitik pra-hospital dapat memendekkan masa pintu-ke-jarum dan meningkatkan hasil rawatan, pelaksanaannya terhalang oleh kekurangan garis panduan tempatan serta latihan yang terhad kepada penyedia perkhidmatan pra-hospital. Satu tinjauan keratan rentas telah dijalankan di Hospital Canselor Tuanku Muhriz (HCTM) antara November 2023 hingga Mei 2024. Peserta terdiri daripada 65 orang pegawai perubatan dengan pengalaman PHC. Soal selidik yang telah disahkan digunakan untuk menilai pengetahuan dan sikap berkaitan terapi trombolitik pra-hospital, merangkumi pengetahuan teori, interpretasi elektrokardiogram (ECG) dan kenyataan sikap. Ujian chi-square digunakan untuk menganalisis hubungan antara pengetahuan dan sikap. Majoriti peserta (93.8%) mencapai tahap pengetahuan yang boleh diterima, dengan 13.8% diklasifikasikan sebagai mempunyai pengetahuan tinggi. Kecekapan tinggi diperhatikan dalam interpretasi ECG bagi kes STEMI, walaupun cabaran masih wujud dalam mengenal pasti STEMI palsu seperti hipertrofi ventrikel kiri. Kebanyakan peserta (89.2%) menunjukkan sikap positif terhadap trombolisis pra-hospital. Walau bagaimanapun, analisis statistik menunjukkan tiada hubungan signifikan antara pengetahuan dan sikap (p = 0.715). Hasil kajian menunjukkan pegawai perubatan mempunyai pengetahuan yang mencukupi tetapi terdapat jurang dalam pengurusan STEMI palsu dan aliran kerja pra-hospital. Sikap positif mencadangkan kesediaan untuk pelaksanaan, namun faktor seperti kebimbangan medikolegal dan peluang latihan mungkin lebih mempengaruhi sikap daripada pengetahuan. Kajian ini menunjukkan kebolehlaksanaan penglibatan pegawai perubatan dalam melaksanakan trombolisis pra-hospital sebagai amalan piawai di Malaysia, dengan penekanan terhadap keperluan latihan yang disasarkan, kursus interpretasi ECG lanjutan dan protokol piawai. Penyelidikan masa hadapan harus diperluaskan ke pelbagai kawasan dan melibatkan kumpulan penyedia perkhidmatan yang lebih luas.
Kata Kunci :
Pengetahuan; penjagaan kecemasan pra-hospital,
sikap; STEMI; terapi trombolitik,
Correspondance Address
Winnie Wong Siaw Tin. Department of Emergency Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, 56000 Cheras, Kuala Lumpur, Malaysia. Tel: +016 5895125 E-mail: winniewongsiawtin@gmail.com
