Background Early revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka. Methods This retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay. Results The mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5–9.9)], diabetes [OR: 1.7 (95% CI: 1.0–2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3–7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0–3.5)] were significantly associated with pre-hospital delays. Conclusion Acute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.
Introduction: The COVID-19 pandemic's impact on cardiovascular (CV) services globally was variable, with little data on trends from South Asia. Hypothesis: We hypothesized changes in trends of CV services delivery and procedure volumes from 2019-2022. We aimed to assess the pandemic's impact at a Bangladesh tertiary cardiac centre. Methods: Data on patient visits, admissions, procedures and catheterization volumes were collected from January 2019 to February 2022. Differences for each month of the preceding year were expressed as a percentage (%Δ). Trends (2019 to 2022) were graphically depicted via line diagrams. Results: Significant reductions of cardiology services occurred in 2020, especially ER visits (Δ-59.5%; p<0.001). Patient and procedure volumes reached almost pre-pandemic levels by Q1 of 2021. A decline of admissions and procedures was seen in March-April 2021 as compared with 2020, coinciding with the Delta variant. By Q4 of 2021, patient visits, outpatient procedures and catheterization volumes had reached near pre-pandemic levels again. During the Omicron surge (Q1 of 2022), a small decline in outpatient visits (Δ-10.9%) and procedures (Δ-6.83%) was seen. However, in-patient admissions (Δ4.39%) and catheterization procedures (Δ5.7%) showed a rise in February 2022, compared to January, with ER visits showing the steepest rise (Δ 41.9%). Although ER visits remained relatively blunted post-pandemic (2020-2021), this trend was not reflected in outpatient visits/procedures, admissions and catheterization procedures, which all increased to pre-pandemic levels by end 2021. Conclusion: Two years on from the pandemic, cardiology services and cath lab volumes have reached almost pre-pandemic levels in 2022, except for ER visits which remained low, albeit gradually rising. Procedure volumes reduced during the Delta variant, but not during the Omicron surge, a positive indication of the learning and adaptability of healthcare system to surges.
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