Comparisons of Prehospital Delay and Related Factors Between Acute Ischemic Stroke and Acute Myocardial Infarction

Abstract

Background Prehospital delay is an important contributor to poor outcomes in both acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We aimed to compare the prehospital delay and related factors between AIS and AMI. Methods and Results We identified patients with AIS and AMI who were admitted to the 11 Korean Regional Cardiocerebrovascular Centers via the emergency room between July 2016 and December 2018. Delayed arrival was defined as a prehospital delay of >3 hours, and the generalized linear mixed‐effects model was applied to explore the effects of potential predictors on delayed arrival. This study included 17 895 and 8322 patients with AIS and AMI, respectively. The median value of prehospital delay was 6.05 hours in AIS and 3.00 hours in AMI. The use of emergency medical services was the key determinant of delayed arrival in both groups. Previous history, 1‐person household, weekday presentation, and interhospital transfer had higher odds of delayed arrival in both groups. Age and sex had no or minimal effects on delayed arrival in AIS; however, age and female sex were associated with higher odds of delayed arrival in AMI. More severe symptoms had lower odds of delayed arrival in AIS, whereas no significant effect was observed in AMI. Off‐hour presentation had higher and prehospital awareness had lower odds of delayed arrival; however, the magnitude of their effects differed quantitatively between AIS and AMI. Conclusions The effects of some nonmodifiable and modifiable factors on prehospital delay differed between AIS and AMI. A differentiated strategy might be required to reduce prehospital delay.

Time to presentation and mortality outcomes among patients with diabetes and acute myocardial infarction

“…Late presentation adversely affects mortality outcomes, including mortality in both STEMI and NSTEMI [ 6 , 14 , 26 , 27 ]. Late presenters with diabetes are at an increased risk of delayed diagnosis and treatment because they are more likely to experience AMI without characteristic chest symptoms [ 28 , 29 ].…”

Factors associated with prehospital delay in acute myocardial infarction in Maldives

“…The onset-to-door time in developed countries is much less than that in South Asian countries. For comparison, the UK, South Korea, and Australia have door-to-needle times of 120, 180, and 132 min, respectively [ 31 , 32 ]. Well-developed prehospital care is the contributing factor to the results and has also shortened the time for countries such as America [ 33 ], Belgium [ 34 ], and Sweden [ 35 ].…”

Prehospital stroke management and mobile stroke units

“…The study found that only 2405 (43%) of the patients arrived at the stroke centre within 3 h and that delays detrimentally affected treatment rates [2]. A study of 11 Korean Regional Centers involving 17 895 stroke patients found that not using emergency medical services (EMS) is a key determinant of hospital arrival more than 3 h after the event [3]. Explaining the observed current delays data collected from 2014 to 2019 by the Paul Coverdell National Acute Stroke Program involving 500 829 patients with stroke or transient ischemic attack (TIA) showed that only 60% of the patients arrived via EMS [4].…”