Factors associated with pre-hospital delay before reperfusion therapy in patients with ST-segment elevation myocardial infarction

Abstract

Introduction: Cardiovascular disease remains the main cause of death in the world, and myocardial infarction represents the main contributor to this mortality. Timely restoration of myocardial blood flow with reperfusion therapy is crucial. Pre-hospital delay is a major obstacle for early reperfusion therapy and has negative impact on mortality and left ventricle function.
 Methods: A prospective study was carried in cardiology unit of a medical college from August 2013 to December 2017. Cases of acute ST segment elevation myocardial infarction that have undergone thrombolysis were recruited.
 Results: Out of 450 patients with ST Elevation Myocardial Infection (STEMI), delayed presentation was seen in 288 (64%) for >6 hrs and 108 (24%) patients for >12 hrs. The duration from onset of symptoms to the presentation in the emergency room (pre-hospital delay) was 12.66 hrs (SD=14.19, range = 30 min to 72 hrs). The door to needle time was 54 min (SD=24) The major factors for pre-hospital delay were misinterpretation of symptoms (59%) and transportation problems (31%).
 Conclusion: Misinterpretation of symptoms remain the most common cause of delayed presentation. Health education for public awareness can reduce the delay. Extension of thrombolytic therapy to district hospital and primary health center level after basic training for medical officer with checklist and collaboration in form of telemedicine with referral cardiac center may have major impact on morbidity and mortality reduction in acute STEMI patients with early reperfusion therapy.

Trends and Predictors of Readmission among Coronary Artery Disease Patients in a Community Heart Hospital in Nepal

“…Cardiac cause for admission was in 71.3%. Cardiac causes for readmission were also quoted as 42% by Shah et al 9 ,57.8% Atti et al 10 20 As prehosptial time 21 and door to needle time 22 and door to balloon time 33 is longer in our settings, revascularization cannot be done in time and significant improvement in both ejection fraction and wall motion abnormalities does not occur even after treatment. Anemia, defined according to WHO in male with haemoglobin < 13gm/dl and female <12 gm/dl, was in 83 (58%) patients which was similar to other study.…”

Prevalence and determinants of delays in care among premature deaths due to acute cardiac conditions and stroke in residents of a district in India

“…8 , 9 , 10 , 27 , 28 , 29 Few studies have reported a higher delay among women, 14 , 28 but many studies including ours did not find so. 27 , 28 , 30 , 31 The primary reason for delay identified in all studies has been the lack of awareness of the symptoms to be related to MI or stroke resulting in non-recognition of the severity of their illness. Our study confirms these findings.…”

Challenges in Managing Acute ST Myocardial Infarction in Community Heart Hospital

“…It is difficult for them to understand every minute of delay in treatment of patients with STEMI can affect 1-year mortality, both in thrombolytic therapy and primary angioplasty and the risk of 1-year mortality can be increased by 7.5% for each 30-minute delay. 15,16,17 Once the patient in the periphery became stable and chest pain free, many refused to complete doses of medicine and request for early discharge. Mean hospital stay was for 3.1±1.1 days.…”