Factors influencing emergency department arrival time and in-hospital management of patients with acute myocardial infarction

Abstract

Reperfusion of the infarct-related artery in the very first hour ("golden hour") of acute myocardial infarction (AMI) significantly reduces mortality rates. Several factors may delay the initiation of reperfusion therapy (ie, thrombolytic therapy or primary percutaneous transluminal coronary angioplasty [PCTA]), most of which are related to patients. A total of 520 patients with suspected AMI were evaluated in the emergency department of Dokuz Eylül University Hospital between March 1996 and October 1999. After inclusion criteria were applied, the study consisted of 178 patients with a history of AMI. Analyzed data that affected patients' arrival to the hospital were obtained from responses to a questionnaire. The Statistical Package for the Social Sciences (SPSS; SPSS Inc., Chicago, Ill), version 11.0, was used for all statistical analyses. The mean "symptom onset-hospital arrival time" was 188+/-325 min for the entire study group. The median delay was 110 min (approximately 2 h). Only 39 (22%) patients arrived to the hospital within the first hour. The mean time needed for late responders (n=109, 74%) (hospital arrival later than 1 h after symptom onset) to arrive was 245-/+363 min. According to the results of this study, many patients with AMI who may be eligible for reperfusion therapy miss the "golden hour" because of late hospital arrival. Some groups of patients (ie, elderly, women, those with diabetes) were especially late in arriving. To reduce such delays, training programs may be advised to focus on these groups of patients. Arrival times to the hospital during AMI can be greatly improved by efficient public education programs targeted to these groups.

Effect of the number of request calls on the time from call to hospital arrival: a cross-sectional study of an ambulance record database in Nara prefecture, Japan

“…The predictive variables were selected on the basis of previous research 17–23. To evaluate the differences of time from call to hospital arrival between the three areas, we conducted a multilevel linear regression analysis with a random intercept model that allowed different intercepts with the three areas.…”

Effectiveness of media awareness campaigns on the proportion of vehicles that give space to ambulances on roads: An observational study

“…In light of these results and relevant literature where there is indication of a significantly higher survival of patients who arrived in hospitals earlier during medical emergencies,10-13 a mass media campaign was conducted in Karachi from march 11 th -26 th 2016 with the aim of raising people’s awareness on the importance of giving way to ambulances. The campaign involved sending out public awareness messages through billboards, running advertisements and talk shows both on television and radio.…”

A Tale of Two Cities: STEMI Interventions in Developed and Developing Countries and the Potential of Telemedicine to Reduce Disparities in Care

“…In striking contrast developing countries lack appropriately recognized or managed AMI care. Ambulance services are often nonexistent; doctors and nurses are lacking; basic thrombolytic therapy is not available; and primary percutaneous coronary intervention (PCI) is unthinkable . As a result of these drawbacks, AMI mortality and long‐term outcomes are abysmal.…”

“…As an example, the vital factor of ambulance services appears to correlate with economic development of the region . This observation is glaring in regions where well‐developed ambulance services are entirely absent …”

“…1,2 This observation is glaring in regions where well-developed ambulance services are entirely absent. 3 AMI and Ambulance Networks. AMI management remains fundamentally dependent upon existing networks of ambulance services that provide the initial, but critical, first step of managing a patient with an AMI.…”