Factors Influencing Pre-Hospital Delay In Patients with Acute Myocardial Infarction

Abstract

Acute coronary syndrome is a lethal condition. Treatment modality and success mostly depend on time yielded since onset of symptoms. It is known for more than 30 years that delay between symptom onset and treatment of less than 60 min are desirable, but pre hospital delays remain unacceptably long worldwide including Bangladesh. A greater understanding of the contributing factors may help to reduce delays. A number of sociodemographic, clinical, social and proximal factors have been associated with pre hospital delay. The total pre hospital delay period consists of two component: time taken by patients to recognize that their symptoms are serious and to contact medical help (decision time) and the time taken from requesting help to admission where emergency coronary care is available (time to hospital delay). Different factors may affect these two components. In hospital delay also known as door-to-treatment, is defined as time from arriving to hospital to initiation of reperfusion therapy. Regardless of how to shorten in hospital delay, if the pre hospital delay is not reduced, then reperfusion therapy cannot achieve the best results. We set out to discover what factors are specifically associated with three components: decision time, home to hospital delay and First Medical Contact (FMC) to revascularization delay. This review may help the National health management system to identify the factors associated with treatment delay in ACS and thus reduces ACS related morbidity and mortality.
 University Heart Journal Vol. 15, No. 2, Jul 2019; 79-85

Factors associated with prehospital delay in acute myocardial infarction in Maldives

“…Generally, patients’ behavioral and cognitive responses toward the symptoms of AMI have been associated with prehospital delay. Some studies have related it to prehospital delay [ 14 ], while others have found that it minimizes the delay [ 36 , 37 ]. Our study analyzed seven variables under these categories and found that two variables were related to prehospital delay.…”

“…Recent studies have proven that prehospital delay is the major contributor to delayed treatment in South Asian countries such as India [ 10 , 11 ], Pakistan [ 12 , 13 ], Bangladesh [ 14 ], and Sri Lanka [ 15 ]. However, there is little or no information regarding the prehospital delay in the Maldives.…”

The Impact of Illness Perception on Delay in Seeking Medical Help in Patients with Acute Chest Pain: A Cross-sectional Study in the United Arab Emirates

“…There are three main reasons for the delay: patient-related, transport and hospital-related delay. Patient-related delay refers to the time from the onset of symptoms to make the initial decision to seek medical assistance [7,8]; this depends on the patients' perception and beliefs about their disease, which was found to be more challenging than transport and hospital delays [7,9].…”

“…Several factors contribute to the delay in seeking medical help, and previous studies found financial problems, lack of health insurance, and lack of time as the most common causes [10,11]. Furthermore, some patients hesitated because of misunderstanding the nature of their pain and other cardiacrelated symptoms [5,8,11,12]. Mistrust between the patient and the physician as a result of delayed attention from the physician and other healthcare providers was also reported [11], as were psychological problems such as anxiety and fear of the hospital and medical equipment [13].…”