Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram

Abstract

BackgroundIn ST-elevation myocardial infarction (STEMI), prehospital delay is a significant factor, decreasing likelihood of revascularization and increasing mortality. Prehospital delays are substantive in Indian patients with STEMI. Our study aimed to investigate factors associated with prehospital delay in patients with STEMI.MethodsA multicentric prospective analysis was conducted at five major cardiac care referral centers in Punjab including a tertiary care teaching hospital over a period of 1 year from January 2015 to December 2015. Patients presenting with STEMI were included in the study. A structured questionnaire was used to gather patient characteristics and factors responsible for prehospital delay.ResultsOf the 619 patients included in the study, 42% presented with more than 6 h of prehospital delay. On univariate analysis, delay was significantly higher among elderly (p = 0.01), illiterate patients (p = 0.02), and patients residing in rural areas (p = 0.04). Recognizing symptoms as cardiac in origin (p < 0.001), hospital as initial medical contact, and availability of prehospital electrocardiogram (ECG) (p = 0.001) were associated with shorter delays. On multivariate analysis, prehospital delay was significant in elderly patients, initial point of care as outpatient clinic, and patients without access to prehospital ECG.ConclusionOur study concludes that demographic and socioeconomic barriers exist that impede rapid care seeking and highlights the need for utilization of prehospital ECG to decrease prehospital delay. Possibilities include, educating the public on the importance of early emergency medical services contact or creating emergency stations in rural areas with ECG capabilities. Our study also invites further research, regarding role of telemedicine to triage patients derived from prehospital ECGs to decrease prehospital delay. Keywords: STEMI, Pre-hospital ECG, Pre-hospital delay, Factors, Telemedicine.

Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh

“…Older age had also been noted to be risk factor of pre-hospital delay (16,18,22) , and this may be due to limited resources and problem with transportation. There was no signi cant difference in pre-hospital delay between both the genders in our study, and this was consistent with most other studies from both developed and developing countries (10,16,(23)(24)(25). However, some studies identi ed female gender as one of the predictors of pre-hospital delay (12,26).…”

Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh

“…Similar finding is present in a previous studies where patients claimed longer distance of primary care center for late presentation (22,24,28). However the mode of transport (ambulance or general vehicle) was not associated with delayed hospital presentation in our study, though a study showed that patients who used private ambulance had shorter delay compared to those who used public ambulance or other transport (26).…”

“…Older age is a widely reported risk factor of prolong pre-hospital delay (16,18,21). No significant sex difference were found in case of pre-hospital delay in this study, which is consistent with other studies from both developed and developing countries including the Bangladeshi one (10,16,(22)(23)(24). However, some other studies identified female sex as significant predictors of prolonged pre-hospital delay (12,25).…”

“…However the mode of transport (ambulance or general vehicle) was not associated with delayed hospital presentation in our study, though a study showed that patients who used private ambulance had shorter delay compared to those who used public ambulance or other transport (26). The role of educational status remains conflicting as some studies found higher educational qualification shortens the pre-hospital delay (12,22,27), while some others found no relation (26,29). Beside these, an interesting fact has brought forth by our study that middle class patients had a much higher odd of delayed hospital admission even more than lower income people.…”

“…Patients' from rural areas and lower income families were more vulnerable for delayed hospital admission though it was not related with their educational qualification. Rural area of residence (22,26) and lower socio-economic condition (27) were specified as risk factors of delayed hospital presentation due to delays in arranging money or proper transport in previous studies. Moreover, patients who had primary care facilities within 5 km were able to reach more likely within 6 hours.…”