Pain to Hospital Times After Myocardial Infarction in Patients from Dalmatian Mainland and Islands, Southern Croatia

Abstract

Aim To analyze pre-hospital delay in patients with myocardial infarction from mainland and islands of Split-Dalmatian County, southern Croatia. MethodsThe study included all patients with myocardial infarction transported by ambulance to the University Hospital Split in 1999Split in , 2003Split in , and 2005. Pre-hospital delay was analyzed in the following intervals: pain-to-call, call-to-ambulance, ambulance-to-door, and door-to-coronary care unit interval. Patients were categorized according to the location from which they were transported: Split, mainland >15 km from Split, and islands.Results There were 1314 patients (62.9% men) transported and hospitalized for myocardial infarction. Total prehospital delay (pain-to-hospital) was significantly reduced from 1999 to 2005 (5.2 hours vs 4.3 hours, P = 0.011). Seventy-five patients (5.7%) were admitted to the coronary care unit within the recommended time-frame of less than 90 minutes, none of which was from the islands, while 248 patients (18.9%) were admitted more than 12 hours from the onset of pain.

Determination of Factors that Affect Time to Hospital Presentation in Patients with Symptoms Suggestive of an Acute Myocardial Infarction

“…Employed patients and patients with medical insurance were found to present to the hospital earlier. However some studies show that lack of medical insurance has no effect on hospital presentation time (27).…”

Pain-to-hospital times, cardiovascular risk factors, and early intrahospital mortality in patients with acute myocardial infarction

“… 3 – 5 Between 1999 and 2005 the number of patients hospitalized due to MI in Central Dalmatia did not show increasing trends. 6 …”

“…However, it has been shown that the pain-to-hospital times for MI patients from Central Dalmatia is too long compared to recommended standards. 6 Since 2005, percutaneous coronary intervention (PCI) is available as a hospital treatment in Central Dalmatia. 6 However, the effectiveness of this treatment depends on administration of thrombolysis shortly after the onset of symptoms, and the main cause of delay in patients reaching the hospital after MI is the time it takes the patient to decide that their symptoms require medical attention.…”

“… 6 Since 2005, percutaneous coronary intervention (PCI) is available as a hospital treatment in Central Dalmatia. 6 However, the effectiveness of this treatment depends on administration of thrombolysis shortly after the onset of symptoms, and the main cause of delay in patients reaching the hospital after MI is the time it takes the patient to decide that their symptoms require medical attention. 7 Although it is recommended that the pain-to-hospital time should be less than 90 minutes, urban patients hospitalized for MI in Central Dalmatia needed a median of 2 hours to call the emergency after the onset of pain, and the total pre-hospital delay was 4.3 hours.…”

“… 7 Although it is recommended that the pain-to-hospital time should be less than 90 minutes, urban patients hospitalized for MI in Central Dalmatia needed a median of 2 hours to call the emergency after the onset of pain, and the total pre-hospital delay was 4.3 hours. 6 Together with recent findings that only 38% of patients with acute MI (AMI) from Central Dalmatia are hospitalized, it is clear that there is a lot of room for improvement of MI care in this geographic area.…”