Pre hospital delay and its associated factors in acute myocardial infarction in a developing country

Abstract

Background Early revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka. Methods This retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay. Results The mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5–9.9)], diabetes [OR: 1.7 (95% CI: 1.0–2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3–7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0–3.5)] were significantly associated with pre-hospital delays. Conclusion Acute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.

Gender Differences in Trends in Incidence and Mortality of Acute Myocardial Infarction in the Small Island Developing State of Barbados

“…Finally, this study explored time delays along the pathways of care experienced by Barbadian patients presenting with AMI. Delays in access to care, particularly access to definitive revascularization for ST-elevation myocardial infarction (STEMI), are associated with poor outcomes and increased AMI mortality in developing countries [ 10 , 28 ]. This study highlighted delays at multiple steps in accessing care for AMI patients within the country’s healthcare system.…”

Gender Particularities and Prevalence of Atypical Clinical Presentation in Non-ST Elevation Acute Coronary Syndrome

“…Sample size may be regarded as a limitation for our study. The method we used to calculate the necessary sample size, however, has been successfully employed previously in the literature [ 19 ] and should assert the validity of the data reported in this study.…”

“…In order to calculate sample size, we used the formula , where n = sample size; z = 1,96, the z value for 95% confidence interval; p = estimated prevalence of a target dichotomous parameter—in our case, the presence of atypical symptoms; d = margin of error accepted (5% in our case). Similarly to Chowdhury et al [ 19 ], the value of p was derived from a relevant study examining the prevalence of our researched dichotomous variable. We found a study conducted by Zdzienicka J. et al [ 20 ], which included 2382 patients from 29 hospitals and found a mean prevalence of 6.4% of atypical symptoms in NSTEMI to be adequate in this respect.…”

Risk Factors of Ischemia Reperfusion Injury After PCI in Patients with Acute ST-Segment Elevation Myocardial Infarction and its Influence on Prognosis

“…Guidelines have shown that opening occluded blood vessels within 12 h of onset of STMEI patients can have beneficial effects on the patient ( 17 ). There is a time window from acute coronary artery occlusion to transmural myocardial necrosis, which is about 6 h. Recanalization of coronary arteries within this time window can save ischemic myocardium on the verge of necrosis, promote the body to recover the forward blood flow and occlude blood vessels as soon as possible, and improve the myocardial microcirculation perfusion level ( 18 , 19 ). The delay in the visit of patients with STMEI can seriously affect the follow-up cardiac function, and early seeing a doctor can provide patients with the opportunity to obtain a good prognosis.…”