Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population

Abstract

BackgroundIn myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased possibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish population and identified determinants of a pre-hospital delay ≥ 2 h.MethodsA total of 89 women (mean age 72.6 years) and 176 men (mean age 65.8 years) from a secondary prevention study were enrolled in an observational study after first time MI between November 2009 and March 2012. Total pre-hospital delay was defined as the time from the onset of symptoms suggestive of MI to admission to the hospital. Decision time was defined as the time from the onset of symptoms until the call to Emergency Medical Services (EMS). The time of symptom onset was assessed during the episode of care, and the time of call to EMS and admission to the hospital was based on recorded data. The first medical contact was determined from a mailed questionnaire. Determinants associated with pre-hospital delay ≥ 2 h were identified by multivariable logistic regression.ResultsThe median total pre-hospital delay was 5.1 h (IQR 18.1), decision time 3.1 h (IQR 10.4), and transport time 1.2 h (IQR 1.0). The first medical contact was to primary care in 52.3 % of cases (22.3 % as a visit to a general practitioner and 30 % by telephone counselling), 37.3 % called the EMS, and 10.4 % self-referred to the hospital. Determinants of a pre-hospital delay ≥ 2 h were a visit to a general practitioner (OR 10.77, 95 % CI 2.39–48.59), call to primary care telephone counselling (OR 3.82, 95 % CI 1.68–8.68), chest pain as the predominant presenting symptom (OR 0.24, 95 % CI 0.08–0.77), and distance from the hospital (OR 1.03, 95 % CI 1.02–1.04). Among patients with primary care as the first medical contact, 67.0 % had a decision time ≥ 2 h, compared to 44.7 % of patients who called EMS or self-referred (p = 0.002).ConclusionsPre-hospital delay in patients with first time MI is prolonged considerably, particularly when primary care is the first medical contact. Actions to shorten decision time and increase the use of EMS are still necessary.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0271-x) contains supplementary material, which is available to authorized users.

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).…”

Tempos de acesso a serviços de saúde face ao infarto do miocárdio

“…This understanding provides explanations for the delay to reach the hospital and points towards actions that can reduce this delay. (19) It is known that cognitive and emotional factors (interpretations, thoughts and actions in view of infarction symptoms) are associated with the delayed decision to seek care. (20) Educational activities by nurses should focus on these factors in order to optimize the search for care.…”

Skubios medicinos pagalbos paieškos delsimas susirgus ūminiu miokardo infarktu

“…Tokias pačias išvadas galima padaryti ir apie mūsų tyrime identifikuotą rizikos veiksnį -simptomų pasireiš-kimą naktį, jis studijų buvo tiek patvirtintas [19], tiek paneigtas [20]. Kalbant apie kitus tyrime nustatytus rizikos veiksnius -gyvenimą kaime (didesnis atstumas iki gydymo įstaigos), simptomų tapatinimą su kita liga, tai daugelio studijų identifikuoti faktoriai, lemiantys vėlesnį medicinos pagalbos suteikimo laiką [10,12]. Tyrimuose nagrinėjami ir kiti galimi rizikos veiksniai: arterinė hipertenzija, cukrinis diabetas, rūkymas, krūtinės angina, buvęs miokardo infarktas, prieš tai atlikta koronarinė revaskuliarizacija ar širdies šuntavimo operacija, tačiau rezultatai dviprasmiški [18,21].…”