Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction

Abstract

Background:Despite efforts aimed at reducing the prehospital delay and treatment delay, a considerable proportion of patients with ST elevation myocardial infarction (STEMI) present late and receive the reperfusion therapy after unacceptably long time periods. This study aimed at finding out the patients' decision delay, prehospital delay, door-to-electrocardiography (ECG), door-to-needle, and door-to-primary percutaneous coronary intervention (PCI) times and their determinants among STEMI patients.Materials and Methods:A cross-sectional study conducted among 96 patients with STEMI admitted in a tertiary care center in South India. The data were collected using interview of the patients and review of records. The distribution of the data was assessed using Kolmogorov–Smirnov test, and the comparisons of the patients' decision delay, prehospital delay, and time to start reperfusion therapy with the different variables were done using Mann–Whitney U-test or Kruskal–Wallis test based on the number of groups.Results:The mean (standard deviation) and median (range) age of the participants were 55 (11) years and 57 (51) years, respectively. The median patients' decision delay, prehospital delay, door-to-ECG, door-to-needle, and door-to-primary PCI times were 75, 290, 12, 75, 110 min, respectively. Significant factors associated (P < 0.05) with patients' decision delay were alcoholism, symptom progression, and attempt at symptom relief measures at home. Prehospital delay was significantly associated (P < 0.05) with domicile, difficulty in arranging money, prior consultation at study center, place of symptom onset, symptom interpretation, and mode of transportation.Conclusions:The prehospital delay time among the South Indian population is still unacceptably high. Public education, improving the systems of prehospital care, and measures to improve the patient flow and management in the emergency department are essentially required. The time taken to take ECG and to initiate reperfusion therapy in this study points to scope for improvement to meet the American Heart Association recommended timings.

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

“…Patients from rural areas and lower income families were more vulnerable to delayed in hospital admission, though it might not be related with their educational qualification. Previous studies have reported that residence from rural areas [ 23 , 27 ] and those from lower socio-economic backgrounds [ 28 ] were at higher risk of delayed hospital admission due to lack of financial resource and availability of transportation. In addition, those staying closer than 5.0 km from primary care facilities were more likely to reach the hospital within 6 h after onset of MI symptoms.…”

“…However, our study showed that the mode of transportation (ambulance or general vehicle) was not associated pre-hospital delay. Interesting, a study from South India reported that patients who used private ambulance had shorter delay compared to those who used public ambulance or other types of transportation [ 27 ].…”

Barriers and facilitators to implementing coronary care networks in South Africa: a qualitative study

“…This could be related to the fact that patients misperceive their symptoms as not being serious, attributing it to other more benign conditions, "this could maybe just be heartburn (P1, ECP)." Studies from many different settings, [27][28][29][30] including South Africa, 6 corroborate the notion that misinterpretation of symptoms and attempts at self-medication are the main reasons for delays in seeking healthcare after symptom onset. A further reason for this delay seemed to be related to access to transport, "they can't get there, either taxis are expensive or taxis don't run after hours (P9, EP)," and "access to a vehicle, is almost unheard of (P9, EP)."…”

Factors associated with pre-hospital delay before reperfusion therapy in patients with ST-segment elevation myocardial infarction

“…[18] The present study highlights the door to needle time was 54 min (SD=24) which is comparable to the study from South India and Beijing which depicted the median door-to-needle time were 75 and 82 min respectively. [19,20] However, few studies showed significantly lower door to needle time i.e 40 min and 34 min respectively. [12,21] The current study enlightened the most commonly used thrombolytic agent was tenecteplase (TNK) 54.7%.…”