An Observational study of prehospital and hospital delay in reperfusion for acute myocardial infarction at a University Hospital in India

Choudhary, Rahul; Sharma, Sudhanshu; Kumar, Vineet; Gautam, D. K.

doi:10.4103/2395-5414.201378

Cited by 11 publications

(18 citation statements)

References 2 publications

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“…The current study showed that approximately 79% of the total pre-hospital delays were due to patient-related factors, and only 21% of the delays were due to transportation. They also showed that a good number of hours are wasted prior to physician consultation [ 25 ]. One solution is large scale programs of awareness of heart attack symptoms and signs.…”

Section: Discussionmentioning

confidence: 99%

Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center

Mujtaba

Sohail

Ram

et al. 2021

Cureus

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Objective This study aimed to assess the duration of pre-hospital delay among ST-Segment Elevation Myocardial Infarction (STEMI) patients and its contributing factors. Methodology A cross-sectional study was conducted at Rural Satellite Center in Larkana, Pakistan from May to September 2020. A total of 240 STEMI patients who underwent primary percutaneous coronary intervention (P-PCI) were included. The patients' demographic characteristics, index event characteristics, mode of transportation, misinterpretations, misdiagnoses, and financial problems were recorded. Data were analyzed using SPSS version 22.0 (IBM Corp., Armonk, NY, USA). Results The observed pre-hospital time was 120 minutes; 229 (median; interquartile range [IQR]). It was found that 33.3% of patients arrived within one hour of the symptom onset, while 20.4% of patients delayed hospital arrival for more than six hours. The delay rate was highest among patients aged 41 to 65 years. Moreover, delayed admissions were more common among females as compared to males (p=0.008). Among the causes of delay in hospital arrival were misinterpretation, misdiagnosis, and transportation and financial issues. Of these, misdiagnosis significantly influenced the delay rate, i.e., more than 50% of the misdiagnosed patients arrived hospital after six hours of symptom onset (p<0.05). Conclusion The P-PCI rural satellite center had a positive impact as the observed pre-hospital delay rate was considerably less as compared to that reported in the existing literature. Moreover, the confounding factors were misdiagnosis and misinterpretations. We need to develop the concept of immediate appropriate help-seeking among patients.

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Section: Discussionmentioning

confidence: 99%

Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center

Mujtaba

Sohail

Ram

et al. 2021

Cureus

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“…[ 36 ] One possible explanation for the association between education and delays is that education level could affect patients’ knowledge/awareness about the disease and its symptoms. [ 37 , 38 ] Another possible explanation is that education level might just be a proxy for socioeconomic status, which has been known to be a factor influencing prehospital delay. [ 24 , 39 , 40 ] Ultimately, since education impacts one's ability to collect and interpret information and to solve problems on many levels and may play an important role in both choosing lifestyle and health behaviors and searching health care, [ 41 ] the DT and the OTB might be affected by different choices in the process of decision-making and seeking medical care.…”

Section: Discussionmentioning

confidence: 99%

Symptom clusters and treatment time delay in Korean patients with ST-elevation myocardial infarction on admission

et al. 2018

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Most patients with acute myocardial infarction (AMI) experience more than one symptom at onset. Although symptoms are an important early indicator, patients and physicians may have difficulty interpreting symptoms and detecting AMI at an early stage. This study aimed to identify symptom clusters among Korean patients with ST-elevation myocardial infarction (STEMI), to examine the relationship between symptom clusters and patient-related variables, and to investigate the influence of symptom clusters on treatment time delay (decision time [DT], onset-to-balloon time [OTB]). This was a prospective multicenter study with a descriptive design that used face-to-face interviews. A total of 342 patients with STEMI were included in this study. To identify symptom clusters, two-step cluster analysis was performed using SPSS software. Multinomial logistic regression to explore factors related to each cluster and multiple logistic regression to determine the effect of symptom clusters on treatment time delay were conducted. Three symptom clusters were identified: cluster 1 (classic MI; characterized by chest pain); cluster 2 (stress symptoms; sweating and chest pain); and cluster 3 (multiple symptoms; dizziness, sweating, chest pain, weakness, and dyspnea). Compared with patients in clusters 2 and 3, those in cluster 1 were more likely to have diabetes or prior MI. Patients in clusters 2 and 3, who predominantly showed other symptoms in addition to chest pain, had a significantly shorter DT and OTB than those in cluster 1. In conclusion, to decrease treatment time delay, it seems important that patients and clinicians recognize symptom clusters, rather than relying on chest pain alone. Further research is necessary to translate our findings into clinical practice and to improve patient education and public education campaigns.

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“…Our findings indicate that approximately 25% of overall chest pain patients and 14% of ACS cases present 12 h after the onset of symptoms. Previous studies reported similar prevalence rates (ie, 18-33%) (13,20). However, it is worth noting that delay has been defined differently throughout literature.…”

Section: Prevalence Of Delay In Seeking Carementioning

confidence: 91%

“…For instance, it has been reported that the majority of STEMI patients (59%) presented within 6 h of symptom onset and only 25% of patients waited > 60 min (22,23). In another study, it has been shown that up to 33% of STEMI patients would wait > 12 h to seek medical care (20). Many other studies just simply reported the average time of delay (in minutes) (24)(25)(26).…”

Section: Prevalence Of Delay In Seeking Carementioning

confidence: 99%

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Prevalence and Predictors of Delay in Seeking Emergency Care in Patients Who Call 9-1-1 for Chest Pain

Frisch

Faramand²,

Li³

et al. 2019

The Journal of Emergency Medicine

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Background: Delay in seeking medical treatment for suspected acute coronary syndrome can lead to negative patient outcomes. Objective: Our aim was to evaluate the prevalence and predictors of delay in seeking care in high-risk chest pain patients with or without acute coronary syndrome (ACS). Methods: This was a secondary analysis of an observational cohort study of patients transported by Emergency Medical Services for a chief complaint of chest pain. Important demographic and clinical characteristics were extracted from electronic health records. Two independent reviewers adjudicated the presence of ACS. Logistic regression was used to model the predictors of delay in seeking care. Results: The final sample included 743 patients (99% non-Hispanic). Overall, 24% presented > 12 h from onset of symptoms. Among those with ACS (n = 115), 14% presented > 12 h after onset of symptoms. Race, smoking, diabetes, and related symptoms were associated with delayed seeking behavior. In multivariate analysis, non-Caucasian race (black or others) was the only independent predictor of > 12 h delay in seeking care (odds ratio 1.4; 95% confidence interval 1.0-1.9). Conclusions: One in four patients with chest pain, including 14% of those with ACS, wait more than 12 h before seeking care. Compared to non-blacks, black patients are 40% more likely to delay seeking care > 12 h.

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An Observational study of prehospital and hospital delay in reperfusion for acute myocardial infarction at a University Hospital in India

Cited by 11 publications

References 2 publications

Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center

Pre-hospital Delay and Its Reasons in Patients With Acute Myocardial Infarction Presenting to a Primary Percutaneous Coronary Intervention-Capable Center

Symptom clusters and treatment time delay in Korean patients with ST-elevation myocardial infarction on admission

Prevalence and Predictors of Delay in Seeking Emergency Care in Patients Who Call 9-1-1 for Chest Pain

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