Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalisation: a cross-sectional study

Abstract

BackgroundThe characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients.MethodsThis was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014.ResultsA total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66±11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (p<0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58).ConclusionsAmbulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.

Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study

“…The fact that pain was associated with a time-sensitive diagnosis is not unexpected, as this is previously described [ 38 , 48 , 49 ]. Pain may be due to the loss of perfusion (angina, myocardial infarction) and low oxygen tension (hypoxia) with resulting inflammatory response [ 50 ].…”

“…A large proportion had a history of atrial fibrillation [8], which indicated that it was not a new finding that caused adverse illness among these patients. The fact that pain was associated with a time-sensitive diagnosis is not unexpected, as this is previously described [38,48,49]. Pain may be due to the loss of perfusion (angina, myocardial infarction) and low oxygen tension (hypoxia) with resulting inflammatory response [50].…”

Short Term Complications of Acute Myocardial Infarction in a Tertiary Hospital

“…Among other symptoms, anxiety was also found in significant number of patients. These findings correspond to several other studies [11][12] . ECG findings revealed that NSTEMI was more common (55%) than STEMI (45%).…”

Clinical Features, Treatment Choices and in-Hospital Outcome of Patients with ST-Segment Elevation Myocardial Infarction in Eastern Region of Nepal: A Hospital-Based Study

“…The most common presenting symptom was chest pain (97.0%) followed by sweating (78.0%) similar to other studies [10] which indicates that chest pain associated with sweating can be considered as important symptoms in the diagnosis of MI. Most of our patients (46.3%) presented with in 6 hours of the onset of symptoms in contrast to the study done in another peripheral center of Nepal [5] where the majority of the patients (48.4%) had presented 48 hours after the symptom onset.…”