Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Abstract

BackgroundThe two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably.In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count.This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase.MethodA literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.ResultsIn both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women).With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably.In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke.ConclusionBoth in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.

Time Lapse between Initial Stroke Symptoms to Performance of CT Scan in Patients with Ischemic Stroke in Pakistan

“…11 The results are however in accordance with Kim et al who also did not find any association of prehospital delay with age or sex. [12] Elderly population living alone in developed countries like Japan is also at a greater risk of prehospital delay such as described by Yanagida T et al [7]No such factor was found in our study as a cause in our population.…”

“…[5] In a previous study history of previous stroke has been implicated as a factor in shorter delay while accompanied diabetes has been associated with a longer delay of hospital arrival in patients with diabetes. [11] We however admit the limitation of study not to have recorded such history in all of our patients.…”

Myocardial Infarction: Sex Differences in Symptoms Reported to Emergency Dispatch

“…3 Additionally, current Australian and American College of Cardiology and American Heart Association (ACC/AHA) guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommend the time from first medical contact to percutaneous coronary intervention (PCI) to be as-soon-as-possible 4 or less than 90 minutes, 5,6 with suggestions that EMS to PCI time should be less than 90 minutes as well. 5,7 Many studies have investigated reasons for underuse of emergency ambulances 8,9 and delay in seeking treatment 10,11 in MI patients. Research has shown that pre-hospital median delays range from 84 to over 400 minutes.…”

Pre-hospital care in stable patients with acute coronary syndrome: Factors and predictors of pre-hospital delays in a tertiary public health institute

“…Other studies reveal that patient delays were associated with sex (women had longer PHDs, as they took longer time to make decisions), ethnicity (an increased PHD, in the case of AMI, was found among the Asian and Latino populations in the USA), indecisiveness, fear, atypical presentation, lack of information, misinterpretation, reluctance to call a physician, lack of encouragement, and having a medical history and depression. [15][16][17] PHDs were further exacerbated when patients sought treatment at an intermediate care facility, which may not be equipped to deal with cardiac emergencies. The total mean travel times to arrive at, stay in an intermediate health institution, and subsequently arrive at the hospital were 0.5, 4.1, and 1.2 hours, respectively.…”