Gender Differences in Factors Associated With Prehospital Delay Among Acute Coronary Syndrome Patients in Pakistan

Allana, Saleema; Khowaja, Khurshid; Ali, Tazeen Saeed; Moser, Debra K.; Khan, Aamir Hameed

doi:10.1177/1043659614524787

Cited by 14 publications

(18 citation statements)

References 31 publications

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“…Our findings that women were more likely to have prehospital delays among patients with STEMI have been reported in previous studies 9 11 20 28 29. Possible explanations include women suffering more atypical symptoms,30 31 the women-discriminating culture and lower socioeconomic status,32 more sympathy that prevents women from troubling anyone33 and so on.…”

Section: Discussionsupporting

confidence: 72%

Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China

Lin

Xie

et al. 2019

BMJ Open

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ObjectivesTo describe the prehospital and in-hospital delays to care and factors associated with the delays among patients with ST-segment elevation myocardial infarction (STEMI) in non-percutaneous coronary intervention (PCI) hospitals in China.Design, setting and participantsWe analysed data from a large registry-based quality of care improvement trial conducted from 2011 to 2014 among 101 non-PCI hospitals in China. A total of 7312 patients with STEMI were included. Prehospital delay was defined as time from symptom onset to hospital arrival >120 min, first ECG delay as time from arrival to first ECG >10 min, thrombolytic therapy delay as time from first ECG to thrombolytic therapy >10 min and in-hospital delay as time from arrival to thrombolytic therapy >30 min. Logistic regressions with generalised estimating equations were preformed to identify the factors associated with each delay.ResultsThe rates of prehospital delay, first ECG delay, thrombolytic therapy delay and in-hospital delay were 67.1%, 31.4%, 85.8% and 67.8%, respectively. Patients who were female, older than 65 years old, illiterate, farmers, onset during late night and forenoon, had heart rate ≥100 beats/m at admission were more likely and patients who had history of myocardial infarction, hypertension or SBP <90 mm Hg at admission were less likely to have prehospital delay. First ECG delay was more likely to take place in patients arriving on regular hours. Thrombolytic therapy delay rate was lower in patients who had prehospital delay or first ECG delay but higher in those with heart rate ≥100 beats/m at admission. In-hospital delay rate was lower in patients with a history of dyslipidaemia and those who arrived during regular hours.ConclusionChinese patients with STEMI in low medical resource areas suffered severe prehospital and in-hospital delays to care. Future efforts should be made to improve the prehospital delay among vulnerable populations with low socioeconomic status.Trial registration number NCT01398228; Post-results.

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Section: Discussionsupporting

confidence: 72%

Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China

Lin

Xie

et al. 2019

BMJ Open

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“…Self-medication (36.0%) and traffic (22.7%) were major reasons for delay time. *** ** ** Good Allana, et al, 2015 [33] Descriptive, cross-sectional comparative study. 2 tertiary care hospitals in Pakistan 249 Males 53.4% and females 46.6%.…”

Section: Methodsmentioning

confidence: 99%

Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review

Beza

Leslie

Bekele

et al. 2021

IJC Heart & Vasculature

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Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle income countries (LMICs). A major factor that is contributing to the poor clinical outcomes among LMICs is largely due to prehospital treatment delays. This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical and health system characteristics that contribute to treatment delays. We conducted a comprehensive review of the relevant literature published in English between January 1990 through May 2020 using predefined inclusion and exclusion criteria. Twenty-nine studies were included and time to treatment was defined from ACS symptom onset to first medical contact and dichotomized further as less than or >12-hours. The mean time from symptom onset to first medical contact was 12.7 h which ranged from 10-minutes to 96 h. There was consensus among studies that being older, female, illiterate, living in a rural area, and financially limited was associated with longer treatment delays. Lack of a developed emergency transportation system, poor communication and organization between community facilities and interventional facilities were also cited as major contributors for ACS treatment delays. Findings from this systematic review provide future directions to potentially reduce prehospital delays in LMICs and improve ACS outcomes.

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“…14 Studies show that women have longer prehospital delay times for symptoms suggestive of ACS compared to men. [15][16][17] Clinical presentation and outcomes of ACS have been reported to vary between women and men, with more women presenting with non-ST segment elevation ACS (NSTE-ACS), suffering higher rates of complications, and experiencing higher in-hospital mortality. 18 ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) often result in different outcomes and require different treatments.…”

Section: Introductionmentioning

confidence: 99%

The Quality of Symptoms in Women and Men Presenting to the Emergency Department With Suspected Acute Coronary Syndrome

Mirzaei¹,

Steffen²,

Vuckovic³

et al. 2019

Journal of Emergency Nursing

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Introduction: More than 5.5 million patients present to emergency departments (EDs) in the United States annually for potential acute coronary syndrome (ACS); however, diagnosing ACS remains a challenge in the EDs. Our aim was to describe the quality of symptoms (chest discomfort/pain description, location/radiation, and overall symptom distress) reported by women and men ruled-in and ruled-out for ACS in the EDs. Methods: The sample consisted of 1,064 patients presenting to the EDs with symptoms that triggered a cardiac workup. Trained research staff obtained data using the ACS Patient Information Questionnaire upon patient presentation to the EDs. Results: The sample (n = 1,064) included 474 (44.55%) patients ruled-in and 590 (55.45%) patients ruled-out for ACS. Symptom distress was significantly higher in patients ruled-in versus

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Gender Differences in Factors Associated With Prehospital Delay Among Acute Coronary Syndrome Patients in Pakistan

Abstract: Women delayed longer than men in seeking treatment for their ACS symptoms. Different factors were associated with PDT in women and men. This study may provide important insights for designing interventional studies to reduce PDT in Pakistani ACS patients.

Cited by 14 publications

References 31 publications

Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China

Prehospital and in-hospital delays to care and associated factors in patients with STEMI: an observational study in 101 non-PCI hospitals in China

Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review

The Quality of Symptoms in Women and Men Presenting to the Emergency Department With Suspected Acute Coronary Syndrome

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