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

Abstract

<jats:title>Abstract</jats:title> <jats:p><jats:bold>Background: </jats:bold>Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study aimed to investigate the significant factors associated with prolonged pre-hospital delay and the impact of this delay on in-hospital mortality among patients with MI in Northern Bangladesh.<jats:bold>Methods: </jats:bold>This cross sectional study was conducted in December 2019 in cardiology ward of a 1000-bed tertiary care hospital of Bangladesh. Patients admitted in the ward with the diagnosis of myocardial infarction were included in the study. Socio demographic data, clinical features and patients’ health seeking behavior was collected in a structured questionnaire from the patients. Median with interquartile range (IQR) of pre hospital delay were calculated and compared between different groups. Chi-square (χ²) test and binary logistic regression were used to estimate the determinants of pre-hospital delay and effect of pre-hospital delay on in-hospital mortality.<jats:bold>Results: </jats:bold>337 patients was enrolled in the study and their median (IQR) pre-hospital delay was 9.0 (13.0) hours. 39.5% patients admitted in the specialized hospital within 6 hours. In logistic regression, determinants of pre-hospital delay were patients age (for &lt;40 years aOR 2.43, 95% CI 0.73-8.12; for 40 to 60 years aOR 0.44, 95% CI 0.21-0.93), family income (for lower income aOR 5.74, 95% CI 0.89-37.06; for middle income aOR 14.22, 95% CI 2.15-94.17), distance from primary care center £5 km (aOR 0.42, 95% CI 0.12-0.90), predominant chest pain (aOR 0.15, 95% CI 0.05-0.48), considering symptoms as non-significant (aOR 17.81, 95% CI 5.92-53.48), referral from primary care center (for government hospital aOR 4.45, 95% CI 2.03-9.74; for private hospital OR 98.67, 95% CI 11.87-820.34); (R<jats:sup>2</jats:sup>=<jats:sup> </jats:sup>0.528) and not having family history of MI (aOR 2.65, 95% CI 1.24-5.71). Risk of in-hospital mortality was almost four times higher who admitted after 6 hours compared to their counterpart (aOR 0.28, 95% CI 0.12-0.66); (R<jats:sup>2</jats:sup> =0.303).<jats:bold>Conclusion: </jats:bold>Some modifiable factors contribute to higher pre-hospital delay of MI patients, resulting in increased in-hospital mortality. Patients’ awareness about cardiovascular diseases and improved referral pathway of the existing health care system may reduce<jats:bold> </jats:bold>this unexpected delay.</jats:p>

Analyze the Rate of Late Arrival in Patients with Acute Myocardial Infarction and the Factors That Cause it

“…Late arrival from onset of symptoms to hospital is the major cause of increasing morbidity and mortality rate in acute myocardial patients [13], and ST elevation myocardial infarction is one of the leading causes of mortality and morbidity worldwide.…”

Correlates of Delayed Initial Contact to Emergency Services among Patients with Suspected ST-Elevation Myocardial Infarction

“…This finding was consistent with previous literature. One study in India noted that longer distance, rural residence, and issues with transportation were found to be predictors for late presentation [ 14 ]. This same study also noted that this variable may not be generalizable to other populations as all areas and locations differ in health-seeking behavior and sociodemographic factors [ 14 ].…”

“…One study in India noted that longer distance, rural residence, and issues with transportation were found to be predictors for late presentation [ 14 ]. This same study also noted that this variable may not be generalizable to other populations as all areas and locations differ in health-seeking behavior and sociodemographic factors [ 14 ]. Another study found that although some individuals lived farther from the hospital, they only used ambulance services about 5% of the time, which may have indicated the lack of understanding of the importance of early EMS contact and the sense of urgency that is warranted with acute treatment [ 15 ].…”

Study of outcomes of delay in referral of patients with acute myocardial infarction

“…[ 6 7 ] Therefore, reducing the delay in starting standard treatments such as reperfusion therapy is a critical strategy to increase the success rate of treatment in AMI. [ 8 ]…”