Pre-Hospital Factors Influencing Time of Arrival at Emergency Departments for Patients with Acute ST-Elevation Myocardial Infarction

Abstract

BackgroundPre-hospital delay is currently a major factor limiting early reperfusion among ST-elevation myocardial infarction (STEMI) patients worldwide. This study aims to determine pre-hospital factors affecting symptom-to-door time among STEMI patients in Malaysia.MethodsThis cross-sectional study included 222 STEMI patients admitted to two tertiary hospitals in Malaysia. By determining symptom-to-door time, the study population was categorised into two definitive treatment seeking groups: early (≤ 3 h) and delayed (> 3 h). Data was collected focusing on socio-demographical data, risk factors and comorbidities, clinical presentation, situational factors and action taken by patients.ResultsThe mean age of our patients was 58.0 (SD = 11.9) years old, and the population consisted of 186 (83.8%) males and 36 (16.2%) females. Our study found that the median symptom-to-door time was 130.5 (IQR 240) min, with 64% of subjects arriving early and 36% arriving late. Pre-hospital delays were found to be significant among females (adj OR = 2.42; 95% CI: 1.02, 5.76; P = 0.046), patients with recurrence of similar clinical presentations (adj OR = 2.74; 95% CI: 1.37, 5.46; P = 0.004), patients experiencing atypical symptoms (adj OR = 2.64; 95% CI: 1.11, 6.31; P = 0.029) and patients who chose to have their first medical contact (FMC) for their symptoms with a general practitioner (adj OR = 2.80; 95% CI: 1.20, 6.56; P = 0.018). However, patients with hyperlipidaemia (adj OR = 0.46; 95% CI: 0.23, 0.93; P = 0.030), self-perceived cardiac symptoms (adj OR = 0.36; 95% CI: 0.17, 0.73; P = 0.005) and symptoms that began in public places (adj OR = 0.21; 95% CI: 0.06, 0.69; P = 0.010) tended to seek treatment earlier.ConclusionThe symptom-to-door time among the Malaysian population is shorter in comparison to other developing countries. Nevertheless, identified, modifiable pre-hospital factors can be addressed to further shorten symptom-to-door time among STEMI patients.

Pre-hospital delay among patients with acute myocardial infarction in Saudi Arabia

“…26,27 The mean age of the participants in this study was similar to that in a study in Malaysia. 28 Previous studies found that females were more likely to arrive late compared with males, but our findings failed to find statistically significant differences between males and females. 16,29,30 In the current study, bivariate analysis showed that current smokers were less likely to arrive late, and current smokers might perceived high susceptibility to Values are presented as numbers and percentages (%).…”

“… 7 Other previous studies found that patients who had history of hypercholesteremia were less likely to arrive late to the hospital. 28 , 33 …”

“…7 Other previous studies found that patients who had history of hypercholesteremia were less likely to arrive late to the hospital. 28,33 Patients who perceived the symptoms as cardiac in origin were less likely to arrive late to a hospital. 27,34,35 A similar finding was reported in the current study.…”

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

“…In the majority of studies, male gender and younger age were associated with earlier treatment of ACS compared to females and older adults, respectively [19] , [23] , [31] , [33] , [34] , [35] . Several studies reported however, that there were no differences in treatment for ACS due to either gender or age characteristics.…”

“…The overall in-hospital mortality rate was 19.51%, MACE at 30 days, 23.17% (38/164), respectively. ** * * Fair Lim et al, 2019 [35] Cross-sectional, descriptive. 2 tertiary care hospitals in Malaysia 222 Mean age 58 ± 11.9 years.…”