Symptoms awareness, emergency medical service utilization and hospital transfer delay in myocardial infarction

Abstract

BackgroundThe length of time between symptom onset and reperfusion therapy in patients with ST-segment elevation acute myocardial infarction (STEMI) is a key determinant of mortality. Information on this delay is scarce, particularly for developing countries. The objective of the study is to prospectively evaluate the individual components of reperfusion time (RT) in patients with STEMI treated at a University Hospital in 2012.MethodsMedical records were reviewed to determine RT, its main (patient delay time [PDT] and system delay time [SDT]) and secondary components and hospital access variables. Cognitive responses were evaluated using a semi-structured questionnaire.ResultsA total of 50 patients with a mean age of 59 years (SD = 10.5) were included, 64% of whom were male. The median RT was 430 min, with an interquartile range of 315–750 min. Regarding the composition of RT in the sample, PDT corresponded to 18.9% and SDT to 81.1%. Emergency medical services were used in 23.5% of cases. Patients treated in intermediate care units showed a significant increase in SDT (p = 0.008). Regarding cognitive variables, PDT was approximately 40 min longer among those who answered “I didn’t think it was serious” (p = 0.024).ConclusionsIn a Brazilian tertiary public hospital, RT was higher than that recommended by international guidelines, mainly because of long SDT, which was negatively affected by time spent in intermediate care units. Emergency Medical Services underutilization was noted. A patient’s low perception of severity increased PDT.Electronic supplementary materialThe online version of this article (10.1186/s12913-018-3312-6) contains supplementary material, which is available to authorized users.

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

“…In several other studies, presenting directly to a tertiary facility significantly reduced mean treatment time versus those who were initially seen at a general hospital or by a primary clinician [19] , [20] , [21] , [26] , [27] , [28] , [34] , [35] , [37] , [41] . There was general agreement among studies that a lack of available reperfusion centers outside of major urban areas, limited diagnostic resources (EKG, cardiac enzymes) and adequately trained clinicians to recognize ACS prolonged symptom onset to treatment time [21] , [26] , [27] , [28] , [30] , [31] , [42] , [43] . In addition, system factors such as crowding in the emergency departments, and a lack of available bed capacity in reperfusion hospitals also contributed to major delays in treatment time [16] .…”

“…In the current study, the duration of time from symptom onset to first medical contact ranged from less than 10 min [14] to 96 h [15] with a mean of 12.7 h. In three studies, the focus was the delay between arrival to the emergency department and treatment initiation [16] perceptions of treatment urgency for ACS symptoms [17] and the overall time delay to treatment [18] . Four studies reported that all patients sought medical contact within 12 h of symptom onset [19] , [20] , [21] , [22] , while 26 studies reported treatment delays of 12 h or more, of these, 7 studies showed that at least 50% of the study population were delayed for 12 h until the initial medical contact [15] , [23] , [24] , [25] , [26] , [27] , [28] . Only 1 study by Sharma and colleagues [29] targeted characteristics of patients arriving over 12-hours from symptom onset to treatment.…”

“…Poor travel conditions, lack of suitable roads, traffic congestion, limited access to transportation and vehicle mechanical problems were among the reasons for delay in seeking treatment for ACS in rural locations [23] , [24] , [27] , [30] , [31] . A lack of an organized system for collaboration between hospitals and physicians were important roadblocks for more timely treatment for ACS symptoms [21] , [30] , [35] , [40] . A consistent theme in several LMICs was the lack of available insurance or universal coverage for healthcare.…”

“…MACE occurred in 11.7% with higher BMI and duration of diabetes the greatest predictors. *** ** ** Good Mesas et al, 2018 [21] Observational, cross-sectional, descriptive. Tertiary care hospital in Brazil.…”

Quantity and Quality of Healthcare Professionals, Transfer Delay and In-Hospital Mortality Among ST-Segment Elevation Myocardial Infarction: A Mixed-Method Cross-Sectional Study of 89 Emergency Medical Stations in China

“…Therefore, the duration of time from symptom onset to reperfusion therapy, which includes patient delay, transfer delay, and in-hospital delay, is a crucial factor determining mortality in STEMI patients. The primary cause of delay in reperfusion is system delay 4 , which mainly comprises transfer delay. Compared with door-in-door-out patients, the door-toballoon time for patients who are directly transferred to emergency medical stations with in-hospital percutaneous coronary intervention capabilities is shorter and their prognosis is better 5 .…”