Time to treatment in patients of suspected acute coronary syndrome in Pakistan: A clinical audit

Khursheed, Munawar; Fayyaz, Jabeen; Feroze, Asher; Shakeel, Nishi; Bhatti, Junaid Ahmad

doi:10.1016/j.hrtlng.2014.08.007

Cited by 6 publications

(11 citation statements)

References 28 publications

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“…This finding is similar to the findings of a study in Pakistan in which treatment of acute coronary syndrome was on average initiated within ten minutes after reaching the hospital. 13 …”

Section: Discussionmentioning

confidence: 99%

Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi

2020

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Objective: To determine the time from onset of symptoms to start of fibrinolysis and treatment in acute ST elevated myocardial infarction patients and identify the factors which cause delay in treatment. Methods: A cross sectional study was conducted at National Institute of Cardiovascular Diseases, Karachi on 360 conveniently selected patients of ST elevated myocardial infarction from July to September in the year 2017. Structured questionnaire was used to obtain detailed information on socio-demographics, factors which cause delay and timing of onset of symptoms to arrival of patient in emergency ward. Results: Overall, the total average time from the start of symptoms to initiation of treatment was 119.85±63.32 minutes. Only 5.1% patient reached within one hour while 57.7% reached within two hours. Old age group of 60 and above was positively associated with timely arrival (OR=2.75, 95% CI 1.33-5.68, p=0.006). Significant positive association of using personal car as mode of transport to reach the hospital (OR=5.25, 95% CI 2.94-9.35, p<0.001) was also found as compared to using ambulance. Distance from facility was suggestive of negative association in the model but was statistically insignificant. Conclusion: According to the findings of this study, more than one third of patients reached the hospital within two hours of initiation of symptoms while only 5.1% reached within one hour. The delay was mostly pre-hospital attributed to arranging transport, stay at first medical contact and time taken from first medical contact to the hospital. doi: https://doi.org/10.12669/pjms.36.5.2104 How to cite this:Jalbani FA, Shaikh S, Fatima S. Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi. Pak J Med Sci. 2020;36(5):---------. doi: https://doi.org/10.12669/pjms.36.5.2104 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…This finding is similar to the findings of a study in Pakistan in which treatment of acute coronary syndrome was on average initiated within ten minutes after reaching the hospital. 13 …”

Section: Discussionmentioning

confidence: 99%

Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi

2020

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“…Studies have suggested that AMI patients face significant delays before adequate treatment is available to them. Framework delays and access to reperfusion are distinguished as drivers of destitute compliance rate and remained significant challenges inside the AMI framework of care within the hospitals of Pakistan [15,26]. Execution in quality indicators measurement can, subsequently, be progressed by simply expanding adherence to these guidelines.…”

Section: Discussionmentioning

confidence: 99%

“…It has a strong significance in accomplishing rapid revascularization due to on-time diagnosis and treatment which largely affects survival [14]. Accurate burden assessment of patients with AMI in low- and middle-income countries is mostly unavailable; however, crude estimates indicate that the burden of AMI has been steadily increasing over the last decades in low- and middle-income countries [15]. Cardiovascular risk factors for ischemic heart disease and AMI are on the rise in Pakistan and a leading cause of morbidity and mortality [16].…”

Section: Introductionmentioning

confidence: 99%

Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study

Rehman

Wang

et al. 2019

IJERPH

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A wide variation exists in the practice patterns of acute myocardial infarction (AMI) care worldwide, leading to differences in clinical outcomes. This study aims to evaluate the quality of process care and its impact on in-hospital outcomes among AMI patients in Pakistan, as no such study has been conducted in Pakistan thus far based upon recommended guidelines. We investigated a sample of 2663 AMI patients across 11 territory hospitals in Punjab province of Lahore, Faisalabad, Multan, Rawalpindi, and Islamabad from January 1, 2016 to December 31, 2017, with an in-hospital mortality rate of 8.6%. We calculated compliance rates of quality indicators (QIs) for all eligible patients. The association between process care and in-hospital outcome was assessed using hierarchical generalized linear model that adjusted for patient and hospital characteristics. In addition, we examined the effect of patient composite scores on clinical outcomes. Aspirin (73.08%) and clopidogrel (67.86%) indicated relatively better conformance than other QIs. The percutaneous coronary intervention also showed significantly low adherence. All QIs showed no significant association with in-hospital mortality. In contrast, 4 out of 8 QIs were observed positively correlated with in-hospital length of stay (LOS). The overall patient composite score was found to be statistically significant with in-hospital LOS. The assessment of quality of care showed low adherence to clinical care recommendations, and increased adherence was associated with longer in-hospital LOS among AMI patients. Evaluation of valid QIs for AMI treatment and their impact on in-hospital outcomes is an important tool for improving health care delivery in the overall AMI population in Pakistan. Low adherence to performance measures strongly compel to focus on guideline-based tools for AMI in Pakistan.

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“…It provides decreased mortality in terms of early management of ACS. There are many various protocols such as chest pain units for early management of ACS on the aim of reducing mortality rates (4,8). The first step of these protocols always begins diagnosis stage in the ED by emergency physicians (22).…”

Section: Discussionmentioning

confidence: 99%

“…It is suggested that short term mortality increased in misdiagnosed ACS patients with chest pain (7). The ECG recording and cardiac biomarkers as creatine kinase (CK), creatine kinase-myocardial band (CK-MB) and troponin provide early diagnosis in the ED (8,9). In the light of these information, the determination of which patients have ACS and which patients have other diseases and can discharge early from the ED (10) should be done by emergency physicians as soon as possible.…”

Section: Introductionmentioning

confidence: 99%

The Role of Emergency Physicians on the Management of Chest Pain

Başol¹,

Çığşar²,

Atalay³

et al. 2015

J Contemp Med

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Giriş ve Amaç: Göğüs ağrısı, acil serviste yaygın ve önemli bir başvuru şikayetidir. Özellikle akut koroner sendromu (AKS) içeren ayırıcı tanı acil servis hekimleri tarafından dikkatlice yapılmalıdır. Sunulan bu calışma acil servise göğüs ağrısı şikayeti ile gelen hastaların AKS olup olmamalarına göre incelenmesini amaçlamaktadır. Materyal-Metod: Çalışma, ileriye dönük olarak bir yıllık süreçte göğüs ağrısı şikayeti ile bir üniversite acil servisine başvuran hastalar ile yapıldı. Hastaların yaş, cinsiyet, özgeçmiş, acil servise geliş şekli, elektrokardiyografi (EKG) çekilme zamanı, ana tanısı, konsultasyon durumu, son durumu ve acil serviste kalış süreleri kayıt edildi. Veriler SPSS 17.0 programı ile analiz edildi. Bulgular: Acil servise göğüs ağrısı ile başvuran 325 hasta çalışmaya dahil edildi. Bu hastaların %24.3'ü AKS tanısı aldı. Hastaların çoğunun (%42.5) ambulans ile acil servise geldiği, 110 (%33.8) hastanın kardiyolojiye konsulte edildiği saptandı. İleri yaş AKS ile istatistiksel olarak anlamlı düzeyde ilişkili bulundu (p<0.001). Bunun yanında, sıkıstırici, baskı tarzında ve yanıcı tip göğüs ağrıları da AKS ile ilişkili saptandı (p<0.040). Acil serviste kalış süresi AKS olan hastalarda olmayanlara göre daha kısaydı (p<0.001). Sonuç: Bu çalışma, acil servise göğüs ağrısı ile başvuran hastaların yönetiminde acil servis hekimlerinin rolüne dikkat çekmektedir. Erken ve doğru tani özellikle AKS yönetiminde çok önemli ve elzemdir.

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Time to treatment in patients of suspected acute coronary syndrome in Pakistan: A clinical audit

Cited by 6 publications

References 28 publications

Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi

Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi

Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study

The Role of Emergency Physicians on the Management of Chest Pain

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