Assessment of pre-hospital and in-hospital factors leading to delays in initiation of treatment in patient with ST segment elevation myocardial infarction
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20201977Keywords:
Chest pain, Delay, Risk factors, STEMIAbstract
Background: India has the highest burden of acute coronary syndrome (ACS) patients in the world. While managing patients with ACS, especially those with acute ST elevation myocardial infarction (STEMI), time plays an important role in determining the morbidity and mortality.
Methods: An observational prospective study was conducted among patients admitted with symptomatic STEMI. Questionnaire based information was obtained regarding demographic profile, risk factors, treatment seeking behaviour including duration and reasons for delay and treatment in the hospital. Outcome was assessed at discharge and at 30 days.
Results: A total of 100 patients were given a definite diagnosis of STEMI. The mean age was 55.38 (SD 10.28) years. Majority 80 (80%) were males and females constituted 20%. Sedentary lifestyle was the major risk factor present in sixty (60%) patients. The median time from symptoms to hospital was 420 min (range 30-2880 minutes). Only 17% patients reached hospital within 2 hours of symptoms and 37% between 2 to 6 hours and 46% after 6 hours. Thirty five patients (35%) thought it to be a heart attack. Hospital delay was recorded in 50% patients with ECG done in more than 10 minutes. Outcome at 30 day depicted as mortality in three patients with loss to follow in 18 (18%) and angina in 6 out of 81 (7.4%) patients.
Conclusions: Both pre hospital and in hospital delays have adverse effect on the outcome and thus efforts should be made to minimize these delays.
References
Ghaffar A, Reddy KS, Singhi M. Burden of non-communicable diseases in South Asia. BMJ. 2004;328(7443):807-10.
Foo CY, Bonsu KO, Nallamothu BK, Reid CM, Dhippayom T, Reidpath DD, et al. Coronary intervention door-to-balloon time and outcomes in ST-elevation myocardial infarction: a meta-analysis. Heart. 2018;104(16):1362-9.
Guan W, Venkatesh AK, Bai X, Xuan S, Li J, Li X, et al. Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study. Eur Heart J Quality Care Clin Outcomes. 2019;5(1):63-71.
George L, Ramamoorthy L, Satheesh S, Saya RP, Subrahmanyam DK. Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction. J Emerg Trauma Shock. 2017;10(2):64.
Peng YG, Feng JJ, Guo LF, Li N, Liu WH, Li GJ, et al. Factors associated with prehospital delay in patients with ST-segment elevation acute myocardial infarction in China. Am J Emerg Med. 2014;32(4):349-55.
Mohan B, Bansal R, Dogra N, Sharma S, Chopra A, Varma S, et al. Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram. Indian Heart J. 2018;70:194-8.
Venkatesan VC, Madhavi S, Kuzhanthaivel P. A study to explore the factors related to treatment seeking delay among adults diagnosed with acute myocardial infarction at KMCH, Coimbatore. Indian Heart J. 2018;70(6):793-801.
Khan A, Phadke M, Lokhandwala YY, Nathani PJ. A study of prehospital delay patterns in acute myocardial infarction in an urban tertiary care institute in Mumbai. J Assoc Physicians India. 2017;65(5):24-7.
Venkatachelam R, Adilakshmi B, Manohar T, Rao M, Abbaiah S. Factors affecting time to arrival in hospital among patients with acute myocardial infarction (MI). J Sci Innov Res. 2015;4(2):109-14.
Xavier D, Pais P, Devereaux PJ, Xie C, Prabhakaran D, Reddy KS, et al. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371(9622):1435-42.
Prashantha B, Idris MZ, Ahmad N, Agarwal M, Yadav SC, Singh VK. Determinants of prehospital delay among patients attending cardiac emergency with acute chest pain of cardiac origin in Lucknow District. Int J Adv Res. 2013;1(7):121-9.
Mohanan PP, Mathew R, Harikrishnan S, Krishnan MN, Zachariah G, Joseph J, et al. Presentation, management, and outcomes of 25 748 acute coronary syndrome admissions in Kerala, India: results from the Kerala ACS Registry. Eur Heart J. 2013;34(2):121-9.
Lawesson SS, Isaksson RM, Ericsson M, Ängerud K, Thylén I. Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study. BMJ Open. 2018;8(5):e020211.
Duraes AR, Bitar YS, Freitas AC, MP Filho I, Freitas BC, Fernandez AM. Gender differences in ST-elevation myocardial infarction (STEMI) time delays: experience of a public health service in Salvador-Brazil. Am J Cardiovasc Dis. 2017;7(5):102.
Alshahrani H, Mc Conkey R, Wilson J, Youssef M, Fitzsimons D. Female gender doubles pre-hospital delay times for patients experiencing ST segment elevation myocardial infarction in Saudi Arabia. Eur J Cardiovasc Nurs. 2014;13(5)399-407.
Benamer H, Bataille S, Tafflet M, Jabre P, Dupas F, Laborne FX, et al. Longer pre-hospital delays and higher mortality in women with STEMI: the e-MUST Registry. Euro Intervention. 2016;12(5):542-9.