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[Regional differences in prehospital time delay for patients with acute myocardial infarction; Rotterdam and
J Broer1, J K Bleeker, J Bouma
1GGD Groningen, afd. Beleid en Onderzoek Gezondheidszorg.
Objective:
To describe pre-hospital delay times in patients with acute myocardial infarction (AMI) in two regions in the Netherlands: Groningen (a region with high mortality for coronary heart disease (CHD)) and Rotterdam (a region with low CHD mortality).
Design:
Descriptive.
Method:
The pre-hospital treatment delay of AMI patients in Rotterdam in 1990-1991 versus 1993-1995 was compared and also compared between Groningen en Rotterdam (1993-1995). In each region 3 hospitals participated (1 academic, 2 regional). The data were collected with a structured interview within 7 days after onset of symptoms in hospitalized AMI patients (n = 924) or by interviewing relatives of deceased patients (n = 40). The median patient, general practitioner (GP) and ambulance delays were calculated.
Results:
Total median pre-hospital delay was 2.5 hours (5-95-percentile: 50 min-36 hours). Median patient delay time was shorter in Groningen than in Rotterdam (respectively 30 and 45 min) and the same applied to doctor delay times (respectively 38 and 72 min). In Rotterdam doctor delay time decreased by 23 min between 1990-1991 and 1993-1995. Median ambulance delay was 30 min in Rotterdam and 35 min in Groningen. Total pre-hospital delay times of self referred patients were 32-78 min shorter than those of patients who consulted a GP before admission.
Conclusion:
Reduction of pre-hospital delay in Rotterdam between 1990-1991 and 1993-1995 was due to faster decision time by the GP. The short pre-hospital treatment delay in Groningen in hospitalized patients suggests that relatively more AMI patients die outside hospital which may contribute to the high CHD mortality in this region.