Pre-hospital delay in acute myocardial infarction in an urban Indian hospital: a prospective study
R E Rajagopalan1, S Chandrasekaran, M Pai
1Department of Critical Care Medicine, Dr Rangarajan Memorial Hospital, Sundaram Medical Foundation, Shanthi Colony, Anna Nagar, Chennai 600040, Tamil Nadu, India. umaram@vsnl.com
Insights
Delays in seeking hospital treatment for acute myocardial infarction are common in India, with 36% of patients waiting over 6 hours. Consulting a general practitioner first significantly increases this delay, alongside older age.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Timely hospital presentation is critical for successful acute myocardial infarction (MI) treatment.
- Factors influencing delayed MI treatment-seeking in India remain under-evaluated.
Purpose of the Study:
- To systematically evaluate factors contributing to delayed hospital admission for acute myocardial infarction (MI) in an Indian population.
- To identify predictors of delayed presentation among MI patients.
Main Methods:
- Prospective evaluation of patients admitted with acute MI to an urban community hospital.
- Data collection included admission characteristics, medical history, pre-hospital symptoms, and treatment patterns within 48 hours.
- Logistic regression analysis was used to identify independent predictors of delayed admission.
Main Results:
- Out of 133 MI patients with complete data, 36.1% delayed hospital admission by over 6 hours.
- Consulting a general practitioner first (OR 5.57) and being over 65 years old (OR 3.24) were independent predictors of delay.
- Severe symptoms (OR 0.32) and prodromal angina (OR 0.25) were associated with minimized delay.
Conclusions:
- While 50% of acute MI patients present within 3 hours, a significant proportion (36%) experience delays exceeding 6 hours.
- Visits to a general practitioner, patient age, and symptom characteristics are key correlates of delayed MI treatment-seeking.
- Understanding these factors is crucial for developing strategies to reduce pre-hospital delay in acute MI care in India.
Background:
Successful treatment of acute myocardial infarction is dependent on early presentation of the patient to the hospital. The factors that contribute to delay in seeking treatment have not been systematically evaluated in the Indian milieu.
Methods:
Patients admitted with acute myocardial infarction to a 125-bed urban community hospital were evaluated prospectively. A record of admission characteristics, prior medical history, pre-hospital symptoms and treatment patterns was completed within 48 hours of each admission. Independent predictors of delayed admission were identified by logistic regression.
Results:
Of 144 consecutive admissions with myocardial infarction, 133 had completed data as per the protocol [mean (SD) age 59 (12.7) years; 79.6% men]. The distribution of presentation times was skewed, with the mode, median and mean being 1, 3 (interquartile range 1.25-11) and 10.9 (SD 20.5) hours, respectively. Seventy-nine patients (59.4%) consulted a general practitioner prior to hospital referral and 48 patients (36.1%) delayed admission to hospital by more than 6 hours from the onset of symptoms. On multivariate analysis, individuals who were initially seen by a general practitioner (OR 5.57; 95% CI 1.84-16.8) and those over the age of 65 years (OR 3.24; 95% CI 1.06-9.89) were identified as 'delayers', while patients with severe symptoms (OR 0.32; 95% CI 0.12-0.87) or prodromal angina (OR 0.25; 95% CI 0.08-0.82) minimized delay.
Conclusion:
Though 50% of patients with acute myocardial infarction present to hospital within 3 hours, about 36% delay seeking treatment by more than 6 hours. Besides age and the pattern and severity of symptoms, visits to the general practitioner were found to be an independent correlate of delay.
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