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Delayed presentation of acute coronary syndrome: a challenge in its early management
P Acharya1, R R Adhikari, J Bhattarai
1Department of Internal Medicine, B.P. Koirala Institute of Health Sciences, Dharan, Nepal. acharya.pramod@gmail.com
Insights
Patients with acute coronary syndrome (ACS) in eastern Nepal often present late to tertiary care, impacting treatment and outcomes. Improving local centers and awareness is crucial for better ACS management.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Timely presentation of acute coronary syndrome (ACS) is critical for effective treatment and prognosis.
- Delayed presentation is a significant factor associated with adverse outcomes in ACS patients.
Purpose of the Study:
- To investigate the reasons for delayed presentation of ACS patients at a tertiary care center in eastern Nepal.
- To identify factors contributing to late medical attention for acute coronary syndrome in the region.
Main Methods:
- A cross-sectional descriptive study involving 100 consecutive ACS patients.
- Data collection included demographic profiles, presentation delays, prior management at local centers, and final diagnoses.
Main Results:
- Patients from outside Dharan City experienced longer delays (63 hours) compared to those within the city (20 hours).
- Common causes of delay included transportation issues and inadequate workup at local health facilities.
- Late presentation significantly hindered optimal management of ACS.
Conclusions:
- A substantial number of ACS patients from eastern Nepal present late to tertiary care facilities.
- Recommendations include equipping local centers with ECG, enhancing ambulance services, and increasing public awareness about coronary artery disease.
- Improving local healthcare infrastructure and services is vital to improve ACS outcomes in the region.
Introduction:
The time of presentation of acute coronary syndrome from the onset of chest pain determines the treatment modality and prognosis. Delayed presentation is associated with a poor outcome. In the present study, we tried to find out the causes of late presentation of ACS in a tertiary care center in the eastern part of Nepal.
Methods:
It was a cross-sectional descriptive study that included 100 consecutive patients with ACS presenting to our institute over a period of 8 months. They were studied for their demographic profile, delay in presentation, the management done at the local centers and their final diagnosis.
Results:
We found that patients living within Dharan City reached BPKIHS within 20 hours of the onset of chest pain while those from outside the city who came directly reached within 63 hours. Other patients reached their respective local centers (health posts, district hospitals and private clinics) within 39 hours. The commonest cause of delay was vehicular problem followed by unnecessary delay at the local centers. The work up for chest pain was inadequate in these centers. Late presentation to our institute significantly affected the optimal management.
Conclusions:
We found that significant number of patients with ACS from eastern Nepal presented late in our tertiary care center. In order to improve ACS outcome in this region, we advise equipping the local centers with electrocardiogram machines, improvement in ambulance services and a greater emphasis on coronary artery disease awareness programs as well as initiating preventive measures.
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