The causes of prehospital delay in myocardial infarction
Cornelia Gärtner1, Linda Walz, Eva Bauernschmitt
1Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie des Klinikums rechts der Isar, Technische Universität München, Munich, Germany.
Insights
Patient decision time is key in myocardial infarction care. Uncertainty, older age, and female sex are linked to longer prehospital delays, impacting treatment.
Area of Science:
- Cardiology
- Public Health
- Health Psychology
Background:
- Timely reperfusion is critical for myocardial infarction (MI) patient outcomes.
- Prehospital delay significantly impacts MI clinical course, with patient decision time being a major factor.
Purpose of the Study:
- To review and synthesize factors influencing prehospital delay in patients experiencing acute coronary syndromes.
- To identify key determinants of delayed hospital presentation for myocardial infarction.
Main Methods:
- A selective literature review was conducted, referencing a prior meta-analysis.
- A PubMed search utilized terms including "prehospital delay," "myocardial infarction," "psychological factors," and "gender."
- 73 relevant papers were selected for analysis.
Main Results:
- Reasons for delays exceeding 120 minutes remain unclear.
- Patient uncertainty regarding symptoms, advanced age, and female sex are associated with prolonged prehospital delays.
- Factors influencing delay operate at symptom perception, symptom recognition, and help-seeking decision levels.
Conclusions:
- Interventions targeting prehospital delay must address symptom perception and recognition.
- Addressing psychological and demographic factors is crucial for improving timely MI care.
- Future trials should consider diverse subpopulations to mitigate prehospital delays effectively.
Introduction:
The elapsed time between the onset of symptoms and reperfusion is a critical determinant of the clinical course of patients with myocardial infarction. The patients' own decision time is the most important component of prehospital delay.
Methods:
Selective literature review based on the references in a meta-analysis, complemented by a PubMed search on the expression "prehospital delay" in combination with "myocardial infarction," "acute coronary syndrome," "psychological factors," "gender," and "public campaign." A total of 73 papers addressing factors that influence prehospital delay were selected.
Results:
The reasons for delays of more than 120 minutes in a patient with symptoms of myocardial infarction reaching the hospital are still not sufficiently elucidated. Patients' uncertainty about their symptoms, advanced age, and female sex are three factors that appear to be associated with longer delays.
Discussion:
Factors influencing prehospital delay operate at the following levels: the perception of acute symptoms, the recognition of the importance of these symptoms, and the decision to call for help. Intervention trials should consider these levels in meeting the needs of clinically relevant subpopulations.
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