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Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction
Linsha George1, Lakshmi Ramamoorthy1, Santhosh Satheesh2
1College of Nursing, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India.
Insights
ST elevation myocardial infarction (STEMI) patients in South India experience significant prehospital delays. Interventions are needed to improve emergency care systems and patient education to reduce delays in reperfusion therapy.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- Significant delays in reperfusion therapy for ST elevation myocardial infarction (STEMI) persist despite efforts to reduce prehospital and treatment times.
- This study investigates patient decision delay, prehospital delay, and in-hospital times (door-to-ECG, door-to-needle, door-to-primary PCI) for STEMI patients.
Purpose of the Study:
- To identify and analyze determinants of delays in STEMI patient care.
- To evaluate the timeliness of reperfusion therapy in a South Indian tertiary care center.
Main Methods:
- A cross-sectional study involving 96 STEMI patients admitted to a tertiary care center in South India.
- Data collected via patient interviews and record reviews.
- Statistical analysis included Kolmogorov-Smirnov test, Mann-Whitney U-test, and Kruskal-Wallis test.
Main Results:
- Median delays: 75 min (patient decision), 290 min (prehospital), 12 min (door-to-ECG), 75 min (door-to-needle), 110 min (door-to-primary PCI).
- Factors influencing patient decision delay: alcoholism, symptom progression, home symptom relief attempts.
- Factors influencing prehospital delay: domicile, financial issues, prior consultation, symptom onset location, symptom interpretation, transportation mode.
Conclusions:
- Prehospital delay in STEMI patients in South India remains unacceptably high.
- Public education and enhanced prehospital care systems are crucial.
- Improvements in emergency department patient flow and management are needed to meet recommended reperfusion times.
Background:
Despite efforts aimed at reducing the prehospital delay and treatment delay, a considerable proportion of patients with ST elevation myocardial infarction (STEMI) present late and receive the reperfusion therapy after unacceptably long time periods. This study aimed at finding out the patients' decision delay, prehospital delay, door-to-electrocardiography (ECG), door-to-needle, and door-to-primary percutaneous coronary intervention (PCI) times and their determinants among STEMI patients.
Materials And Methods:
A cross-sectional study conducted among 96 patients with STEMI admitted in a tertiary care center in South India. The data were collected using interview of the patients and review of records. The distribution of the data was assessed using Kolmogorov-Smirnov test, and the comparisons of the patients' decision delay, prehospital delay, and time to start reperfusion therapy with the different variables were done using Mann-Whitney U-test or Kruskal-Wallis test based on the number of groups.
Results:
The mean (standard deviation) and median (range) age of the participants were 55 (11) years and 57 (51) years, respectively. The median patients' decision delay, prehospital delay, door-to-ECG, door-to-needle, and door-to-primary PCI times were 75, 290, 12, 75, 110 min, respectively. Significant factors associated (P < 0.05) with patients' decision delay were alcoholism, symptom progression, and attempt at symptom relief measures at home. Prehospital delay was significantly associated (P < 0.05) with domicile, difficulty in arranging money, prior consultation at study center, place of symptom onset, symptom interpretation, and mode of transportation.
Conclusions:
The prehospital delay time among the South Indian population is still unacceptably high. Public education, improving the systems of prehospital care, and measures to improve the patient flow and management in the emergency department are essentially required. The time taken to take ECG and to initiate reperfusion therapy in this study points to scope for improvement to meet the American Heart Association recommended timings.
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