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Area of Science:

  • Cardiology
  • Emergency Medicine
  • Health Services Research

Background:

  • Rapid reperfusion therapy is crucial for acute myocardial infarction (AMI) outcomes.
  • Patient transport to primary angioplasty centers can introduce significant delays.
  • Optimizing inter-facility transfer protocols is essential for improving AMI care.

Purpose of the Study:

  • To compare total ischemic times between inter-facility transferred patients and self-referred patients with AMI.
  • To identify factors contributing to delays in the treatment pathway for transferred AMI patients.

Main Methods:

  • A historical cohort study analyzed 621 AMI patients treated from April 2014 to September 2015.
  • Patients were categorized into transferred (Group A) and self-referred (Group B) cohorts.
  • Transfer delays were estimated from emergency department reception of transfer requests.

Main Results:

  • Transferred patients (Group A) had significantly longer symptom onset-to-arrival times (385 min) than self-referred patients (Group B, 307 min).
  • A substantial transfer delay of 147 minutes was observed for Group A.
  • Increased travel distance correlated significantly with longer transport times (R=0.55, p<0.001).
  • No significant difference in mortality was found between the two groups.

Conclusions:

  • Inter-facility transfer for AMI treatment results in prolonged ischemic times, particularly for patients traveling longer distances.
  • Current transfer protocols may not meet recommended timeframes for optimal reperfusion.
  • Addressing transport delays is critical for improving outcomes in transferred AMI patients.