Patient and system delays in the treatment of acute coronary syndrome
Marta Viana1, Olga Laszczyńska1, Carla Araújo2
1EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal.
Insights
Many ST-segment elevation myocardial infarction (STEMI) and high-risk non-ST-elevation acute coronary syndrome (NSTE-ACS) patients experience delays in treatment. Patient and system factors contribute to a failure to achieve timely reperfusion, impacting patient outcomes.
Area of Science:
- Cardiology
- Acute Coronary Syndromes
- Health Services Research
Background:
- European Society of Cardiology guidelines recommend early reperfusion for STEMI and timely invasive strategies for high-risk NSTE-ACS.
- Significant patient and system delays can impede timely treatment for acute coronary syndromes.
- Understanding predictors of delay is crucial for improving patient outcomes.
Purpose of the Study:
- To assess patient and system delays in STEMI and NSTE-ACS patients.
- To identify factors contributing to prolonged delays based on diagnosis and risk profile.
- To evaluate the proportion of patients receiving timely reperfusion.
Main Methods:
- A cohort of 939 patients admitted to two Portuguese hospitals between August 2013 and December 2014 was analyzed.
- Patient demographics, symptom onset, first medical contact, and treatment timelines were recorded.
- Statistical analysis was used to identify predictors of delay.
Main Results:
- A high percentage of patients, particularly high-risk NSTE-ACS (57.7%) and intermediate-risk NSTE-ACS (52.1%), experienced delays from symptom onset to first medical contact (≥120 min).
- STEMI patients also faced delays (43.3%).
- Patient-related factors (self-transport, misinterpretation of symptoms) and system-related factors (non-PCI hospital admission, weekend admission, complications) were associated with prolonged delays. 78.0% of STEMI and 65.8% of high-risk NSTE-ACS patients exceeded recommended treatment times.
Conclusions:
- Both patient-related and system-related delays prevent a significant number of STEMI and high-risk NSTE-ACS patients from receiving timely reperfusion.
- Interventions targeting patient education and healthcare system efficiency are needed to improve treatment access.
Introduction:
Early reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) is indicated by the European Society of Cardiology, while a timely invasive strategy is recommended for patients with high-risk and intermediate-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). This study aims to assess patient and system delays according to diagnosis and risk profile, and to identify predictors of prolonged delay.
Methods:
We assembled a cohort of patients (n=939) consecutively admitted to the cardiology department of two hospitals, one in the metropolitan area of Porto and one in the north-east region of Portugal, between August 2013 and December 2014.
Results:
The proportion of patients with time from symptom onset to first medical contact (FMC) ≥120 min was highest among high-risk NSTE-ACS (57.7%), followed by intermediate-risk NSTE-ACS (52.1%) and STEMI (43.3%). Regardless of diagnosis and risk stratification, use of own transportation and inability to interpret cardiac symptoms correctly were associated with prolonged delays. Regarding system delays, we found that 78.0% of patients with STEMI and 65.8% of patients with high-risk NSTE-ACS were treated in a timeframe exceeding the recommended limits. Admission to a non-percutaneous coronary intervention-capable hospital, admission on weekends and complications at admission were associated with prolonged delays to treatment.
Conclusions:
Due to both patient and system delays, a large proportion of STEMI and high-risk NSTE-ACS patients still fail to have access to timely reperfusion.
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