Correlates of Delayed Initial Contact to Emergency Services among Patients with Suspected ST-Elevation Myocardial
Osayi Lawani1, Nicholas Gorman2, Fiona Gorman3
1HCA Houston Healthcare Kingwood, 22999 US Hwy 59 N, Kingwood, TX 77339, USA.
Insights
Patient characteristics like distance from hospital, marital status, and disability significantly impact prehospital delay for acute myocardial infarction (AMI). Addressing these factors can improve timely treatment and patient outcomes.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Timely diagnosis and treatment of myocardial ischemia are critical to prevent severe complications like arrhythmias and death.
- Patient-related delays in seeking hospital care are a major contributor to overall treatment delays in acute myocardial infarction.
Purpose of the Study:
- To identify patient characteristics associated with prehospital delays in seeking care for myocardial infarction.
- To inform the development of health interventions aimed at reducing delays and improving patient outcomes.
Main Methods:
- A retrospective chart review was conducted on 287 patients diagnosed with ST-elevation myocardial infarction (STEMI).
- Statistical analysis, including stepwise logistic regression, was used to identify predictors of timely medical contact and treatment.
Main Results:
- Factors predicting first medical contact (FMC) within 120 minutes included distance from hospital, being unmarried, self-medicating, disability, and hemodynamic stability.
- Patient gender and disability, along with an initial nondiagnostic electrocardiogram, predicted door-to-balloon (DTB) time within 90 minutes.
Conclusions:
- Targeted interventions for high-risk patients and public education campaigns are necessary to improve prevention strategies for acute myocardial infarction.
- Further research is needed to identify additional predictors of delay and refine interventions to enhance survival rates.
Background:
Early diagnosis and treatment of a patient displaying symptoms of myocardial ischemia is paramount in preventing detrimental tissue damage, arrhythmias, and death. Patient-related hospital delay is the greatest considerable cause of total delay in treatment for acute myocardial infarction.
Objective:
To identify patient characteristics contributing to prehospital delay and ultimately developing health interventions to prevent future delay and improve health outcomes.
Methods:
A retrospective chart review of 287 patients diagnosed with ST-elevation myocardial infarction (STEMI) was evaluated to examine correlates of patient-related delays to care.
Results:
Stepwise logistic regression modeling with forward selection (likelihood ratio) was performed to identify predictors of first medical contact (FMC) within 120 minutes of symptom onset and door-to-balloon (DTB) time within 90 minutes. Distance from the hospital, being unmarried, self-medicating, disability, and hemodynamic stability emerged as variables that were found to be predictive of FMC within the first 120 minutes after symptom onset. Similarly, patient characteristics of gender and disability and having an initial nondiagnostic electrocardiogram emerged as significant predictors of DTB within 90 minutes.
Conclusions:
Individual attention to high-risk patients and public education campaigns using printed materials, public lectures, and entertainment mediums are likely needed to disseminate information to improve prevention strategies. Future research should focus on identifying the strengths of prehospital predictors and finding other variables that can be established as forecasters of delay. Interventions to enhance survival in acute STEMI should continue as to provide substantial advances in overall health outcomes.
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