Pre hospital delay and its associated factors in acute myocardial infarction in a developing country
Ishmum Zia Chowdhury1, Md Nurul Amin2, Mashhud Zia Chowdhury3
1BIRDEM General Hospital, Dhaka, Bangladesh.
Insights
Pre-hospital delays significantly impact acute myocardial infarction (AMI) patient outcomes in Dhaka. Factors like atypical chest pain, diabetes, distance, and socioeconomic status contribute to these delays, hindering timely treatment.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Timely treatment is crucial for improving outcomes and reducing mortality in acute myocardial infarction (AMI).
- Low- and middle-income countries face challenges in managing AMI due to pre-hospital delays.
- This study investigates pre-hospital delay factors in AMI patients in Dhaka, Bangladesh.
Purpose of the Study:
- To identify and analyze the factors contributing to pre-hospital delay in acute myocardial infarction (AMI) patients.
- To understand the impact of sociodemographic and geographic factors on timely medical care seeking for AMI.
- To inform strategies for improving emergency cardiac care accessibility in urban settings.
Main Methods:
- Retrospective cohort study of 333 AMI patients in Dhaka.
- Data collected via semi-structured interviews and hospital records.
- Multivariate logistic regression used to identify predictors of pre-hospital delay.
Main Results:
- Median pre-hospital delay was 11.5 hours; 48.9% of patients arrived >12 hours post-symptom onset.
- Atypical chest pain, diabetes, residing >30 km from a hospital, and lower/middle socioeconomic status were associated with delays.
- Patients with absence of typical chest pain had 5.21 times higher odds of delay.
Conclusions:
- Pre-hospital delays in AMI are significantly associated with atypical chest pain, diabetes, geographic distance, and lower socioeconomic status.
- Findings highlight the need for targeted interventions addressing these barriers in Dhaka.
- Improving timely access to care for AMI patients requires consideration of sociodemographic and geographic factors.
Background:
Early revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka.
Methods:
This retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay.
Results:
The mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5-9.9)], diabetes [OR: 1.7 (95% CI: 1.0-2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3-7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0-3.5)] were significantly associated with pre-hospital delays.
Conclusion:
Acute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.
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