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Door-to-Balloon Time and Mortality Among Patients Undergoing Primary PCI, Challenges and Experience from Somalia's
Mohamed Omar Hassan1, Said Abdirahman Ahmed1, Mohamed Sheikh Hassan2
1Department of Cardiology, Mogadishu Somali Turkish Training and Research Hospital, Mogadishu, Somalia.
Insights
Door-to-balloon time is critical for myocardial infarction treatment, but delays are common in Somalia due to resource limitations. Addressing social and financial barriers is essential to improve patient outcomes and reduce mortality rates.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Door-to-balloon time is a critical metric for acute myocardial infarction (MI) management, with a target of under 90 minutes for optimal patient outcomes.
- Delayed door-to-balloon times are frequently observed in low-resource settings, exacerbated by challenges in healthcare infrastructure, transportation, and socioeconomic factors.
- These delays are associated with poorer patient outcomes and increased mortality following MI.
Purpose of the Study:
- To investigate the factors contributing to door-to-balloon time delays in patients undergoing percutaneous coronary intervention (PCI) in Somalia.
- To analyze the demographic, clinical, and angiographical characteristics of patients experiencing delayed treatment.
- To identify the primary causes of delays and their impact on patient outcomes and mortality.
Main Methods:
- A retrospective analysis was conducted on 103 patients' medical records at Mogadishu Somali Turkish Training and Research Hospital from May 2022 to July 2023.
- Data collected included patient demographics, clinical characteristics, angiographical findings, and door-to-balloon times.
- Variables analyzed encompassed causes of delay, procedure length, and patient outcomes.
Main Results:
- The study included 103 patients, predominantly male (73%), with a mean age of 58 years. Common risk factors were hypertension (33%), smoking (38%), and diabetes (39%).
- The median door-to-balloon time was 169 minutes, significantly exceeding the recommended 90 minutes, with social and financial limitations identified as primary causes.
- The Left Anterior Descending (LAD) artery was the most frequently obstructed vessel (63%). Complications in the delayed treatment group led to a substantial mortality rate of 24.2%.
Conclusions:
- Door-to-balloon time remains a critical determinant of outcomes in acute myocardial infarction, particularly in resource-limited nations like Somalia.
- Significant delays in treatment are driven by socioeconomic and infrastructural challenges, necessitating targeted interventions.
- Improving healthcare infrastructure, public health education, and emergency medical services is crucial to mitigate delays and enhance patient survival rates in Somalia.
Introduction:
The door-to-balloon time, the time between a patient's arrival at the hospital and percutaneous coronary intervention, is crucial for managing myocardial infarction. Aiming for less than 90 minutes is recommended, as shortened times are associated with improved outcomes. However, limited healthcare resources, infrastructure, transportation and poverty impact management, leading to poorer outcomes and delayed door to balloon time. Addressing these challenges and their causes is essential for optimal care.
Methodology:
A retrospective analysis of 103 patients' medical history records from May 2022 to June 2023 at the Mogadishu Somali Turkish Training and Research Hospital in Somalia was conducted. The data was mainly collected from the hospital's electronic medical records system, analyzing patient demographics, clinical characteristics, and angiographical records. The study analyzed variables responsible for door-to-balloon (D2B) time delay, patient angiography results, cause of delay, procedure length, etc.
Results:
A study of 103 patients who had angiography performed between May 2022 and July 2023 was done. The predominant gender in the study was 73% male, with a mean age of 58 years. The most common risk factors were hypertension (33%), smoking (38%), and diabetes (39%). Of all the vessels, the Left Anterior Descending (LAD) was the most commonly obstructed (63%). Time delays from door-to-balloon were frequent, median door-to-balloon time was 169 minutes, frequently brought on by social problems and financial limitations. The majority (77.4%) of the patients had only percutaneous angiography (PCI), while 22.6% were recommended for bypass following PCI of the infarct-related artery (IRA). Complications in the delayed treatment group were the main cause of the death rate of 24.2%.
Conclusion:
Door-to-balloon time is crucial for acute myocardial infarction treatment which is challenging in impoverished countries like Somalia. Investments in healthcare infrastructure, public health education, and emergency services can improve patient outcomes.
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