Influence of pre-hospital to post-hospital delay factors on MI complications: a prospective cohort study
Javeria Akhter1, Khalid Naseeb2, Sameera Ali1
1Shaheed Zulfiqar Ali Bhutto Institute of Science and Technology, Karachi, Pakistan.
Insights
Delays in treatment for ST elevation myocardial infarction (STEMI) are linked to patient factors like symptom awareness and system issues. Improving patient education on recognizing cardiac symptoms is crucial for reducing STEMI complications.
Area of Science:
- Cardiology
- Public Health
- Emergency Medicine
Background:
- ST elevation myocardial infarction (STEMI) is a critical cardiovascular emergency.
- Timely treatment initiation is vital for improving patient outcomes in STEMI.
- Delays in treatment can significantly increase morbidity and mortality.
Purpose of the Study:
- To identify patient-related and system-related factors contributing to treatment delays in STEMI patients.
- To analyze the impact of these delays on in-hospital complications.
Main Methods:
- A prospective cohort study involving 348 STEMI patients was conducted.
- Patients were categorized based on treatment delay thresholds (≤90 and ≤120 minutes).
- Data on socio-demographics, co-morbidities, reasons for delay, and complications were collected and analyzed.
Main Results:
- Delays were associated with male gender, education level, and employment status.
- Key patient-related delays included lack of symptom awareness, belief in self-resolution, and attributing symptoms to gastric issues.
- System-related delays involved transportation issues and improper referrals.
- A significant proportion of patients experienced in-hospital complications, both pre- and post-percutaneous coronary intervention.
Conclusions:
- Pre- and post-hospital delays significantly impact STEMI complications.
- Enhanced patient education on recognizing cardiac symptoms and seeking timely medical attention is essential.
- Interventions targeting both patient-related and system-related factors are needed to reduce STEMI complications.
Objectives:
To identify factors contributing to delays in in the initiation of treatment among ST elevation myocardial infarction patients.
Methods:
The prospective cohort study was conducted at the National Institute of Cardiovascular Disease, Karachi, from December 2020 to June 2021, and comprised ST elevation myocardial infarction patients of either gender aged at least 18 years. Time delay categories were 1st and 2nd delays that were patient-related, and 3rd delay that was system-related), with thresholds of ≤90 minutes and ≤120 minutes. Those who experienced delays were placed in group A, while the rest were in group B. Socio-demographic factors, co-morbidities, reasons of delay and in-hospital complications were recorded. Data was analysed using SPSS (version 21).
Results:
Of the 348 patients, 174(50%) were in group A; 129(74.1%) males and 45(25.9%) females with overall mean age 57.52±10.59 years. The remaining 174(50%) were in group B; 148(85.1%) males and 26(14.9%) females with overall mean age 54.4±12.1 years. The delays were associated with male gender, education level and employment status (p<0.05). Factors contributing to 1st delay included lack of cardiac symptom awareness 77(77%), belief in symptom resolution 38(38%), attributing symptoms to gastric issues 30(30%), and dependency 14(14%). Transportation issues 4(66.7%), indirect commutation 3(50%) and distance 82(47.1%) caused the 2nd delay, while improper referrals 2(50%) and decision delays of more than an hour 1(25%) were common in the 3rd delay. Moreover, 150(86.2%) experienced in-hospital complications, and 88(50.6%) encountered both pre- and post-percutaneous coronary intervention complications (p=0.01).
Conclusions:
Pre-hospital and post-hospital delaying factors had an impact on ST elevation myocardial infarction complications, highlighting the need for improved patient education on recognising cardiac symptoms and seeking timely medical attention to reduce ST elevation myocardial infarction complications.
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