Related Experiment Videos
Delay in presentation after myocardial infarction
A G Heriot1, S J Brecker, D J Coltart
1Department of Cardiology, St Thomas Hospital, London, UK.
Insights
Delays in seeking treatment for acute myocardial infarction (AMI) are common in the UK. Patients contacting their general practitioner (GP) experienced significantly longer delays, potentially reducing the effectiveness of thrombolytic therapy.
Area of Science:
- Cardiology
- Public Health
Background:
- Thrombolytic therapy significantly reduces mortality in acute myocardial infarction (AMI) when administered early.
- Delayed patient presentation in the UK may diminish the benefits of timely thrombolysis for AMI.
Purpose of the Study:
- To assess the duration and causes of patient delay in seeking hospital care after the onset of chest pain in acute myocardial infarction (AMI).
- To evaluate the impact of seeking general practitioner (GP) care versus direct hospital admission on overall treatment delay.
Main Methods:
- A prospective interview-based study was conducted with 103 patients presenting with AMI at two London hospitals.
- Data collected included time from chest pain onset to hospital arrival, reasons for delay, and patient awareness of thrombolytic treatments.
Main Results:
- Nearly half (49%) of AMI patients experienced delays exceeding 2 hours, with 21% exceeding 4 hours.
- Patients contacting their GP had significantly longer total delays (median 160 mins) compared to those using ambulances (82 mins) or self-transport (90 mins).
- While decision time was similar, the travel time to hospital after deciding to seek care was substantially longer for patients consulting their GP (110 mins vs. 56 mins).
Conclusions:
- Significant delays in patient presentation for AMI are prevalent in the UK, particularly when general practitioners are involved in the care pathway.
- These delays may compromise the efficacy of time-sensitive thrombolytic therapy for acute myocardial infarction.
- Increased public awareness of AMI symptoms and thrombolysis benefits, alongside streamlined emergency pathways, could improve treatment outcomes.
Abstract:
Thrombolytic therapy reduces mortality in acute myocardial infarction (AMI), giving maximal benefit with early treatment. In the UK delayed presentation after AMI may reduce the advantages of thrombolysis. To assess this, 103 patients presenting with AMI to two London Hospitals were interviewed to determine the length and cause of delay from onset of chest pain to arrival at hospital. Forty-nine per cent of patients took longer than 2 h to arrive at hospital, and 21% took longer than 4 h. Patients who contacted their general practitioner (GP) had a significantly prolonged time delay (160 mins; 65-730: median; range) compared to those who went directly to hospital by ambulance (82 mins; 15-395; P < 0.0005), or on their own (90 min; 15-855; P < 0.005). Patients calling their GP took a similar duration to decide to seek help [decision time (30 min versus 25 mins) P = NS], but significantly longer to reach hospital once the decision was made (110 min versus 56 min; P < 0.0001), than those proceeding directly to hospital. Believing the pain was cardiac in origin significantly shortened decision time (15 min versus 45 min; P < 0.05), as did knowledge of the existence of thrombolysis (15 min versus 50 min; P < 0.05) and lack of prior cardiac symptoms (18 min versus 42 min; P < 0.05). Only 14% were aware of thrombolysis. Rank correlation confirmed that decision and total delay time were age independent. Delays of this magnitude may compromise the efficiency of thrombolysis.(ABSTRACT TRUNCATED AT 250 WORDS)