Factors associated with pre-hospital delay before reperfusion therapy in patients with ST-segment elevation myocardial infarction
Abstract
Introduction: Cardiovascular disease remains the main cause of death in the world, and myocardial infarction represents the main contributor to this mortality. Timely restoration of myocardial blood flow with reperfusion therapy is crucial. Pre-hospital delay is a major obstacle for early reperfusion therapy and has negative impact on mortality and left ventricle function.
Methods: A prospective study was carried in cardiology unit of a medical college from August 2013 to December 2017. Cases of acute ST segment elevation myocardial infarction that have undergone thrombolysis were recruited.
Results: Out of 450 patients with ST Elevation Myocardial Infection (STEMI), delayed presentation was seen in 288 (64%) for >6 hrs and 108 (24%) patients for >12 hrs. The duration from onset of symptoms to the presentation in the emergency room (pre-hospital delay) was 12.66 hrs (SD=14.19, range = 30 min to 72 hrs). The door to needle time was 54 min (SD=24) The major factors for pre-hospital delay were misinterpretation of symptoms (59%) and transportation problems (31%).
Conclusion: Misinterpretation of symptoms remain the most common cause of delayed presentation. Health education for public awareness can reduce the delay. Extension of thrombolytic therapy to district hospital and primary health center level after basic training for medical officer with checklist and collaboration in form of telemedicine with referral cardiac center may have major impact on morbidity and mortality reduction in acute STEMI patients with early reperfusion therapy.
Downloads
References
Mishra SR, Neupane D, Bhandari PM, Khanal V, Kallestrup P. Burgeoning burden of non-communicable diseases in Nepal: a scoping review. Globalization and health. 2015 Dec;11(1):32. DOI: 10.1186/s12992-015-0119-7 PMID: 26178459
White HD, Chew DP. Acute myocardial infarction. Lancet. 2008;372(9638):570–84 DOI: 10.1016/S0140-6736(08)61237-4 PMID: 18707987
O’Gara PT, Kushner FG, Ascheim DD, Casey Jr DE, Chung MK, De Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB. CF/AHA Task Force. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2013 Jan 29;127(4):529-5. DOI: 10.1161/CIR.0b013e3182742c84 PMID: 23247303
McNamara RL, Herrin J, Wang Y, Curtis JP, Bradley EH, Magid DJ, Rathore SS, Nallamothu BK, Peterson ED, Blaney ME, Frederick P. Impact of delay in door-to-needle time on mortality in patients with ST-segment elevation myocardial infarction. The American journal of cardiology. 2007 Oct 15;100(8):1227-32. DOI: 10.1016/j.amjcard.2007.05.043 PMID: 17920362
Wu JR, Moser DK, Riegel B, McKinley S, Doering LV. Impact of prehospital delay in treatment seeking on in-hospital complications after acute myocardial infarction. Journal of Cardiovascular Nursing. 2011 May 1;26(3):184-93. DOI: 10.1097/JCN.0b013e3181efea66
De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004 Mar 16;109(10):1223-5. DOI: 10.1161/01.CIR.0000121424.76486.20 PMID: 15007008
Reimer KA, Jennings RB. The" wavefront phenomenon" of myocardial ischemic cell death. II. Transmural progression of necrosis within the framework of ischemic bed size (myocardium at risk) and collateral flow. Laboratory investigation; a journal of technical methods and pathology. 1979 Jun;40(6):633-44. PMID: 449273
Shiomi H, Nakagawa Y, Morimoto T, Furukawa Y, Nakano A, Shirai S, Taniguchi R, Yamaji K, Nagao K, Suyama T, Mitsuoka H. Association of onset to balloon and door to balloon time with long term clinical outcome in patients with ST elevation acute myocardial infarction having primary percutaneous coronary intervention: observational study. BMJ. 2012;3257:1-14. PMID: 22623632
Prasantha B, Idris MZ, Ahmad N, Agarwal M, Yadav SC, Singh VK. Determinants of prehospital delay among patients attending cardiac emergency with acute chest pain of cardiac origin in Lucknow district. Int J Adv Res. 2013;1:121–9. Full Text: http://www.journalijar.com/uploads/2013-10-03_131624_45.pdf
Krumholz HM, Herrin J, Miller LE, Drye EE, Ling SM, Han LF, et al. Improvements in door-to-balloon time in the United States, 2005 to 2010. Circulation. 2011;124:1038– 45. DOI: 10.1161/CIRCULATIONAHA.111.044107 PMID: 21859971
Perkins-Porras L, Whitehead DL, Strike PC, Steptoe A. Pre-hospital delay in patients with acute coronary syndrome: factors associated with patient decision time and home-to-hospital delay. European Journal of Cardiovascular Nursing. 2009 Mar;8(1):26-33.
Beig JR, Tramboo NA, Kumar K, Yaqoob I, Hafeez I, Rather FA, Shah TR, Rather HA. Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study. Journal of the Saudi Heart Association. 2017 Jan 1;29(1):7-14. DOI: 10.1016/j.jsha.2016.06.001 PMID: 28127213
Ribeiro S, Gaspar A, Rocha S, Nabais S, Azevedo P, Salgado A, Pereira MA, Correia A. Predictors of pre-hospital delay in patients with ST-segment elevation myocardial infarction. Revista portuguesa de cardiologia: orgao oficial da Sociedade Portuguesa de Cardiologia= Portuguese journal of cardiology: an official journal of the Portuguese Society of Cardiology. 2010 Oct;29(10):1521-32. PMID: 21265494
Qian L, Ji KT, Nan JL, Lu Q, Zhu YJ, Wang LP, Liao LM, Tang JF. Factors associated with decision time for patients with ST-segment elevation acute myocardial infarction. Journal of Zhejiang University SCIENCE B. 2013 Aug 1;14(8):754-8. DOI: 10.1631%2Fjzus.BQICC709 PMID: 23897796
Baños-González MA, Henne-Otero OL, Torres-Hernández ME, Torres-López JE, González-Aguila CL, SangeadoSantos M, et al. Factors associated with delay to reperfusion therapy in patients with ST-Segment Elevation Myocardial Infarction in a hospital in the southeast of Mexico. Gac Med Mex. 2016;152(4):495-502. PMID: 27595253
Park YH, Kang GH, Song BG, Chun WJ, Lee JH, Hwang SY, Oh JH, Park K, Kim YD. Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction. Journal of Korean medical science. 2012 Aug 1;27(8):864-9. DOI: 10.3346/jkms.2012.27.8.864 PMID: 22876051
Song L, Yan HB, Yang JG, Sun YH, Hu DY. Impact of patients' symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction. Chinese medical journal. 2010 Jul;123(14):1840-5. PMID: 20819565
Rajagopalan RE, Chandrasekaran S, Pai M, Rajaram R, Mahendran S. Pre-hospital delay in acute myocardial infarction in an urban Indian hospital: a prospective study. The National medical journal of India. 2001;14(1):8-12. PMID: 11242708
George L, Ramamoorthy L, Satheesh S, Saya RP, Subrahmanyam DK. Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction. Journal of emergencies, trauma, and shock. 2017 Apr;10(2):64. DOI: 10.4103/0974-2700.201580 PMID: 28367010
Song L, Yan HB, Yang JG, Sun YH, Liu SS, Li C, Hu DY. Factors associated with delay of reperfusion-decision for patients with ST-segment elevation myocardial infarction. Zhonghua xin xue guan bing za zhi. 2010 Apr;38(4):301-5. PMID: 20654072
Khan A, Phadke M, Lokhandwala YY, Nathani PJ. A Study of Prehospital Delay Patterns in Acute Myocardial Infarction in an Urban Tertiary Care Institute in Mumbai. Journal of The Association of Physicians of India. 2017 May;65:24-7. PMID: 28598044. Publisher Full Text
Taghaddosi M, Dianati M, Bidgoli JF, Bahonaran J. Delay and its related factors in seeking treatment in patients with acute myocardial infarction. ARYA atherosclerosis. 2010;6(1):35-41. PMID: 22577411. Publisher Full Text
Angerud KH, Brulin C, Naslund U, Eliasson M. Longer pre-hospital delay in first myocardial infarction among patients with diabetes: an analysis of 4266 patients in the northern Sweden MONICA Study. BMC cardiovascular disorders. 2013 Dec;13(1):6. DOI: 10.1186%2F1471-2261-13-6 PMID: 23356233. Publisher Full Text
Farshidi H, Rahimi S, Abdi A, Salehi S, Madani A. Factors associated with pre-hospital delay in patients with acute myocardial infarction. Iranian Red Crescent Medical Journal. 2013 Apr;15(4):312-6. DOI: 10.5812%2Fircmj.2367 PMID: 24083004. Publisher Full Text
Mathews R, Peterson ED, Li S, Roe MT, Glickman SW, Wiviott SD, Saucedo JF, Antman EM, Jacobs AK, Wang TY. Use of Emergency Medical Service Transport Among Patients With St-segment–elevation Myocardial Infarction: Findings From the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry–get With the Guidelines. Circulation. 2011 Jul 12;124(2):154-63. DOI: 10.1161/CIRCULATIONAHA.110.002345 PMID: 21690494.
Copyright (c) 2018 Ram Chandra Kafle, Navaraj Paudel, Girija Shankar Jha, Dibya Sharma, Vijay Madhav Alurkar
This work is licensed under a Creative Commons Attribution 4.0 International License.
- The Journal of Lumbini Medical College (JLMC) publishes open access articles under the terms of the Creative Commons Attribution (CC BY) License which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
- JLMC requires an exclusive licence to publish the article first in its journal in print and online.
- The corresponding author should read and agree to the following statement before submission of the manuscript for publication,
- License agreement
- In submitting an article to Journal of Lumbini Medical College (JLMC) I certify that:
- I am authorized by my co-authors to enter into these arrangements.
- I warrant, on behalf of myself and my co-authors, that:
- the article is original, has not been formally published in any other peer-reviewed journal, is not under consideration by any other journal and does not infringe any existing copyright or any other third party rights;
- I am/we are the sole author(s) of the article and have full authority to enter into this agreement and in granting rights to JLMC are not in breach of any other obligation;
- the article contains nothing that is unlawful, libellous, or which would, if published, constitute a breach of contract or of confidence or of commitment given to secrecy;
- I/we have taken due care to ensure the integrity of the article. To my/our - and currently accepted scientific - knowledge all statements contained in it purporting to be facts are true and any formula or instruction contained in the article will not, if followed accurately, cause any injury, illness or damage to the user.
- I, and all co-authors, agree that the article, if editorially accepted for publication, shall be licensed under the Creative Commons Attribution License 4.0. If the law requires that the article be published in the public domain, I/we will notify JLMC at the time of submission, and in such cases the article shall be released under the Creative Commons 1.0 Public Domain Dedication waiver. For the avoidance of doubt it is stated that sections 1 and 2 of this license agreement shall apply and prevail regardless of whether the article is published under Creative Commons Attribution License 4.0 or the Creative Commons 1.0 Public Domain Dedication waiver.
- I, and all co-authors, agree that, if the article is editorially accepted for publication in JLMC, data included in the article shall be made available under the Creative Commons 1.0 Public Domain Dedication waiver, unless otherwise stated. For the avoidance of doubt it is stated that sections 1, 2, and 3 of this license agreement shall apply and prevail.
Please visit Creative Commons web page for details of the terms.
