Causes of Pre-Hospital Delay in Patients with Acute Myocardial Infarction

Abstract

Abstract Objective: To determine the factors influencing the delay in presentation of symptomatic patients of acute myocardial infarction at hospital emergency depart-ment. Study Design: An observational study. Place and Duration of Study: Department of Medi-cine, Mayo Hospital, King Edward Medical Univer-sity, Lahore, from June, 2010 to June 2011. Methodology: 300 patients were included in the stu-dy with the following criteria: symptomatic myocar-dial infarction uncomplicated by cardiac arrest, age less than 70 years and presentation less than 24 hours after onset of chest pain. Myocardial infarction was defined as history of characteristic chest pain with either an ECG showing standard changes of myocar-dial infarction, and / or a rise in cardiac markers of more than double the upper normal range. After infor-med consent, the following data was collected from the subjects and entered in a structured proforma: pati-ent demographics, previous cardiac and medical his-tory, duration of delay, type of delay, the reason for the delay and the first response of the patient. SPSS 19 was used to analyze the data and the results were des-cribed in term of descriptive statistics. Results: Amongst the total of 300 patients, 234 (78%) were males and 66 (22%) were females. Age ranged between 31 - 66 years. 204 (68%) had no previous cardiac history, 24 (8%) had suffered from angina alo-ne and 72 (24 %) had been diagnosed to have had MI previously. One hundred fifty six (52%) were hyper-tensive, 72 (24%) were diabetic, 66 (22%) had both hypertension and diabetes mellitus. Twenty four (8%) had previously suffered from a cerebrovascular acci-dent, 12 (4%) were having hyperlipidemia and 6 (2%) had an underlying vasculitic disorder. 174 (58%) had delayed decision time, while 120 (40%) had delayed response time; only 6 (2%) presented within ½ hour of chest pain. The commonest reason (70%) for patient's delay in presentation was that they thought it was not serious and would settle on its own. Maximum number of those having chest pain (44%) presented directly to the hospital emergency. Conclusion: Factors including patient's demographic, past medical history, clinical presentation, recognition of symptoms, and the first contact approached for help