Factors influencing arrival of patients with acute myocardial infarction at emergency departments: implications for community nursing interventions

Abstract

This paper identifies the characteristics of Greek patients with acute myocardial infarction who have long prehospital delays and identifies the factors that are specifically associated with these delays. The time between the first appearance of symptoms until the hospitalization of the patient with myocardial infarction correlates statistically significantly with in-hospital and long-term mortality. The study took place in two Greek coronary care units from 1 June 2007 to 31 July 2008. From 232 consecutive patients with myocardial infarction, 160 were enrolled. Data were collected by a trained hospital staff nurse, who interviewed all patients within 48 hours of hospital admission. Smokers arrived statistically significantly sooner at the hospital than non-smokers [smokers' prehospital time delay: 78.9 (sd = 3.2) minutes vs. non-smokers' prehospital time delay: 98.2 (sd = 4.1) minutes, Mann-Whitney U-test, Z = -2.5, P < 0.05]. Patients with hyperlipidaemia arrived with a mean delay of 13 minutes less than normolipidaemic patients. Those with inferior ST segment elevation myocardial infarction exhibited statistically significantly shorter delay times than those with anterior or lateral (inferior vs. anterior, P = 0.003, inferior vs. lateral, P = 0.024, anova with Bonferroni-Holm post hoc test, F = 7.5, P = 0.001). Community nurses should educate all patients about myocardial infarction, not only those at high risk but also those without known risk factors for ischaemic heart disease.