P35 Irish pre-hospital delay times in acute coronary syndrome: an on-going dilemma

Abstract

Purpose: This study measured baseline pre-hospital delay times among patients diagnosed with acute coronary syndrome in Ireland and compared them with baseline equivalents recorded five years previously by O’Donnell (2006). Pre-hospital delay time was interpreted as the time from acute symptom onset until arrival at the emergency department.Background: A significant number of deaths and substantial disability could be prevented if patients sought earlier treatment for symptoms of acute coronary syndrome. Researchers have reported European pre-hospital delay times between 2.0 hours and 3 hours 56 minutes. Irish median prehospital delay times of 3.1 and 1.8 hours for women and men respectively were reported by O’Donnell et al (2006). The revelation that there was an excessively long pre-hospital delay time by women in Ireland received much media coverage at that time.Methods: Data were collected for this cross-sectional study from patients who were admitted to an emergency department with an ACS event and diagnosed with a myocardial infarction (N = 936). They were recruited from 5 Major Teaching Hospitals in Dublin. Ethical approval was granted. The Response to Symptoms Questionnaire was used to ascertain the information. Data were analysed using SPSSv18. The delay time data was significantly skewed and was therefore log transformed for analysis. Results: Sample profile: Age: 62.59±11.91; Gender: 26%. Female; Diagnosis: 44% STEMI; 56% NSTEMI. The overall median delay time was 2.57 hours. A hierarchical multiple regression model was used to examine the effect of age, gender and diagnosis on delay time. The variance explained by the total model was significant: F(3,392) = −2.896, p = 0.046. By diagnosis, median delay times were 2.08 and 3.0 hours for STEMI and NSTEMI respectively. This was the only variable found to be statistically significant (beta=0.092, p = 0.005). By gender, median delay times were 2.5 hours (male) and 3.0 hours (female).Conclusion: Pre-hospital delay time in ACS has been highlighted for decades as a major international problem. Decreasing the time to treatment for patients with acute myocardial infarction is a life-saving goal. Yet, despite the extensive media coverage given to O’Donnell’s findings in 2006, pre-hospital delay times in Ireland have remained virtually unchanged among women and increased among men. This underscores the need for behaviour-altering approaches to the reduction of pre-hospital delay. This may take the form of targeted public education or educational interventions aimed at reducing pre-hospital delay.