Prehospital Delay and its Impact on 30 days Outcomes in patients with Myocardial Infarction in Alshaab teaching hospital, Khartoum November2020-April 2021

Abstract

BackgroundIschemic heart diseases are the most common cause of death worldwide, Prehospital delay associated with increased mortality and poorer outcome. This study aimed to determine whether particular patient's characteristics are associated with delays in seeking care, it also determined the impact of the delay on in-hospital outcomes, 30 days’ outcomes, and the cardiac functional status for patients after 30 days of their disease. MethodsThis prospective 30 days’ cohort study was conducted in Al shaab tertiary hospital in Khartoum. All patients diagnosed with myocardial infarction from 13th of January to 13th of February 2021 were included. Sociodemographic, clinical features, and health seeking behavior were collected using structured questionnaire, Patients were followed up by telephone to collect in-hospital and 30 days’ outcomes data. The Duke Activity Status Index (DASI) was used to assess the cardiac functional status after 30 days; Wilcoxon rank-sum test, Chi-square test of independence and Fisher's exact test were used to find if there is difference between groups categorized according to pre-hospital delay to tertiary hospital (< 6 hours or ≥ 6 hours), and to find the difference in the prognosis of patients according to pre-hospital delay time to hospital. Results98 patients were enrolled. The mean age for the participants was (58.6 ± 10.3) years. The mean total pre-hospital delay time was (11.0 ± 6.3) hours and the mean time patients took to decide that their condition requires medical attention was (5.6 ± 5.9) hours. The mean time for first medical interactions patients had was (6.9 ± 6.0) hours. Patients misperception of symptoms significantly contributed to prolonged pre-hospital times (p=0.002). Prolonged referral time led to prolonged prehospital time as the mean time for making the referrals was (2.7 ± 3.1) hours (p=0.005). STEMI patients tended to have earlier first medical interactions than patients diagnosed with Non-STEMI. Hypertensive patients had prolonged first medical interactions (p=0.016). In addition, prolonged time to first medical interaction led to a significant decrease in the cardiac functional status index after 30 days of admission as measured by the Duke Activity Status Index (DASI). ConclusionSome modifiable factors contribute to longer pre-hospital delay of myocardial infarction patients, resulting in decreased cardiac functional status after one month, patient's awareness about cardiovascular disease and improved referral pathway of the existing health care system may reduce the delay.