Abstract
BackgroundPatients with a presumed diagnosis of acute coronary syndrome (ACS) or stroke may have had contact with several healthcare providers prior to hospital arrival. The aim of this study was to describe the various prehospital paths and the effect on time delays of patients with ACS or stroke.MethodsThis prospective observational study included patients with presumed ACS or stroke who may choose to contact four different types of health care providers. Questionnaires were completed by patients, general practitioners (GP), GP cooperatives, ambulance services and emergency departments (ED). Additional data were retrieved from hospital registries.ResultsTwo hundred two ACS patients arrived at the hospital by 15 different paths and 243 stroke patients by ten different paths. Often several healthcare providers were involved (60.8 % ACS, 95.1 % stroke). Almost half of all patients first contacted their GP (47.5 % ACS, 49.4 % stroke). Some prehospital paths were more frequently used, e.g. GP (cooperative) and ambulance in ACS, and GP or ambulance and ED in stroke. In 65 % of all events an ambulance was involved. Median time between start of symptoms and hospital arrival for ACS patients was over 6 h and for stroke patients 4 h. Of ACS patients 47.7 % waited more than 4 h before seeking medical advice compared to 31.6 % of stroke patients. Median time between seeking medical advice to arrival at hospital was shortest in paths involving the ambulance only (60 min ACS, 54 min stroke) or in combination with another healthcare provider (80 to 100 min ACS, 99 to 106 min stroke).ConclusionsPrehospital paths through which patients arrived in hospital are numerous and often complex, and various time delays occurred. Delays depend on the entry point of the health care system, and dialing the emergency number seems to be the best choice. Since reducing patient delay is difficult and noticeable differences exist between various prehospital paths, further research into reasons for these different entry choices may yield possibilities to optimize paths and reduce overall time delay.
Highlights
Patients with a presumed diagnosis of acute coronary syndrome (ACS) or stroke may have had contact with several healthcare providers prior to hospital arrival
If a ST-elevated myocardial infarction was suspected based on the electrocardiogram (ECG) made in the ambulance, patients were transported to the hospital with percutaneous coronary intervention (PCI) facilities; otherwise the patient was transported to the nearest hospital
Overall 74.9 % of the patients were diagnosed with acute ischemic stroke, 7.4 % transient ischemic attack, 7.8 % hemorrhagic stroke and 9.9 % with other diagnoses, such as peripheral vertigo or epileptic seizure
Summary
Patients with a presumed diagnosis of acute coronary syndrome (ACS) or stroke may have had contact with several healthcare providers prior to hospital arrival. Treatment of ischemic stroke consists of intravenous thrombolysis with recombinant tissue plasminogen activator (rt-PA) In both cases treatment should start as soon as possible after first symptoms to prevent further tissue damage. Door-to-balloon time indicates the timeframe between arrival of the patient with myocardial infarction at the hospital and start of PCI. Mainly because of prehospital delay, many patients arrive too late for treatment, and in clinical reality across the entire stroke population this treatment can be given to only a minority (1–8 %) of such patients [4]. Improving these disappointing numbers seems to be very difficult
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