Delay and its Related Factors in Seeking Treatment in Patients with Acute Myocardial Infarction

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Abstract

BACKGROUND

Early diagnosis and treatment of myocardial infarction can prevent life-threatening complications such as dysrhythmias and death. The aim of this study was to determine the length of delay and its related factors in seeking treatment among a group of patients with myocardial infarction.

METHODS

In a cross-sectional design, all the patients who had referred to a general teaching hospital (Kashan, Iran) for treatment of myocardial infarction from April 2004 to March 2005 were recruited. Demographic characteristics, the amount of delay, and the causes of having delay were recorded.

RESULTS

Two hundred patients were recruited for this study from which 131 (69%) patients had delay in seeking treatment. Factors such as gender, age, economical status, educational level, referring to a general physician before referring to the hospital, the severity of symptoms, residential place (urban vs. rural), and the time of the onset of the symptoms (day vs. night) were determined to be related to having delay. The most important causes of having delay were: "hoping the symptoms to alleviate spontaneously", "attributing the symptoms to other problems other than heart problems", and "disregarding the symptoms".

CONCLUSION

Regarding the most important causes of having delay in this study, the importance of educating people about the symptoms of myocardial infarction and the importance of early referral to the hospitals is clarified.

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Most cited references 42

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Acute myocardial infarction.

Hendrik Vos, Eric Boersma, Don Poldermans … (2003)

Acute myocardial infarction is a common disease with serious consequences in mortality, morbidity, and cost to the society. Coronary atherosclerosis plays a pivotal part as the underlying substrate in many patients. In addition, a new definition of myocardial infarction has recently been introduced that has major implications from the epidemiological, societal, and patient points of view. The advent of coronary-care units and the results of randomised clinical trials on reperfusion therapy, lytic or percutaneous coronary intervention, and chronic medical treatment with various pharmacological agents have substantially changed the therapeutic approach, decreased in-hospital mortality, and improved the long-term outlook in survivors of the acute phase. New treatments will continue to emerge, but the greatest challenge will be to effectively implement preventive actions in all high-risk individuals and to expand delivery of acute treatment in a timely fashion for all eligible patients.

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Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry).

Lynette Goldberg, Scott Jackson, Álvaro Avezum … (2002)

Our primary study aim was to examine extent of, and factors associated with, delay in seeking medical care in a large multinational registry of patients with acute myocardial infarction (AMI) and unstable angina pectoris. A secondary goal was to examine the relation between duration of prehospital delay and receipt and timing of coronary reperfusion strategies. Investigators from 14 countries are participating in the Global Registry of Acute Coronary Events (GRACE) project. The study sample consisted of 3,693 patients with ST-segment elevation AMI, 2,935 with non-ST-segment elevation AMI, and 3,954 patients with unstable angina hospitalized between 1999 and 2001. The average and median delay times were longest in patients with non-ST-segment elevation AMI (6.1 and 3.0 hours, respectively) followed by patients with unstable angina (5.6 and 3.0 hours) and those with ST-segment elevation AMI (4.7 and 2.3 hours). Approximately 41% of patients with ST-segment elevation AMI presented to the 94 study hospitals within 2 hours of the onset of acute coronary symptoms; this compared with approximately one third of patients with non-ST-segment elevation AMI and unstable angina. Several demographic and clinical characteristics were associated with prehospital delay. In patients with ST-segment elevation AMI, duration of prehospital delay was inversely related to the receipt of thrombolytic therapy, but was inconsistently related to the use of percutaneous coronary interventions. The results of this study demonstrate that a large proportion of patients continue to exhibit prolonged delay in seeking medical care after the onset of acute coronary symptoms and remain in need of targeted educational efforts to reduce extent of delay.

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Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial.

Benjamin D. Simons, Lynette Goldberg, R Luepker … (2000)

Delayed access to medical care in patients with acute myocardial infarction (AMI) is common and increases myocardial damage and mortality. To evaluate a community intervention to reduce patient delay from symptom onset to hospital presentation and increase emergency medical service (EMS) use. The Rapid Early Action for Coronary Treatment Trial, a randomized trial conducted from 1995 to 1997 in 20 US cities (10 matched pairs; population range, 55,777-238,912) in 10 states. A total of 59,944 adults aged 30 years or older presenting to hospital emergency departments (EDs) with chest pain, of whom 20,364 met the primary population criteria of suspected acute coronary heart disease on admission and were discharged with a coronary heart disease-related diagnosis. One city in each pair was randomly assigned to an 18-month intervention that targeted mass media, community organizations, and professional, public, and patient education to increase appropriate patient actions for AMI symptoms (primary population, n=10,563). The other city in each pair was randomly assigned to reference status (primary population, n=9801). Time from symptom onset to ED arrival and EMS use, compared between intervention and reference city pairs. General population surveys provided evidence of increased public awareness and knowledge of program messages. Patient delay from symptom onset to hospital arrival at baseline (median, 140 minutes) was identical in the intervention and reference communities. Delay time decreased in intervention communities by -4.7% per year (95% confidence interval [CI], -8.6% to -0.6%), but the change did not differ significantly from that observed in reference communities (-6. 8% per year; 95% CI, -14.5% to 1.6%; P=.54). EMS use by the primary study population increased significantly in intervention communities compared with reference communities, with a net effect of 20% (95% CI, 7%-34%; P<.005). Total numbers of ED presentations for chest pain and patients with chest pain discharged from the ED, as well as EMS use among patients with chest pain released from the ED, did not change significantly. In this study, despite an 18-month intervention, time from symptom onset to hospital arrival for patients with chest pain did not change differentially between groups, although increased appropriate EMS use occurred in intervention communities. New strategies are needed if delay time from symptom onset to hospital presentation is to be decreased further in patients with suspected AMI. JAMA. 2000;284:60-67

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Author and article information

Journal

Journal ID (nlm-ta): ARYA Atheroscler

Journal ID (iso-abbrev): ARYA Atheroscler

Journal ID (publisher-id): ARYA

Title: ARYA Atherosclerosis

Publisher: Isfahan Cardiovascular Research Center, Isfahan University of Medical Sciences

ISSN (Print): 1735-3955

ISSN (Electronic): 2251-6638

Publication date (Print): Spring 2010

Volume: 6

Issue: 1

Pages: 35-41

Affiliations

[1 ]Department of Medical-Surgical Nursing, Kashan University of Medical Sciences, Kashan, Iran

[2 ]Medical Student, Kashan University of Medical Sciences, Kashan, Iran

[3 ]Department of Medical Technology, Kashan University of Medical Sciences, Kashan, Iran

Author notes

Corresponding author: Mohsen Taghaddosi, E-mail: taghadosi_1345@ 123456yahoo.com

Article

Publisher ID: ARYA-06-035

PMC ID: 3347806

PubMed ID: 22577411

SO-VID: 88fea8b6-5c41-495a-abf0-bd7c3fc085c5

License:

This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Delay and its Related Factors in Seeking Treatment in Patients with Acute Myocardial Infarction

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Abstract

BACKGROUND

METHODS

RESULTS

CONCLUSION

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Orthopedics

Most cited references 42

Acute myocardial infarction.

Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry).

Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial.

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