Factors associated with delayed hospital arrival among patients with acute myocardial infarction

ABSTRACT

Introduction: Cardiovascular diseases are the main cause of mortality and morbidity worldwide. Prehospital delay is the most significant obstacle for effective AMI management despite efforts in public and patients’ education.

Aim: The purpose of this study was to identify the sociodemographic, personal and clinical predictors of prehospital delay in care seeking among patients with AMI.

Methods: A cross sectional study among 119 AMI patients was carried out during a three months’ period in two large hospitals in Athens. Data were recorded by a face to face interview. The patients were analyzed in two groups according to symptoms onset -to-door time ( short delay time group < 2 hours vs long delay group > 2 hours ).

Results: The median delay time was 4 hours and 41 minutes and only 17,8% (n21) of patients were admitted to hospital within the first 2 hours of symptoms onset. The main factors that were found to be correlated with longer prehospital delay (>2hours), were the long distance more than 10km away from the hospital (p=<0.001), The absence of company during the incident (p= 0.003), and not living in Athens (p= 0.049). Having high level education, more than 9 years (p= 0.008), arrival by ambulance (p= 0.001), family history of coronary artery disease (0.015) and self-perceived cardiac symptoms (p= 0.025) were associated with shorter prehospital delay. In multivariate logistic regression analysis, distance from hospital (b 0.301, p 0.044), smoking (b 3.135, p 0.048) and family history heart disease (b 3.782, p 0, 021) were independent predictors of prolonged prehospital delay.

Conclusions: The delay time from symptoms onset to hospital admission was high in patients with AMI. Factors such as distance from the hospital, negative family history and absence of smoking are associated with prehospital delay.

Keywords: Acute myocardial infarction, prehospital delay, treatment delay, symptoms onset