Factors influencing pre-hospital delay among patients with acute myocardial infarction in Iran

( views:314, downloads:0 )
Author:
Maryam Momeni(Nursing Education, Qazvin University of Medical Sciences,Qazvin Nursing and Midwifery College, Qazvin, Iran)
Arsalan Salari(Department of Cardiology , Cardiovascular Disease Research Center, Guilan University of Medical Sciences, Heshmat Hospital, Rasht, Iran)
Shora Shafighnia(General Practitioner , Cardiovascular Disease Research Center, Guilan University of Medical Sciences, Heshmat Hospital, Rasht, Iran)
Atefeh Ghanbari(Nursing Education, Social Determinants of Health Research Center, Guilan University of Medical Sciences, Rasht, Iran)
Fardin Mirbolouk(Department of Cardiology , Cardiovascular Disease Research Center, Guilan University of Medical Sciences, Heshmat Hospital, Rasht, Iran)
Journal Title:
Chinese Medical Journal
Issue:
Volume 125, Issue 19, 2012
DOI:
10.3760/cma.j.issn.0366-6999.2012.19.008
Key Word:
pre-hospital; delay; acute myocardial infarction; cardiovascular disease

Abstract: Background Acute myocardial infarction (AMI) is the leading cause of morbidity and disability among Iranian population.Pre-hospital delay is an important cause of increasing early and also late mortality in AMI.Thus the aim of the present study was to identify the factors influencing pre-hospital delay among patients with AMI in Iran.Methods Between August 2010 and May 2011,a cross-sectional and single-center survey was conducted on 162 consecutive patients with ST-elevation myocardial infarction (STEMI) admitted to Cardiac Care Unit (CCU) of Dr.Heshmat Hospital,Rasht.All patients were interviewed by the third author within 7 days after admission by using a four-part questionnaire including socio-demographic,clinical,situational and cognitive factors.Data were analyzed by descriptive and Logistic regression model at P < 0.05 using SPSS 16.Results Mean age was (60.11±12.29) years in all patients.Majority of patients (65.4%) were male.The median of pre-hospital delay was 2 hours,with a mean delay of 7.4 hours (±16.25 hours).Regression analysis showed that admission in weekend (P <0.04,OR=1.033,95% Cl=1.187-2.006) and misinterpretation of symptoms as cardiac origin (P <0.002,OR=1.986,95% Cl=1.254-3.155) and perceiving symptoms to not be so serious (P <0.003,OR=3.264,95%Cl=1.492-7.142) were factors influencing pre-hospital delay > 2 hours.Conclusions Our findings highlight the importance of cognitive factors on decision-making process and pre-hospital delays.Health care providers can educate the public on AMI to enable them recognize the signs and symptoms of AMI correctly and realize the benefits of early treatment.

  • 1.Donyavi T,Naieni KH,Nedjat S,Vahdaninia M,Najafi M,Montazeri A.Socioeconomic status and mortality after acute myocardial infarction:a study from Iran.Int J Equity Health 2011; 10:9.
  • 2.Smolderen KG,Spertus JA,Nallamothu BK,Krumholz HM,Tang F,Ross JS,et al.Health care insurance,financial concerns in accessing care, and delays to hospital presentation in acute myocardial infarction.JAMA 2010;303:1392-1400.
  • 3.Fukuoka Y,Dracup K,Kobayashi F,Froelicher ES,Rankin SH,Ohno M,et al.Trajectory of pre-hospital delay in patients with acute myocardial infarction in the Japanese health care system.Int J Cardiol 2006; 107:188-193.
  • 4.Zerwic JJ,Ryan CJ,DeVon HA,Drell MJ.Treatment seeking for acute myocardial infarction symptoms:differences in delay across sex and race.Nursing Res 2003; 52:159-167.
  • 5.Ottesen MM, Dixen U, Torp-pedersen C, Kober L.Pre-hospital delay in acute coronary syndrome-an analysis of the components of delay.Int J Cardiol 2004; 96:97-103.
  • 6.Banks AD,Dracup K.Factors associated with prolonged prehospital delay of African Americans with acute myocardial infarction.Am J Crit Care 2006; 15:149-157.
  • 7.Girtner C,Walz L,Bauernschmitt E,Ladwig K.The causes of prehospital delay in myocardial infarction.Dtsch Arztebl Int 2008; 105:286-291.
  • 8.Postma S,Dambrink JE,de Boer M,Gosselink AT,Eggink GJ,van de Wetering H,et al.Prehospital triage in the ambulance reduces infarct size and improves clinical outcome.Am Heart J 2011; 161:276-282.
  • 9.Lφvlien M,Schei B,Hole T.Prehospital delay,contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction.Eur J Cardiovasc Nurs 2007; 6:308-313.
  • 10.Alidoosti M.Determinants of pre-hospital delay in patients with acute myocardial infarction.Acta Medica Iranica 2004;42:50-54.
  • 11.Khraim FM, Scherer YK, Dorn JM, Carey MG.Patient-surrogate agreement of predictors of decision delay among patients with acute myocardial infarction: a questionnaire survey.Int J Nurs Stud 2010; 47:1418-1424.
  • 12.Hwang SY,Jeong MH.Cognitive factors that influence delayed decision to seek treatment among older patients with acute myocardial infarction in Korea.Eur J Cardiovasc Nurs 2010; doi:10.1016/j.ejcnurse.2010.11.002.
  • 13.Lesneski L.Factors influencing treatment delay for patients with acute myocardial infarction.Appl Nurs Res 2010; 23:185-190.
  • 14.Sar(i) I,Acar Z,(O)zer O,Erer B,Tekbas E, (U)cer E,et al.Factors associated with prolonged prehospital delay in patients with acute myocardial infarction.Türk Kardiyol Dem Ars-Arch Turk Soc Cardiol 2008; 36:156-162.
  • 15.Ayrik C,Ergene U,Kinay O,Nazli C,Unal B,Ergene O.Factors influencing emergency department arrival time and in-hospital management of patients with acute myocardial infarction.Advs Ther 2006; 23:244-255.
  • 16.Goldberg RJ,Steg PG,Sadiq I,Granger CB,Jackson EA,Budaj A,et al.Extent of,and factors associated with,delay to hospital presentation in patients with acute coronary disease (The GRACE Registry).Am J Cardiol 2002; 89:791-796.
  • 17.Perkins-Porras L,Whitehead DL,Strike PC,Steptoe A.Pre-hospital delay in patients with acute coronary syndrome:factors associated with patient decision time and home-to hospital delay.Eur J Cardiovasc Nurs 2009; 8:26-33.
  • 18.Thuresson M,Jarl(o)v MB,Lindahl B,Svensson L,Zedigh C,Herlitz J.Thoughts,actions,and factors associated with prehospital delay in patients with acute coronary syndrome.Heart Lung 2007; 36:398-409.
  • 19.Johansson I,Stromberg A,Swahn E.Factors related to delay times in patients with suspected acute myocardial infarction.Heart Lung 2004; 33:291-300.
  • 20.McKinley S,Dracup K,Moser DK,Ball C,Yamasaki K,Kim CJ,et al.International comparison of factors associated with delay in presentation for AMI treatment.Eur J Cardiovasc Nurs 2004; 3:225-230.
  • 21.Bonow RO,Mann DL,Zipes DP,LibbyP.Braunwald's heart disease:a textbook of cardiovascular medicine.Philadelphia:Saunders; 2012:1087-1110.
  • 22.Thuresson M,Jarl(o)v MB,lindahl B,Svensson L,Zedigh C,Herlitz J.Factors that influence the use of ambulance in acute coronary syndrome.Am Heart J 2008; 156:170-176.
  • 23.Schuler J,Meier B,Behrens S,Thimme W.Present treatment of acute myocardial infarction in patients over 75 years,data from the Berlin myocardial infarction registry.Clin Res Cardiol 2006; 96:360-367.
  • 24.Sheifer SE,Rathore SS,Gersh B J,Weinfurt KP,Oetgen WJ,Breall JA,et al.Time to presentation with acute myocardial infarction in the elderly:associations with race,sex,and socioeconomic characteristics.Circulation 2000; 102:1651-1656.
  • 25.Ingarfield SL,Jacobs IG,Jelinek GA,Mountain D.Patient delay and use of ambulance by patients with chest pain.Emerg Med Australas 2005; 17:218-223.
  • 26.Pattenden J,Watt I,Lewin R J,Stanford N.Decision making processes in people with symptoms of acute myocardial infarction:qualitative study.BMJ 2002; 324:1006-1009.
  • 27.Parikh SV,Jacobi JA,Chu E,Addo TA,Warner JJ,Delaney KA,et al.Treatment delay in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction:a key process analysis of patient and program factors.Am Heart J 2008; 155:290-297.
  • 28.Crowley RW,Yeoh HK,Stukenborg GJ,Medel R,Kassell NF,Dumont AS.Influence of weekend hospital admission on short-term mortality after intra cerebral hemorrhage.Stroke 2009; 40:2387-2392.
  • 29.Moser DK,Mckinley S,Dracup K,Chung ML.Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms.Patient Educ Couns 2005; 56:45-54.
  • 30.Burnett RE,Blumenthal JA,Mark DB,Leimberger JD,Califf RM.Distinguishing between early and late responders to symptoms of acute myocardial infarction.Am J Cardiol 1995;75:1019-1022.
  • 31.Buckley T,McKinley S,Gallagher R,Dracup K,Moser DK,Aitken LM.The effect of education and counseling on knowledge,attitudes and beliefs about responses to acute myocardial infarction symptoms.Eur J Cardiovas Nurs 2007;6:105-111.
  • 32.Finnegan JR Jr,Meischke H,Zapka JG,Leviton L,Meshack A,Benjamin-Garner R,et al.Patient delay in seeking care for heart attack symptoms:findings from focus groups conducted in five U.S.regions.Prey Med 2000; 31:205-213.
  • 33.Rosenfeld AG.Women's risk of decision delay in acute myocardial infarction:implications for research and practice.AACN Clin Issues 2001; 12:29-39.
  • 34.Dracup K,Moser DK.Beyond socio-demographics:factors influencing the decision to seek treatment for symptoms of acute myocardial infarction.Heart Lung 1997; 26:253-262.
WanfangData CO.,Ltd All Rights Reserved
About WanfangData | Contact US
Healthcare Department, Fuxing Road NO.15, Haidian District Beijing, 100038 P.R.China
Tel:+86-010-58882616 Fax:+86-010-58882615 Email:yiyao@wanfangdata.com.cn