Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram
Background: In ST-elevation myocardial infarction (STEMI), prehospital delay is a significant factor, decreasing likelihood of revascularization and increasing mortality. Prehospital delays are substantive in Indian patients with STEMI. Our study aimed to investigate factors associated with prehospi...
| Main Authors: | , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2018-12-01
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| Series: | Indian Heart Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S0019483218305571 |
| _version_ | 1818732950598975488 |
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| author | Bishav Mohan Raahat Bansal Naveen Dogra Sarit Sharma Arun Chopra Sudhir Varma Namita Bansal Rohit Tandon Abhishek Goyal Bhupinder Singh Shibba Takkar Chhabra Naved Aslam Gurpreet S. Wander Ambuj Roy |
| author_facet | Bishav Mohan Raahat Bansal Naveen Dogra Sarit Sharma Arun Chopra Sudhir Varma Namita Bansal Rohit Tandon Abhishek Goyal Bhupinder Singh Shibba Takkar Chhabra Naved Aslam Gurpreet S. Wander Ambuj Roy |
| author_sort | Bishav Mohan |
| collection | DOAJ |
| description | Background: In ST-elevation myocardial infarction (STEMI), prehospital delay is a significant factor, decreasing likelihood of revascularization and increasing mortality. Prehospital delays are substantive in Indian patients with STEMI. Our study aimed to investigate factors associated with prehospital delay in patients with STEMI. Methods: A multicentric prospective analysis was conducted at five major cardiac care referral centers in Punjab including a tertiary care teaching hospital over a period of 1 year from January 2015 to December 2015. Patients presenting with STEMI were included in the study. A structured questionnaire was used to gather patient characteristics and factors responsible for prehospital delay. Results: Of the 619 patients included in the study, 42% presented with more than 6 h of prehospital delay. On univariate analysis, delay was significantly higher among elderly (p = 0.01), illiterate patients (p = 0.02), and patients residing in rural areas (p = 0.04). Recognizing symptoms as cardiac in origin (p < 0.001), hospital as initial medical contact, and availability of prehospital electrocardiogram (ECG) (p = 0.001) were associated with shorter delays. On multivariate analysis, prehospital delay was significant in elderly patients, initial point of care as outpatient clinic, and patients without access to prehospital ECG. Conclusion: Our study concludes that demographic and socioeconomic barriers exist that impede rapid care seeking and highlights the need for utilization of prehospital ECG to decrease prehospital delay. Possibilities include, educating the public on the importance of early emergency medical services contact or creating emergency stations in rural areas with ECG capabilities. Our study also invites further research, regarding role of telemedicine to triage patients derived from prehospital ECGs to decrease prehospital delay. Keywords: STEMI, Pre-hospital ECG, Pre-hospital delay, Factors, Telemedicine. Keywords: STEMI, Pre-hospital ECG, Pre-hospital delay, Factors, Telemedicine |
| first_indexed | 2024-12-17T23:41:43Z |
| format | Article |
| id | doaj.art-8e1c5c87c8584d72a6e1980699e457ee |
| institution | Directory Open Access Journal |
| issn | 0019-4832 |
| language | English |
| last_indexed | 2024-12-17T23:41:43Z |
| publishDate | 2018-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Indian Heart Journal |
| spelling | doaj.art-8e1c5c87c8584d72a6e1980699e457ee2022-12-21T21:28:25ZengElsevierIndian Heart Journal0019-48322018-12-0170S194S198Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogramBishav Mohan0Raahat Bansal1Naveen Dogra2Sarit Sharma3Arun Chopra4Sudhir Varma5Namita Bansal6Rohit Tandon7Abhishek Goyal8Bhupinder Singh9Shibba Takkar Chhabra10Naved Aslam11Gurpreet S. Wander12Ambuj Roy13Dayanand Medical College & Hospital Unit, Hero DMC Heart Institute, Ludhiana; Corresponding author. Dayanand Medical College & Hospital – Unit Hero DMC Heart Institute, Ludhiana, India.Dayanand Medical College & Hospital Unit, Hero DMC Heart Institute, LudhianaIVY Hospital, AmritsarDayanand Medical College & Hospital, LudhianaFortis Escorts Hospital, AmritsarSadbhavna Medical and Heart Institute, PatialaDayanand Medical College & Hospital Unit, Hero DMC Heart Institute, LudhianaDayanand Medical College & Hospital Unit, Hero DMC Heart Institute, LudhianaDayanand Medical College & Hospital Unit, Hero DMC Heart Institute, LudhianaDayanand Medical College & Hospital Unit, Hero DMC Heart Institute, LudhianaDayanand Medical College & Hospital Unit, Hero DMC Heart Institute, LudhianaDayanand Medical College & Hospital Unit, Hero DMC Heart Institute, LudhianaDayanand Medical College & Hospital Unit, Hero DMC Heart Institute, LudhianaAIIMS, New DelhiBackground: In ST-elevation myocardial infarction (STEMI), prehospital delay is a significant factor, decreasing likelihood of revascularization and increasing mortality. Prehospital delays are substantive in Indian patients with STEMI. Our study aimed to investigate factors associated with prehospital delay in patients with STEMI. Methods: A multicentric prospective analysis was conducted at five major cardiac care referral centers in Punjab including a tertiary care teaching hospital over a period of 1 year from January 2015 to December 2015. Patients presenting with STEMI were included in the study. A structured questionnaire was used to gather patient characteristics and factors responsible for prehospital delay. Results: Of the 619 patients included in the study, 42% presented with more than 6 h of prehospital delay. On univariate analysis, delay was significantly higher among elderly (p = 0.01), illiterate patients (p = 0.02), and patients residing in rural areas (p = 0.04). Recognizing symptoms as cardiac in origin (p < 0.001), hospital as initial medical contact, and availability of prehospital electrocardiogram (ECG) (p = 0.001) were associated with shorter delays. On multivariate analysis, prehospital delay was significant in elderly patients, initial point of care as outpatient clinic, and patients without access to prehospital ECG. Conclusion: Our study concludes that demographic and socioeconomic barriers exist that impede rapid care seeking and highlights the need for utilization of prehospital ECG to decrease prehospital delay. Possibilities include, educating the public on the importance of early emergency medical services contact or creating emergency stations in rural areas with ECG capabilities. Our study also invites further research, regarding role of telemedicine to triage patients derived from prehospital ECGs to decrease prehospital delay. Keywords: STEMI, Pre-hospital ECG, Pre-hospital delay, Factors, Telemedicine. Keywords: STEMI, Pre-hospital ECG, Pre-hospital delay, Factors, Telemedicinehttp://www.sciencedirect.com/science/article/pii/S0019483218305571 |
| spellingShingle | Bishav Mohan Raahat Bansal Naveen Dogra Sarit Sharma Arun Chopra Sudhir Varma Namita Bansal Rohit Tandon Abhishek Goyal Bhupinder Singh Shibba Takkar Chhabra Naved Aslam Gurpreet S. Wander Ambuj Roy Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram Indian Heart Journal |
| title | Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram |
| title_full | Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram |
| title_fullStr | Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram |
| title_full_unstemmed | Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram |
| title_short | Factors influencing prehospital delay in patients presenting with ST-elevation myocardial infarction and the impact of prehospital electrocardiogram |
| title_sort | factors influencing prehospital delay in patients presenting with st elevation myocardial infarction and the impact of prehospital electrocardiogram |
| url | http://www.sciencedirect.com/science/article/pii/S0019483218305571 |
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