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Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population
BACKGROUND: In myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased possibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish population and identified determinants of a pre-hospital delay ≥ 2 ...
Autores principales: | , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866271/ https://www.ncbi.nlm.nih.gov/pubmed/27176816 http://dx.doi.org/10.1186/s12872-016-0271-x |
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author | Nilsson, Gunnar Mooe, Thomas Söderström, Lars Samuelsson, Eva |
author_facet | Nilsson, Gunnar Mooe, Thomas Söderström, Lars Samuelsson, Eva |
author_sort | Nilsson, Gunnar |
collection | PubMed |
description | BACKGROUND: In myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased possibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish population and identified determinants of a pre-hospital delay ≥ 2 h. METHODS: A total of 89 women (mean age 72.6 years) and 176 men (mean age 65.8 years) from a secondary prevention study were enrolled in an observational study after first time MI between November 2009 and March 2012. Total pre-hospital delay was defined as the time from the onset of symptoms suggestive of MI to admission to the hospital. Decision time was defined as the time from the onset of symptoms until the call to Emergency Medical Services (EMS). The time of symptom onset was assessed during the episode of care, and the time of call to EMS and admission to the hospital was based on recorded data. The first medical contact was determined from a mailed questionnaire. Determinants associated with pre-hospital delay ≥ 2 h were identified by multivariable logistic regression. RESULTS: The median total pre-hospital delay was 5.1 h (IQR 18.1), decision time 3.1 h (IQR 10.4), and transport time 1.2 h (IQR 1.0). The first medical contact was to primary care in 52.3 % of cases (22.3 % as a visit to a general practitioner and 30 % by telephone counselling), 37.3 % called the EMS, and 10.4 % self-referred to the hospital. Determinants of a pre-hospital delay ≥ 2 h were a visit to a general practitioner (OR 10.77, 95 % CI 2.39–48.59), call to primary care telephone counselling (OR 3.82, 95 % CI 1.68–8.68), chest pain as the predominant presenting symptom (OR 0.24, 95 % CI 0.08–0.77), and distance from the hospital (OR 1.03, 95 % CI 1.02–1.04). Among patients with primary care as the first medical contact, 67.0 % had a decision time ≥ 2 h, compared to 44.7 % of patients who called EMS or self-referred (p = 0.002). CONCLUSIONS: Pre-hospital delay in patients with first time MI is prolonged considerably, particularly when primary care is the first medical contact. Actions to shorten decision time and increase the use of EMS are still necessary. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-016-0271-x) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4866271 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-48662712016-05-14 Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population Nilsson, Gunnar Mooe, Thomas Söderström, Lars Samuelsson, Eva BMC Cardiovasc Disord Research Article BACKGROUND: In myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased possibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish population and identified determinants of a pre-hospital delay ≥ 2 h. METHODS: A total of 89 women (mean age 72.6 years) and 176 men (mean age 65.8 years) from a secondary prevention study were enrolled in an observational study after first time MI between November 2009 and March 2012. Total pre-hospital delay was defined as the time from the onset of symptoms suggestive of MI to admission to the hospital. Decision time was defined as the time from the onset of symptoms until the call to Emergency Medical Services (EMS). The time of symptom onset was assessed during the episode of care, and the time of call to EMS and admission to the hospital was based on recorded data. The first medical contact was determined from a mailed questionnaire. Determinants associated with pre-hospital delay ≥ 2 h were identified by multivariable logistic regression. RESULTS: The median total pre-hospital delay was 5.1 h (IQR 18.1), decision time 3.1 h (IQR 10.4), and transport time 1.2 h (IQR 1.0). The first medical contact was to primary care in 52.3 % of cases (22.3 % as a visit to a general practitioner and 30 % by telephone counselling), 37.3 % called the EMS, and 10.4 % self-referred to the hospital. Determinants of a pre-hospital delay ≥ 2 h were a visit to a general practitioner (OR 10.77, 95 % CI 2.39–48.59), call to primary care telephone counselling (OR 3.82, 95 % CI 1.68–8.68), chest pain as the predominant presenting symptom (OR 0.24, 95 % CI 0.08–0.77), and distance from the hospital (OR 1.03, 95 % CI 1.02–1.04). Among patients with primary care as the first medical contact, 67.0 % had a decision time ≥ 2 h, compared to 44.7 % of patients who called EMS or self-referred (p = 0.002). CONCLUSIONS: Pre-hospital delay in patients with first time MI is prolonged considerably, particularly when primary care is the first medical contact. Actions to shorten decision time and increase the use of EMS are still necessary. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12872-016-0271-x) contains supplementary material, which is available to authorized users. BioMed Central 2016-05-12 /pmc/articles/PMC4866271/ /pubmed/27176816 http://dx.doi.org/10.1186/s12872-016-0271-x Text en © Nilsson et al. 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Article Nilsson, Gunnar Mooe, Thomas Söderström, Lars Samuelsson, Eva Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population |
title | Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population |
title_full | Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population |
title_fullStr | Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population |
title_full_unstemmed | Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population |
title_short | Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population |
title_sort | pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern swedish population |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4866271/ https://www.ncbi.nlm.nih.gov/pubmed/27176816 http://dx.doi.org/10.1186/s12872-016-0271-x |
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