Turk Kardiyol Dern Ars. 2005; 33(7): 392-397

The relationship between prehospital delays of patients with ST-elevation acute myocardial infarction and clinical, demographic, and socioeconomic factors: importance of patient education

Tuğrul Norgaz¹, Gültekin Hobikoğlu¹, Hüseyin Aksu¹, Aycan Esen¹, Mehmet Gül¹, Hasan Orhan Özer¹, Abdurrahman Eksik¹, Ahmet Narin¹

OBJECTIVES
It is of vital importance for patients with acute myocardial infarction (AMI) to receive medical supervision as early as possible. However, the time taken between the onset of symptoms and delivery of care is quite long for many patients. In this study, we evaluated the time from the onset of symptoms to presentation and the factors associated with prehospital delays in patients who were admitted to our hospital with the diagnosis of AMI.
STUDY DESIGN
A structured interview was conducted with 147 consecutive patients (84 men, 63 women; mean age 56.7±11.6 years) with ST-elevation AMI. Prehospital delay, acute and prodromal symptoms of AMI, demographic features, clinical risk factors, history of coronary artery disease, and socioeconomic factors were questioned. Patients were classified as early or late arrivers according to the time of presentation within the first three hours or beyond.
RESULTS
The mean prehospital delay was 4.2±5.2 hours. Seventy-nine patients (53.7%) were early arrivers and 68 patients (46.3%) were late arrivers. Multivariate logistic regression analysis showed that older age (p<0.001), the number of offsprings (p=0.049), and preexisting stable angina pectoris (p=0.046) were significant independent factors associated with late arrivals.
CONCLUSION
Our data show that nearly half of the patients with AMI reach a reperfusion center with a prehospital delay of more than three hours. Education programs should be developed and implemented focusing on AMI symptoms and importance of early presentation, aiming to reduce prehospital delays, and targeting especially patients with coronary artery disease and general community at large.

Keywords: Emergency medical services; myocardial infarction; patient education; thrombolytic therapy; time factors; transportation of patients

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