Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing / 中华医学杂志(英文版)

ABSTRACT

<p><b>BACKGROUND</b>Cumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group).</p><p><b>METHODS</b>Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms.</p><p><b>RESULTS</b>Among the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n = 160) was significantly longer than in the LH group (n = 406) (225 vs. 120 minutes, P < 0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95%CI 1.264 - 3.155), absence of history of myocardial infarction (OR, 1.595; 95%CI 1.086 - 3.347), non-health insurance coverage (OR, 1.931; 95%CI 1.079 - 3.012) and absence of sense of impending doom (OR, 4.367; 95%CI 1.279 - 14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95%CI 1.182 - 3.661) less likely to receive primary PCI compared with those in the LH group.</p><p><b>CONCLUSIONS</b>Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients' pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI.</p>