Delai de prise en charge et acces aux soins de l'infarctus du myocarde dans les structures hospitalieres

ABSTRACT

We aimed to assess the acute myocardial infarction management in Tunis public hospitals during one year [from March 2000 to February 2001]. Method: A standard questionnaire was designed to record prospective data on 740 patients with a follow up during 28 days. Multivariate analysis was performed using the logistic regression model with all-factors as well as age, gender, CHD risk factors as predictors of the delay and fatality. 54% of patients were admitted during the first 6 hours after the onset of symptoms. In multivariate analysis, the delay of consultation is significantly correlated with gender [OR=2.3, p<0.001], age [OR=l.02, p<0.01] and health insurance [OR=1.5, p<0.01]. 90% of patients consulted in emergency wards. The emergency ambulance transported 19.6% of patients. 48% of patients underwent early revascularization of thrombolysis, 51% on men vs 31% on women [p <0.01]. The fatality rate was higher on women 14% vs 6.4% on men [p<0.01] at 5 days and 27.2% vs 13.6% at 28 days. In multivariate analysis, the principal fatality predictive factor was age [RR=l.08, p < 0,001] and delay [2.56 p <0.001] and tobacco smoking [RR=2,83, p <0.0001]. this study highlighted the problem of acute myocardial infarction management in public hospitals in Tunisia and it constitutes a baseline to assess different interventions focusing on cardiovascular diseases control and surveillance