Pre hospital issues in acute myocardial infarction.

ABSTRACT

OBJECTIVES: Time is of prime importance in the management of acute myocardial infarction (AMI). Time to hospital admission should be minimised for maximum thrombolytic benefit. The present paper has evaluated some socio-demographic factors influencing pre hospital delay. METHODS: This prospective observational study of 1,072 patients with AMI admitted to 14 hospitals in South India was done over one year. Socio-demographic factors viz. time of symptom onset, place of residence, type of transportation to hospital, distance travelled, as well as clinical and treatment details were recorded. Hospitals were grouped based on their location into metropolitan and town hospitals. RESULTS: Males predominated (85%) and had AMI at a younger age than females. Most patients (74%) travelled less than 30 km to a hospital. The mean distance travelled to a town hospital was longer than that to a metropolitan hospital (24.2 km vs 21 km; p < 0.0001); however there was no significant difference in the type of transportation or time taken to reach either of the hospitals. Majority (79%) of patients arrived at a hospital within the thrombolytic window of 12 hours (mean time = 11 hours). The occurrence of a previous MI had no influence on time taken to hospital arrival, questioning the role of symptom education as an interventional strategy to reduce pre hospital delay. Patients older than 70 years and females in towns with symptom onset during the day (6 am to 6 pm) took a longer time to reach hospital. CONCLUSION: Community facilities do not affect pre hospital delay. Interventions should focus on reducing decision time to call for help and the role of symptom education needs further evaluation.