[Analysis of causes of excessive prehospital delay of patients with acute myocardial infarction in the province of Teruel]. / Análisis de las causas que motivan una excesiva demora prehospitalaria de pacientes con infarto agudo de miocardio en la provincia de Teruel.

BACKGROUND: To analyze the delay of patients who come to the hospital and are diagnosed with acute myocardial infarction, its causes and the variables with determine it. PATIENTS, MATERIAL AND METHODS: Prospective study of 115 patients (79 male and 36 female). The pre-hospital delay time was measured as the time which passed from the moment when the patient feels the first symptoms "chest pain", until his arrival and registration at the Emergency Service. This time was divided into three subdivisions: decision time, medical time and transport time. We determined: place of origin, indications and means of transport used to reach the hospital, diagnosis and treatment given by the general practitioner before arrival at the hospital, the cardiovascular risk factors, location of patients pain, the time of day and the delay at the Emergency Service. RESULTS: The mean pre-hospital delay was 364 +/- 534 min (median of 195 min). Most of the patients (73.7%) came to hospital during the first six hours. The major part of total delay corresponded to the decision delay (202 +/- 363 min with a median of 75), which occupied 50.1% of the whole (confidence interval 95% [CI 95%], 44.6-55.6%), while the transport time occupied 34.6% (CI 95%, of 30.1-39%) with a median of 50 min. Major pre-hospital delay corresponded to the patients coming from rural areas (p = 0.007), to those asked for medical assistance (p = 0.0029), to diabetics (p = 0.01) and to those who felt the pain during their night sleep (p = 0.0023). Transport time was negatively influenced by old age (p = 0.0012), rural origin (p = 0.0001), the appearance of the night sleep pain (p = 0.031) and calling the general practitioner for first aid (p = 0.0001), but it was not influenced by the form of transport used to get to the hospital. The intra-hospital delay time had an median of 60 min, being longer for older people (p = 0.007), for patients with hypertension (p = 0.014) and those who were admitted from the Intensive Care Unit (p = 0.0001). CONCLUSIONS: The pre-hospital delay detected in our environment is longer than other studies and confirms that half of it is not due to the intrinsic functioning of our health system, even through it should get involved as much as possible to diminish the delay time.

[Delay time to arrive at the hospital of 275 patients with acute myocardial infarction. Study form the province of Teruel (1991-1994)]. / Tiempo de demora en acudir al hospital de 275 pacientes con infarto agudo de miocardio. Análisis de la provincia de Teruel (1991-1994).

BACKGROUND: To study the delay time to arrive of the hospital and its relation with any variables, of patients with acute myocardial infarction from the province of Teruel (Spain). PATIENTS AND METHODS: A prospective study was carried out from January 1991 to October 1994. We included patients who were diagnosticated of the acute myocardial infarction (212 men and 63 women). We considered the time between the thoracic pain and their arrive at the urgency service. We based the diagnosis in clinical, electrocardiographic and enzymatic criteria. RESULTS: The mean delay time was 8 h 46 m. The 66.5% arrives before 6 hours. We found no differences between rural or urban patients. The delay time was minor in men than women (7 h 12 m versus 14 h, p = 0.0019), in younger (< 65 years old) than in the older (6 h 3 m versus 10 h 18 m, p = 0.0278), and in those who were admitted to the ICU (7h 16 m versus 20 h 33 m, p = 0.0001). Was longer in patients with arterial hypertension and diabetes. Was minor in patients with dyslipemia and tobacco habit. Many patients to arrive of the hospital by physician order and with own vehicles, it took less time arrive at the hospital than by ambulance (8 h 30 m versus 18 h, p < 0.05). The medium delay in the emergency area was 2 h 35 m. The delay time was longer in patients who died (16 h versus 7h 30 m, p = 0.0018) and in those who present more frequently cardiac failure. CONCLUSIONS: The mean delay time to arrive at the hospital in patients with acute myocardial infarction from the province of Teruel (Spain) in unreasonable and in takes a poor prognosis, so we consider necessary to study the causes of this delay in order to correct them.