Pre-hospital Delays Among Patients with Acute Coronary Syndrome in the Central Region of Malaysia and Their Associated Factors
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Abstract
Introduction: Early arrival at the hospital and initiation of reperfusion treatment are critical for improving patient outcomes during cardiac events. Pre-hospital delays remain the most significant barrier to the effective management of acute coronary syndrome (ACS). However, there is a lack of data on pre-hospital delays in Malaysia. Therefore, the study aimed to identify the factors contributing to pre-hospital delays. Methods: This cross-sectional study was conducted in two government hospitals. Patients who developed ACS outside the hospital and had their time of symptom onset and time of arrival at the hospital recorded were recruited using universal sampling. Multiple logistic regression was utilised to determine the factors associated with pre-hospital delays of more than 2 hours. Results: A total of 390 patients were included in this study. The median pre-hospital delay time was 3 (interquartile range=1.72) hours, with 77.2% of the patients experiencing delays. Pre-hospital delays of more than 2 hours were significantly associated with atypical chest pain (adjusted odds ratio [AOR]=3.33; 95% confidence interval [CI]=1.73, 6.41; P<0.001), no history of hyperlipidaemia (AOR=2.03; 95% CI=1.09, 3.80; P= .027), transportation sent by another person (AOR=17.11; 95% CI=8.44, 34.71; P<0.001) and self-driven transportation (AOR=16.93; 95% CI=5.09, 56.30; P<0.001). Conclusion: The majority of the patients with ACS experienced pre-hospital delays of more than 2 hours. Interventions aimed at increasing public awareness about the symptoms of ACS and available modes of transportation are important for improving emergency cardiac care in Malaysia.
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Wan Ahmad WA, editors. Annual Report of the NCVD-ACS Registry, 2020-2021. Kuala Lumpur, Malaysia: National Heart Association of Malaysia (NHAM) and the Malaysian Ministry of Health; 2021.
Nowbar AN, Gitto M, Howard JP, Francis DP, Al-Lamee R. Mortality From Ischemic Heart Disease. Circ Cardiovasc Qual Outcomes. 2019;12(6):e005375. doi:10.1161/CIRCOUTCOMES.118.005375.
Taher T, Fu Y, Wagner GS, et al. Aborted myocardial infarction in patients with ST-segment elevation: insights from the Assessment of the Safety and Efficacy of a New Thrombolytic Regimen-3 Trial Electrocardiographic Substudy. J Am Coll Cardiol. 2004;44(1):38-43. doi:10.1016/j.jacc.2004.03.041.
Wu JR, Moser DK, Riegel B, McKinley S, Doering LV. Impact of prehospital delay in treatment seeking on in-hospital complications after acute myocardial infarction. J Cardiovasc Nurs. 2011;26(3):184-193. doi:10.1097/JCN.0b013e3181efea66.
Dracup K, Moser DK, Eisenberg M, Meischke H, Alonzo AA, Braslow A. Causes of delay in seeking treatment for heart attack symptoms. Soc Sci Med. 1995;40(3):379-392. doi:10.1016/0277-9536(94)00278-2.
Khraim FM, Carey MG. Predictors of pre-hospital delay among patients with acute myocardial infarction. Patient Educ Couns. 2009;75(2):155-161. doi:10.1016/j.pec.2008.09.019.
Gersh BJ, Antman EM. Selection of the optimal reperfusion strategy for STEMI: does time matter?. Eur Heart J. 2006;27(7):761-763. doi:10.1093/eurheartj/ehi775.
Antman EM. Time is muscle: translation into practice. J Am Coll Cardiol. 2008;52(15):1216-1221. doi:10.1016/j.jacc.2008.07.011.
De Luca G, Suryapranata H, Ottervanger JP, Antman EM. Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation. 2004;109(10):1223-1225. doi:10.1161/01.CIR.0000121424.76486.20.
Malaysian Clinical Practice Guidelines. Clinical Practice Guidelines Management of ST Elevation Myocardial Infarction ( STEMI ) 2019 4 th Edition. 2019: 62-64. Retrieved from http://www.acadmed.org.my.
Ibánez B, James S, Agewall S, et al. 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Rev Esp Cardiol (Engl Ed). 2017;70(12):1082. doi:10.1016/j.rec.2017.11.010.
Mooney M, McKee G, Fealy G, O' Brien F, O'Donnell S, Moser D. A randomized controlled trial to reduce prehospital delay time in patients with acute coronary syndrome (ACS). J Emerg Med. 2014;46(4):495-506. doi:10.1016/j.jemermed.2013.08.114
Perkins-Porras L, Whitehead DL, Strike PC, Steptoe A. Pre-hospital delay in patients with acute coronary syndrome: factors associated with patient decision time and home-to-hospital delay. Eur J Cardiovasc Nurs. 2009;8(1):26-33. doi:10.1016/j.ejcnurse.2008.05.001.
Quinn JR. Delay in seeking care for symptoms of acute myocardial infarction: applying a theoretical model. Res Nurs Health. 2005;28(4):283-294. doi:10.1002/nur.20086.
Ting HH, Chen AY, Roe MT, et al. Delay from symptom onset to hospital presentation for patients with non-ST-segment elevation myocardial infarction. Arch Intern Med. 2010;170(20):1834-1841. doi:10.1001/archinternmed.2010.385.
Ting HH, Bradley EH, Wang Y, et al. Factors associated with longer time from symptom onset to hospital presentation for patients with ST-elevation myocardial infarction. Arch Intern Med. 2008;168(9):959-968. doi:10.1001/archinte.168.9.959T.
Fukuoka Y, Dracup K, Rankin SH, et al. Prehospital delay and independent/interdependent construal of self among Japanese patients with acute myocardial infarction. Soc Sci Med. 2005;60(9):2025-2034. doi:10.1016/j.socscimed.2004.08.053.
Guan W, Venkatesh AK, Bai X, et al. Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study. Eur Heart J Qual Care Clin Outcomes. 2019;5(1):63-71. doi:10.1093/ehjqcco/qcy022.
George L, Ramamoorthy L, Satheesh S, Saya RP, Subrahmanyam DK. Prehospital delay and time to reperfusion therapy in ST elevation myocardial infarction. J Emerg Trauma Shock. 2017;10(2):64-69. doi:10.4103/0974-2700.201580.
Srimahachota S, Kanjanavanit R, Boonyaratavej S, et al. Demographic, management practices and in-hospital outcomes of Thai Acute Coronary Syndrome Registry (TACSR): the difference from the Western world. J Med Assoc Thai. 2007;90 Suppl 1:1-11.
Lim SC, Rahman A, Yaacob NM. Pre-Hospital Factors Influencing Time of Arrival at Emergency Departments for Patients with Acute ST-Elevation Myocardial Infarction. Malays J Med Sci. 2019;26(1):87-98. doi:10.21315/mjms2019.26.1.8.
Wechkunanukul K, Grantham H, Clark RA. Global review of delay time in seeking medical care for chest pain: An integrative literature review. Aust Crit Care. 2017;30(1):13-20. doi:10.1016/j.aucc.2016.04.002.
Kim HS, Lee KS, Eun SJ, et al. Gender Differences in Factors Related to Prehospital Delay in Patients with ST-Segment Elevation Myocardial Infarction. Yonsei Med J. 2017;58(4):710-719. doi:10.3349/ymj.2017.58.4.710.
McKee G, Mooney M, O'Donnell S, O'Brien F, Biddle MJ, Moser DK. Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome. Int J Cardiol. 2013;168(3):2706-2713. doi:10.1016/j.ijcard.2013.03.022.
Nymark C, Mattiasson AC, Henriksson P, Kiessling A. Emotions delay care-seeking in patients with an acute myocardial infarction. Eur J Cardiovasc Nurs. 2014;13(1):41-47. doi:10.1177/1474515113475953.
Mussi FC, Mendes AS, Queiroz TL, Costa AL, Pereira Á, Caramelli B. Pre-hospital delay in acute myocardial infarction: judgement of symptoms and resistance to pain. Rev Assoc Med Bras (1992). 2014;60(1):63-69. doi:10.1590/1806-9282.60.01.014.
Taghaddosi M, Dianati M, Fath Gharib Bidgoli J, Bahonaran J. Delay and its related factors in seeking treatment in patients with acute myocardial infarction. ARYA Atheroscler. 2010;6(1):35-41.
Rannan-Eliya RP, Anuranga C, Manual A, et al. Improving Health Care Coverage, Equity, And Financial Protection Through A Hybrid System: Malaysia's Experience. Health Aff (Millwood). 2016;35(5):838-846. doi:10.1377/hlthaff.2015.0863.
Safurah Jaafar, Kamaliah Mohd Noh, Khairiyah Abdul Muttalib, Nour Hanah Othman, Healy J. Malaysia Health System Review (Health Systems in Transition). WHO (on behalf Asia Pacific Obs Heal Syst Policies). 2013;3(1):1–122.
Goldberg RJ, Steg PG, Sadiq I, et al. Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). Am J Cardiol. 2002;89(7):791-796. doi:10.1016/s0002-9149(02)02186-0.
Saczynski JS, Yarzebski J, Lessard D, et al. Trends in prehospital delay in patients with acute myocardial infarction (from the Worcester Heart Attack Study). Am J Cardiol. 2008;102(12):1589-1594. doi:10.1016/j.amjcard.2008.07.056.
Nilsson G, Mooe T, Söderström L, Samuelsson E. Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population. BMC Cardiovasc Disord. 2016;16:93. Published 2016 May 12. doi:10.1186/s12872-016-0271-x.
Zhang Z. Model building strategy for logistic regression: Purposeful selection. Ann Transl Med. 2016;4(6):4–10. Ann Transl Med. 2016 ;4(6):111. doi: 10.21037/atm.2016.02.15.
Coventry LL, Bremner AP, Williams TA, Celenza A. The effect of presenting symptoms and patient characteristics on prehospital delay in MI patients presenting to emergency department by ambulance: a cohort study. Heart Lung Circ. 2015;24(10):943-950. doi:10.1016/j.hlc.2015.02.026.
Song L, Yan HB, Yang JG, Sun YH, Hu DY. Impact of patients' symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction. Chin Med J (Engl). 2010;123(14):1840-1845.
Park YH, Kang GH, Song BG, et al. Factors related to prehospital time delay in acute ST-segment elevation myocardial infarction. J Korean Med Sci. 2012;27(8):864-869. doi:10.3346/jkms.2012.27.8.864.
Rafi A, Sayeed Z, Sultana P, Aik S, Hossain G. Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh. BMC Health Serv Res. 2020;20(1):633. Published 2020 Jul 9. doi:10.1186/s12913-020-05505-x.
Juwana YB, Wirianta J, Ottervanger JP, et al. Primary coronary intervention for ST-elevation myocardial infarction in Indonesia and the Netherlands: a comparison. Neth Heart J. 2009;17(11):418-421. doi:10.1007/BF03086295.
Gulati M, Levy PD, Mukherjee D, et al. 2021 AHA/ACC/ASE/CHEST/SAEM/SCCT/SCMR Guideline for the Evaluation and Diagnosis of Chest Pain: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2021 Nov 30;144(22):e455. doi: 10.1161/CIR.0000000000001047.
Peng YG, Feng JJ, Guo LF, et al. Factors associated with prehospital delay in patients with ST-segment elevation acute myocardial infarction in China. Am J Emerg Med. 2014;32(4):349-355. doi:10.1016/j.ajem.2013.12.053
Rafi A, Sayeed Z, Sultana P, Aik S, Hossain G. Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh. BMC Health Serv Res. 2020;20(1):633. doi:10.1186/s12913-020-05505-x.
Khan MS, Jafary FH, Faruqui AM, et al. High prevalence of lack of knowledge of symptoms of acute myocardial infarction in Pakistan and its contribution to delayed presentation to the hospital. BMC Public Health. 2007;7:284. Published 2007 Oct 9. doi:10.1186/1471-2458-7-284.