Dataset Information

Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh.

ABSTRACT:

Background

Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study aimed to investigate the significant factors associated with prolonged pre-hospital delay and the impact of this delay on in-hospital mortality among patients with MI in Northern Bangladesh.

Methods

This cross sectional study was conducted in December 2019 in cardiology ward of a 1000-bed tertiary care hospital of Bangladesh. Patients admitted in the ward with the diagnosis of myocardial infarction were included in the study. Socio demographic data, clinical features and patients' health seeking behavior was collected in a structured questionnaire from the patients. Median with interquartile range (IQR) of pre hospital delay were calculated and compared between different groups. Chi-square (?²) test and binary logistic regression were used to estimate the determinants of pre-hospital delay and effect of pre-hospital delay on in-hospital mortality.

Results

Three hundred thirty-seven patients was enrolled in the study and their median (IQR) pre-hospital delay was 9.0 (13.0) hours. 39.5% patients admitted in the specialized hospital within 6?h. In logistic regression, determinants of pre-hospital delay were patients age (for 2?=?0.303).

Conclusion

Some modifiable factors contribute to higher pre-hospital delay of MI patients, resulting in increased in-hospital mortality. Patients' awareness about cardiovascular diseases and improved referral pathway of the existing health care system may reduce this unexpected delay.

SUBMITTER: Rafi A

PROVIDER: S-EPMC7346615 | biostudies-literature | 2020 Jul

REPOSITORIES: biostudies-literature

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Publications

Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh.

Rafi Abdur A Sayeed Zahidus Z Sultana Papia P Aik Saw S Hossain Golam G

BMC health services research 20200709 1

<h4>Background</h4>Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study aimed to investigate the significant factors associated with prolonged pre-hospital delay and the impact of this delay on in-hospital mortality among patients with MI in Northern Bangladesh.<h4>Methods</h4>This cross sectional study was conducted in December 2019 in cardiology ward of a 1000-bed tertiary care hospital of Bangladesh. Patient ...[more]

PMID: 32646521

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Project description:BackgroundEarly revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka.MethodsThis retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay.ResultsThe mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5-9.9)], diabetes [OR: 1.7 (95% CI: 1.0-2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3-7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0-3.5)] were significantly associated with pre-hospital delays.ConclusionAcute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.

Project description:IntroductionMyocardial Infarction (MI) is a leading cause of death worldwide. In high income countries, quality improvement strategies have played an important role in increasing uptake of evidence-based MI care and improving MI outcomes. The incidence of MI in sub-Saharan Africa is rising, but uptake of evidence-based care in northern Tanzania is low. There are currently no published quality improvement interventions from the region. The objective of this study was to determine provider attitudes towards a planned quality improvement intervention for MI care in northern Tanzania.MethodsThis study was conducted at a zonal referral hospital in northern Tanzania. A 41-question survey, informed by the Theoretical Framework for Acceptability, was developed by an interdisciplinary team from Tanzania and the United States. The survey, which explored provider attitudes towards MI care improvement, was administered to key provider stakeholders (physicians, nurses, and hospital administrators) using convenience sampling.ResultsA total of 140 providers were enrolled, including 82 (58.6%) nurses, 56 (40.0%) physicians, and 2 (1.4%) hospital administrators. Most participants worked in the Emergency Department or inpatient medical ward. Providers were interested in participating in a quality improvement project to improve MI care at their facility, with 139 (99.3%) strongly agreeing or agreeing with this statement. All participants agreed or strongly agreed that improvements were needed to MI care pathways at their facility. Though their facility has an MI care protocol, only 88 (62.9%) providers were aware of it. When asked which intervention would be the single-most effective strategy to improve MI care, the two most common responses were provider training (n = 66, 47.1%) and patient education (n = 41, 29.3%).ConclusionProviders in northern Tanzania reported strongly positive attitudes towards quality improvement interventions for MI care. Locally-tailored interventions to improve MI should include provider training and patient education strategies.

Dataset Information

Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh.

Background

Methods

Results

Conclusion

Publications

Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh.

Similar Datasets

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