Pre hospital delay and its associated factors in acute myocardial infarction in a developing country.

<h4>Background</h4>Early 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...

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Autores principales:	Ishmum Zia Chowdhury, Md Nurul Amin, Mashhud Zia Chowdhury, Sharar Muhib Rahman, Mohsin Ahmed, F Aaysha Cader
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/76a94d22a78743b9949eff2e6d772ffc
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spelling	oai:doaj.org-article:76a94d22a78743b9949eff2e6d772ffc2021-12-02T20:16:08ZPre hospital delay and its associated factors in acute myocardial infarction in a developing country.1932-620310.1371/journal.pone.0259979https://doaj.org/article/76a94d22a78743b9949eff2e6d772ffc2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0259979https://doaj.org/toc/1932-6203<h4>Background</h4>Early 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.<h4>Methods</h4>This 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.<h4>Results</h4>The 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.<h4>Conclusion</h4>Acute 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.Ishmum Zia ChowdhuryMd Nurul AminMashhud Zia ChowdhurySharar Muhib RahmanMohsin AhmedF Aaysha CaderPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11, p e0259979 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Ishmum Zia Chowdhury Md Nurul Amin Mashhud Zia Chowdhury Sharar Muhib Rahman Mohsin Ahmed F Aaysha Cader Pre hospital delay and its associated factors in acute myocardial infarction in a developing country.
description	<h4>Background</h4>Early 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.<h4>Methods</h4>This 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.<h4>Results</h4>The 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.<h4>Conclusion</h4>Acute 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.
format	article
author	Ishmum Zia Chowdhury Md Nurul Amin Mashhud Zia Chowdhury Sharar Muhib Rahman Mohsin Ahmed F Aaysha Cader
author_facet	Ishmum Zia Chowdhury Md Nurul Amin Mashhud Zia Chowdhury Sharar Muhib Rahman Mohsin Ahmed F Aaysha Cader
author_sort	Ishmum Zia Chowdhury
title	Pre hospital delay and its associated factors in acute myocardial infarction in a developing country.
title_short	Pre hospital delay and its associated factors in acute myocardial infarction in a developing country.
title_full	Pre hospital delay and its associated factors in acute myocardial infarction in a developing country.
title_fullStr	Pre hospital delay and its associated factors in acute myocardial infarction in a developing country.
title_full_unstemmed	Pre hospital delay and its associated factors in acute myocardial infarction in a developing country.
title_sort	pre hospital delay and its associated factors in acute myocardial infarction in a developing country.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/76a94d22a78743b9949eff2e6d772ffc
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Pre hospital delay and its associated factors in acute myocardial infarction in a developing country.

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