Factors associated with prehospital delay in men and women with acute coronary syndrome
DOI:
https://doi.org/10.23938/S1137-6627/2016000100006Keywords:
Síndrome Coronario Agudo. Demora prehospitalaria. Género. Servicios de emergencias sanitarias. DesigualdadesAbstract
ABSTRACT
Objective. To identify factors associated with prehospital delay in people who have had an acute coronary syndrome.
Methods. Using a survey we studied patients admitted due to acute coronary syndrome in the 33 Andalusian public hospitals, obtaining information about different types of variables: socio-demographic, contextual, clinical, perception, action, and transportation. Multivariate logistic regression models were applied to calculate the odds ratios for the delay.
Results. Of the 1,416 patients studied, more than half had a delay of more than an hour. This is associated to distance to the hospital and means of transport: when the event occurs in the same city, using the patient’s own means of transport increases the delay, odds ratio = 1.51 (1.02 to 2.23); if the distance is 1 to25 kilometers from the hospital, there is no difference between the patient’s own means of transport and an ambulance, odds ratio = 1.41 and odds ratio =1.43 respectively; and when the distance exceeds25 kilometers transport by ambulance means more delay, odds ratio = 3.13 and odds ratio = 2.20 respectively. Also, typical symptoms reduce delay amongst men but increase amongst women. Also, not caring and waiting for the resolution of symptoms, seeking health care other than a hospital or emergency services, previous clinical history, being away from home, and having an income under 1,500 euros, all increase delay.
Conclusions. Prehospital delay times do not meet health recommendations. The physical and social environment, in addition to clinical, perceptual and attitudinal factors, are associated with this delay.
Keywords. Acute coronary syndrome. Pre-hospital delay. Gender. Emergency medical services. Inequalities.
Downloads
References
1. NICHOLS M, TOWNSEND N, SCARBOROUGH P, RAYNER M. Cardiovascular disease in Europe: epidemiological update. Eur Heart J 2013; 34: 3028-3034.
https://doi.org/10.1093/eurheartj/eht356
2. BOERSMA E, MAAS AC, DECKERS JW, SIMOONS ML. Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour. Lancet 1996; 348: 771-775.
https://doi.org/10.1016/S0140-6736(96)02514-7
3. 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-tohospital delay. Eur J Cardiovasc Nurs 2009; 8: 26-33.
https://doi.org/10.1016/j.ejcnurse.2008.05.001
4. ARMSTRONG PW, GERSHLICK AH, GOLDSTEIN P, WILCOX R, DANAYS T, LAMBERT Y et al. For the STREAM investigative team. Fibrinolysis or primary PCI in ST-segment elevation myocardial infarction. N Engl J Med 2013; 368: 1379-1387.
https://doi.org/10.1056/NEJMoa1301092
5. BOERSMA E and The Primary Coronary Angioplasty vs. Thrombolysis (PCAT)-2 Trialists' Collaborative Group. Does time matter? A pooled analysis of randomized clinical trials comparing primary percutaneous coronary intervention and in-hospital fibrinolysis in acute myocardial infarction patients. Eur Heart J 2006; 27: 779-788.
https://doi.org/10.1093/eurheartj/ehi810
6. NALLAMOTHU B, FOX KA, KENNELLY BM, VAN DE WERF F, GORE JM, STEG PG et al. Relationship of treatment delays and mortality in patients undergoing fibrinolysis and primary percutaneous coronary intervention. The Global Registry of Acute Coronary Events. Heart 2007; 93: 1552-1555.
https://doi.org/10.1136/hrt.2006.112847
7. GOLDBERG RJ1, SPENCER FA, FOX KA, BRIEGER D, STEG PG, GURFINKEL E et al. Prehospital delay in patients with Acute Coronary Syndromes (from the Global Registry of Acute Coronary Events [GRACE]). Am J Cardiol 2009: 103: 598-603.
https://doi.org/10.1016/j.amjcard.2008.10.038
8. GÄRTNER C, WALZ L, BAUERNSCHMITT E, LADWIG KH. The causes of prehospital delay in myocardial infarction. Dtsch Arztebl Int 2008; 105: 286-291.
https://doi.org/10.3238/arztebl.2008.0286
9. LEFLER LL, BONDY KN. Women's delay in seeking treatment with myocardial infarction: a meta-synthesis. J Cardiovasc Nurs 2004; 19: 251-268.
https://doi.org/10.1097/00005082-200407000-00005
10. KAINTH A. HEWITT A. SOWDEN A. Systematic review of interventions to reduce delay in patients with suspected heart attack. Emerg Med J 2004; 21: 506-508.
https://doi.org/10.1136/emj.2003.013276
11. ÁLVAREZ BUENO M, VERA ALMAZÁN A, RODRÍGUEZ GARCÍA JJ. Concepto, desarrollo y objetivos del proyecto ARIAM. Med Intensiva 1999; 23: 273-280.
12. RUIZ-BAILÉN M, DE HOYOS EA, REINA-TORAL A, TORRES-RUIZ JM, ALVAREZ-BUENO M, GÓMEZ JIMÉNEZ FJ et al. Paradoxical effect of smoking in the spanish population with acute myocardial infarction or unstable angina: Results of the ARIAM register. Chest 2004 ; 125: 831-840.
https://doi.org/10.1378/chest.125.3.831
13. BOLÍVAR-MUÑOZ J, DAPONTE-CODINA A, PASCUAL-MARTÍNEZ N, BARRANCO-RUIZ F, SÁNCHEZ-CRUZ JJ, MARTÍN-CASTRO C et al. The decision to ask for urgent attention in patients with ischemic cardiopathy. Int J Qual Health Care 2007; 19: 407-413.
https://doi.org/10.1093/intqhc/mzm038
14. HORNE R, JAMES D, PETRIE K, WEINMAN J, VINCENT R. Patients' interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction. Heart 2000; 83: 388-393.
https://doi.org/10.1136/heart.83.4.388
15. THURESSON M, JARLOV MB, LINDAHL B, SVENSSON L, ZEDIGH C, HERLITZ J et al. Thoughts, actions and factors associated with prehospital delay in patients with acute coronary syndrome. Heart Lung 2007; 36: 398-409.
https://doi.org/10.1016/j.hrtlng.2007.02.001
16. BOLÍVAR-MUÑOZ J, MARTÍNEZ-CASSINELLO R, MATEO-RODRÍGUEZ I, TORRES-RUIZ JM, PASCUAL-MARTÍNEZ N, ROSELL-ORTIZ F et al. Actuaciones de pacientes ante el Síndrome Coronario Agudo, diferencias desde una perspectiva de género. Emergencias 2013; 25: 23-30.
17. FERRAZ-TORRES M1, BELZUNEGUI OTANO T, MARÍN FERNÁNDEZ B, MARTÍNEZ-GARCÍA O, JIMÉNEZ FÁBREGAS X. Diferencias según sexo en el tratamiento y la evolución de los pacientes afectados de síndrome coronario agudo. An Sist Sanit Navar 2014; 37: 249-255.
https://doi.org/10.4321/S1137-66272014000200008
18. MCKEE G, MOONEY M, O'DONNELL S, O'BRIEN F, BIDDLE MJ et al. Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome. Int J Cardiol 2013; 168: 2706-2713.
https://doi.org/10.1016/j.ijcard.2013.03.022
19. SONG L, YAN H, HU D. Patients with acute myocardial infarction using ambulance or private transport to reach definitive care: which mode is quicker? Intern Med J 2010; 40: 112-116.
https://doi.org/10.1111/j.1445-5994.2009.01944.x
20. KHRAIM FM, CAREY MG. Predictors of pre-hospital delay among patients with acute myocardial infarction. Patient Educ Couns 2009; 75: 155-161.
https://doi.org/10.1016/j.pec.2008.09.019
21. LESLIE WS, URIE A, HOOPER J, MORRISON CE. Delay in calling for help during myocardial infarction: reasons for the delay and subsequent pattern of accessing care. Heart 2000; 84: 137-141.
https://doi.org/10.1136/heart.84.2.137
22. SULLIVAN MD, CIECHANOWSKI PS, RUSSO JE, SOINE LA, JORDAN-KEITH K, TING HH et al. Understanding why patients delay seeking care for acute coronary syndromes. Circ Cardiovasc Qual Outcomes 2009; 2: 148-154.
https://doi.org/10.1161/CIRCOUTCOMES.108.825471
23. ALONZO AA. The effect of health care provider consultation on acute coronary syndrome care-seeking delay. Heart Lung 2007; 36: 307-318.
https://doi.org/10.1016/j.hrtlng.2007.05.002
24. COVENTRY LL, FINN J, BREMNER AP. Sex differences in symptom presentation in acute myocardial infarction: A systematic review and meta-analysis. Heart & Lung 2011; 40: 477-491.
https://doi.org/10.1016/j.hrtlng.2011.05.001
25. ROSENFELD AG, LINDAUER A, DARNEY B G. Understanding treatment‐seeking delay in women with acute myocardial infarction: descriptions of decision-making patterns. Am J Crit Care 2005; 14: 285-293.
https://doi.org/10.4037/ajcc2005.14.4.285
26. HART PL. Women's perceptions of coronary heart disease: an integrative review. J Cardiovasc Nurs 2005; 20: 170-176.
https://doi.org/10.1097/00005082-200505000-00008
27. HAMMOND J, SALAMONSON Y, DAVIDSON P, EVERETT B, ANDREW S. Why do women underestimate the risk of cardiac disease? A literature review. Aust Crit Care 2007; 20: 53-59.
https://doi.org/10.1016/j.aucc.2007.02.001
28. EMSLIE C, HUNT K. Men, masculinities and heart disease: A systematic review of the qualitative literature. Curr Sociol 2009; 57: 155-193.
https://doi.org/10.1177/0011392108099161
29. NGUYEN H, GORE J, SACZYNSKI J, YARZEBSKI R, SPENCER FA, GOLDBERG RJ et al. Age and sex differences and 20-year trends (1986 to 2005) in prehospital delay in patients hospitalized with acute myocardial infarction. Circulation: Cardiovascular Quality Outcomes 2010; 3: 590-598.
https://doi.org/10.1161/CIRCOUTCOMES.110.957878
30. LOVLIEN M, SCHEI B, HOLE T. Myocardial infarction: psychosocial aspects, gender differences and impact on pre-hospital delay. J Adv Nurs 2008; 63: 148-154.
https://doi.org/10.1111/j.1365-2648.2008.04654.x
31. ALCONERO A, MUÑOZ P, REVUELTA JM. Tiempos de demora de atención sanitaria en el infarto agudo de miocardio: diferencias por sexos. Rev Esp Cardiol 2013; 66: 64-73.
https://doi.org/10.1016/j.recesp.2012.04.022
32. Comisión sobre determinantes sociales de la salud. Subsanar las desigualdades en una generación. Organización Mundial de la Salud 2009.
33. MOONEY M, MCKEE G, FEALY G, O'BRIEN F, O'DONNELL S, MOSER D et al. A review of interventions aimed at reducing pre-hospital delay time in acute coronary syndrome: what has worked and why? Eur J Cardiovasc Nurs 2012; 11: 445-453.
https://doi.org/10.1016/j.ejcnurse.2011.04.003
34. MIRÓ O. Necesidad de colaboración en investigación entre cardiólogos y médicos de urgencias. An Sist Sanit Navar 2014; 37: 9-16.
https://doi.org/10.4321/S1137-66272014000100002
35. MIRÓ O. Las dificultades para la colaboración en investigación entre cardiólogos y médicos de urgencias. An Sist Sanit Navar 2015; 38: 141.
https://doi.org/10.4321/S1137-66272015000100018
36. Sex and Gender in Cardiovascular Disease; European Gender Medicine. En: http://www.eugenmed.eu/http://www.eugenmed.eu/images/meetings/policy_briefs/EUGenMed_CVD.pdf
Published
How to Cite
Issue
Section
License
Copyright (c) 2016 Anales del Sistema Sanitario de Navarra
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
La revista Anales del Sistema Sanitario de Navarra es publicada por el Departamento de Salud del Gobierno de Navarra (España), quien conserva los derechos patrimoniales (copyright ) sobre el artículo publicado y favorece y permite la difusión del mismo bajo licencia Creative Commons Reconocimiento-CompartirIgual 4.0 Internacional (CC BY-SA 4.0). Esta licencia permite copiar, usar, difundir, transmitir y exponer públicamente el artículo, siempre que siempre que se cite la autoría y la publicación inicial en Anales del Sistema Sanitario de Navarra, y se distinga la existencia de esta licencia de uso.
