Volume 21, Issue 1 (April 2023)
Nursing and Midwifery Journal 2023, 21(1): 12-24 |
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Emamimehr L, Ghahramanian A, Nabighadim A, Rahmani A, Hajieskandar A. PRE-HOSPITAL AND IN-HOSPITAL DELAY IN TREATMENT OF PATIENTS WITH ACUTE MYOCARDIAL INFARCTION ADMITTED TO IMAM KHOMEINI HOSPITAL OF BENAB CITY, IRAN. Nursing and Midwifery Journal 2023; 21 (1) :12-24
URL: http://unmf.umsu.ac.ir/article-1-4839-en.html
URL: http://unmf.umsu.ac.ir/article-1-4839-en.html
Lida Emamimehr1 
, Akram Ghahramanian * 2, Amirreza Nabighadim3 , Azad Rahmani4 , Alireza Hajieskandar5
, Akram Ghahramanian * 2, Amirreza Nabighadim3 , Azad Rahmani4 , Alireza Hajieskandar5
1- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Islamic Azad University of Bonab, Iran
2- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (Corresponding Author) , ghahramaniana@gmail.com
3- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
4- Medical-surgical Department, Nursing & Midwifery Faculty, Medical Education Research Center, Tabriz University of Medical Sciences, South Shariati Street, Tabriz, East Azerbaijan Province, Iran
5- Department of Computer, Bonab Branch, Islamic Azad University, Bonab, Iran
2- Department of Medical Surgical Nursing, Faculty of Nursing and Midwifery, Tabriz University of Medical Sciences, Tabriz, Iran (Corresponding Author) , ghahramaniana@gmail.com
3- Pediatric Urology and Regenerative Medicine Research Center, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
4- Medical-surgical Department, Nursing & Midwifery Faculty, Medical Education Research Center, Tabriz University of Medical Sciences, South Shariati Street, Tabriz, East Azerbaijan Province, Iran
5- Department of Computer, Bonab Branch, Islamic Azad University, Bonab, Iran
Abstract: (728 Views)
Background & Aims: The delay from the onset of acute myocardial infarction (AMI) symptoms to seeking medical help can have life-threatening consequences. This study was performed to determine the pre-hospital and in-hospital delay in treating the patients with AMI hospitalized in the hospital of Bonab city, Iran.
Materials & Methods: The present study was a descriptive, cross-sectional study performed from February 2020 to August 2020. Among 265 patients diagnosed with AMI referred to Imam Khomeini Hospital in Bonab city, 247 patients were eligible to include in the study. The data was collected by a three-part questionnaire including demographic information, the patient's medical history, and reasons for the delay in pre-hospital and in-hospital treatment. The validity and reliability of the questionnaire were checked by content validity and intra-class correlation coefficient, respectively. The data were analyzed in SPSS version 16 at a significance level of less than 0.05.
Results: Most of the patients (%74.5) attributed symptoms of AMI to gastrointestinal and respiratory problems. The mean time for decision-making was 2.31±2.99 hours. Moreover, just a few numbers of them (%6.5) informed the emergency medical services after the onset of symptoms. The mean time of transmission of patients to the Cardiac Care Unit (CCU) was 3.81 hours. From them, %62.34 had not received thrombolytic therapy. Also, the mean time of taking the first dose of aspirin since the onset of symptoms was 3.75±2.99 hours. There was a significant relationship between decision-making time and sex (p= 0.03), rural residence (p= 0.04), and the job of the patients (p=0.001).
Conclusion: Prolonged delay was related to delay in patients’ decision-making for informing emergency medical services as well as referral of primary care services to the CCU ward. Interventions should be taken to recognize cognitive and behavioral factors involved in decision-making. New public health strategies should be developed to facilitate rapid access to acute care for AMI and to increase knowledge of people about the signs and symptoms of AMI.
Materials & Methods: The present study was a descriptive, cross-sectional study performed from February 2020 to August 2020. Among 265 patients diagnosed with AMI referred to Imam Khomeini Hospital in Bonab city, 247 patients were eligible to include in the study. The data was collected by a three-part questionnaire including demographic information, the patient's medical history, and reasons for the delay in pre-hospital and in-hospital treatment. The validity and reliability of the questionnaire were checked by content validity and intra-class correlation coefficient, respectively. The data were analyzed in SPSS version 16 at a significance level of less than 0.05.
Results: Most of the patients (%74.5) attributed symptoms of AMI to gastrointestinal and respiratory problems. The mean time for decision-making was 2.31±2.99 hours. Moreover, just a few numbers of them (%6.5) informed the emergency medical services after the onset of symptoms. The mean time of transmission of patients to the Cardiac Care Unit (CCU) was 3.81 hours. From them, %62.34 had not received thrombolytic therapy. Also, the mean time of taking the first dose of aspirin since the onset of symptoms was 3.75±2.99 hours. There was a significant relationship between decision-making time and sex (p= 0.03), rural residence (p= 0.04), and the job of the patients (p=0.001).
Conclusion: Prolonged delay was related to delay in patients’ decision-making for informing emergency medical services as well as referral of primary care services to the CCU ward. Interventions should be taken to recognize cognitive and behavioral factors involved in decision-making. New public health strategies should be developed to facilitate rapid access to acute care for AMI and to increase knowledge of people about the signs and symptoms of AMI.
Keywords: Acute Myocardial Infarction, Decision Making, Emergency Care, In-Hospital, Pre-Hospital, Treatment Delay
References
1. Kaptoge S, Pennells L, De Bacquer D, Cooney MT, Kavousi M, Stevens G, et al. World Health Organization cardiovascular disease risk charts: revised models to estimate risk in 21 global regions. Lancet Glob Health 2019;7(10):e1332-45. Available from: http://dx.doi.org/10.1016/s2214-109x(19)30318-3. [DOI:10.1016/S2214-109X(19)30318-3] [PMID]
2. Azami-Aghdash S, Gharaee H, Aghaei MH, Derakhshani N. Cardiovascular diseases patient's Quality of Life in Tabriz-Iran: 2018. Journal of Community Health Research. 2019;8(4):245-52. [DOI:10.18502/jchr.v8i4.2080]
3. Ohira T, Iso H. Cardiovascular disease epidemiology in Asia: an overview. Circ J 2013;77(7):1646-52. [DOI:10.1253/circj.CJ-13-0702] [PMID]
4. Sarrafzadegan N, Mohammadifard N. Cardiovascular Disease in Iran in the Last 40 Years: Prevalence, Mortality, Morbidity, Challenges and Strategies for Cardiovascular Prevention. Arch Iran Med 2019;22(4). [Google Scholar]
5. khosravi A, Ebrahim H. Evaluation of 1-Year Survival Rate and Effective Factors in Patients with Acute Myocardial Infarction. Knowl Health J 2008;3(1):9-15. [URL]
6. Kim H-S, Lee K-S, Eun SJ, Choi S-W, Kim DH, Park T-H, et al. Gender Differences in Factors Related to Prehospital Delay in Patients with ST-Segment Elevation Myocardial Infarction. Yonsei Med J 2017;58(4):710-9. [DOI:10.3349/ymj.2017.58.4.710] [PMID] [PMCID]
7. Bouisset F, Deney A, Ferrières J, Panagides V, Becker M, Riviere N, et al. Mechanical complications in ST-elevation myocardial infarction: The impact of pre-hospital delay. Int J Cardiol 2021;345:14-9. Available from: http://dx.doi.org/10.1016/j.ijcard.2021.10.020. [DOI:10.1016/j.ijcard.2021.10.020] [PMID]
8. Bulluck H, Yellon DM, Hausenloy DJ. Reducing myocardial infarct size: challenges and future opportunities. Heart 2016;102(5):341-8. [DOI:10.1136/heartjnl-2015-307855] [PMID] [PMCID]
9. Baek Y-S, Park S-D, Kim S-H, Lee M-J, Shin S-H, Kim D-H, et al. Clinical and angiographic predictors of microvascular dysfunction in ST-segment elevation myocardial infarction. Yonsei Med J 2015;56(5):1235-43. [DOI:10.3349/ymj.2015.56.5.1235] [PMID] [PMCID]
10. Banks AD, Dracup K. Factors associated with prolonged prehospital delay of African Americans with acute myocardial infarction. Am J Crit Care 2006;15(2):149-57. [DOI:10.4037/ajcc2006.15.2.149]
11. Vallabhajosyula S, Vallabhajosyula S, Bell MR, Prasad A, Singh M, White RD, et al. Early vs. delayed in-hospital cardiac arrest complicating ST-elevation myocardial infarction receiving primary percutaneous coronary intervention. Resuscitation 2020;148:242-50. [DOI:10.1016/j.resuscitation.2019.11.007] [PMID]
12. Alrawashdeh A, Nehme Z, Williams B, Stub D. Emergency medical service delays in ST-elevation myocardial infarction: a meta-analysis. Heart 2020;106(5):365-73. [DOI:10.1136/heartjnl-2019-315034] [PMID]
13. Fonarow GC, Zhao X, Smith EE, Saver JL, Reeves MJ, Bhatt DL, et al. Door-to-Needle Times for Tissue Plasminogen Activator Administration and Clinical Outcomes in Acute Ischemic Stroke Before and After a Quality Improvement Initiative. JAMA 2014;311(16):1632-40. [DOI:10.1001/jama.2014.3203] [PMID]
14. Song J-X, Zhu L, Lee C-Y, Ren H, Cao C-F, Chen H. Total ischemic time and outcomes for patients with ST-elevation myocardial infarction: does time of admission make a difference? J Geriatr Cardiol 2016;13(8):658. [PMCID]
15. Ribeiro S, Gaspar A, Rocha S, Nabais S, Azevedo P, Salgado A, Pereira MA, Correia A. Predictors of pre-hospital delay in patients with ST-segment elevation myocardial infarction. Rev Port Cardiol 2010 Oct;29(10):1521-32. [Google Scholar]
16. Nielsen CG, Laut KG, Jensen LO, Ravkilde J, Terkelsen CJ, Kristensen SD. Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay. Eur Heart J Acute Cardiovasc Care 2017 Oct;6(7):583-91. [DOI:10.1177/2048872616676570] [PMID]
17. 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):1840-5. [URL]
18. Sari I, Acar Z, Ozer O, Erer B, Tekbaş E, Uçer E, Genç A, Davutoğlu V, Aksoy M. Factors associated with prolonged prehospital delay in patients with acute myocardial infarction. Turk Kardiyol Dern Ars 2008;36(3):156-62. [Google Scholar]
19. O'Donnell S, Condell S, Begley C, Fitzgerald T. In-hospital care pathway delays: gender and myocardial infarction. J Adv Nurs 2005;52(1):14-21. [DOI:10.1111/j.1365-2648.2005.03559.x] [PMID]
20. O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, De Lemos JA, et al. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013;61(4):e78-e140. [Google Scholar]
21. Windecker S, Neumann F-J, Jüni P, Sousa-Uva M, Falk V. Considerations for the choice between coronary artery bypass grafting and percutaneous coronary intervention as revascularization strategies in major categories of patients with stable multivessel coronary artery disease: an accompanying article of the task force of the 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2018;40(2):204-12. [DOI:10.1093/eurheartj/ehy532] [PMID]
22. Hoseinian A, Pourfarzi F, Sepahvand N, Habibzadeh SH, B. B, Doostkami H, et al. The Study of Interval between Onset of the Clinical Symptoms and Streptokinase Receiving in Patients with Acute Myocardial Infarction. J Ardabil Univ Med Sci 2012;12(1):16-24. [Google Scholar]
23. Samadikhah J, Alizade M, Rezaeifar P, Ahadpour A, Ebrahimi BH. Delays in Administration of Streptokinase in Patients with Acute Myocardial Infarction Hospitalized in Shahid Madani Hospital of Tabriz University of Medical Sciences. Med J Tabriz Univ Med Sci 2007;29(3): 71-5. [DOI:10.1016/S0167-5273(08)70724-1]
24. Farshidi H, Abdi AN, Rahimi S, Salehi S. Factors associated with prehospital delay in patients with acute myocardial infarction. Med J Hormozgan 2013;17(1):15-22. [DOI:10.5812/ircmj.2367] [PMID] [PMCID]
25. Sari I, Acar Z, Ozer O, Erer B, Tekbaş E, Uçer E, Genç A, Davutoğlu V, Aksoy M. Factors associated with prolonged prehospital delay in patients with acute myocardial infarction. Turk Kardiyol Dern Ars 2008;36(3):156-62. [Google Scholar]
26. Poursheykhian M, Moghadamnia, Nasirzadeh F. Duration of chest pain to hospitalization in cardiac center, in acute myocardial infarction cases admitted in Rasht, Iran J Forensic Med 2008;13(4):228-34. [URL]
27. Rezaey K, Kohestany HR, Baghcheghy N, Yazdankhahfard M. Evaluation of the time Interval between the onset of symptoms to hospitalization in acute myocardial infarction cases admitted, in Bushehr port in 1384. J Arak Uni Med Sci 2008;11(4):67-75 [Google Scholar]
28. Beig JR, Tramboo NA, Kumar K, Yaqoob I, Hafeez I, Rather FA, et al. Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study. J Saudi Heart Assoc 2017;29(1):7-14. [DOI:10.1016/j.jsha.2016.06.001] [PMID] [PMCID]
29. Rad M, Bidi A, KHALIGH G, Rad M. Factors Linked to Delayed Reference of Myocardial Infarction Patients to Emergency Department of Sabzevar Vaseii Hospital in 1390-91. Beyhagh 2015;20(3):19-29. [URL]
30. Rahmani R, Hamidi Z, Karimi-zarchi AA, Salari M. Evaluation of trigger factors incidence of time and delaying factors in patients with acute myocardial infarction. Koosar Med J 2006;11:273-8. [Google Scholar]
31. Choudhary R, Sharma SM, Kumar V, Gautam DK. An Observational study of prehospital and hospital delay in reperfusion for acute myocardial infarction at a University Hospital in India. J Pract Cardiovasc Sci 2016;2(3):163. [DOI:10.4103/2395-5414.201378]
32. Gharakhani M, Naghsh-Tabrizi B, Emami F, Seif-Rabiee MA. Evaluation of the time interval between the beginning of acute chest pain in the patients with acute myocardial infarction and admission of them at coronary care unit and the related factors. Hamadan Univ Med Sci J 2007;14:51-5. [Google Scholar]
33. Nguyen HL, Gore JM, Saczynski JS, Yarzebski J, Reed G, Spencer FA, Goldberg RJ. Age and sex differences and 20-year trends (1986 to 2005) in prehospital delay in patients hospitalized with acute myocardial infarction. Circ Cardiovasc Qual Outcomes 2010;3(6):590-88. [DOI:10.1161/CIRCOUTCOMES.110.957878] [PMID] [PMCID]
34. Nguyen HL, Saczynski JS, Gore JM, Goldberg RJ. Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes 2010;3(1):82-92. [DOI:10.1161/CIRCOUTCOMES.109.884361] [PMID] [PMCID]
35. Sabzevari S, Mohammad-Alizadeh S, Bagherian B, Mirzaei F. Comparison of symptoms of angina and myocardial infarction in women and men. Mazandaran Univ Med Sci J 2007;17(57):42-9. [URL]
36. 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] [PMID] [PMCID]
37. Mesas CE, Rodrigues RJ, Mesas AE, Feijó VB, Paraiso LM, Bragatto GF, et al. Symptoms awareness, emergency medical service utilization and hospital transfer delay in myocardial infarction. BMC Health Serv Res 2018;18(1):490. [DOI:10.1186/s12913-018-3312-6] [PMID] [PMCID]
38. Berger JS, Stebbins A, Granger CB, Ohman EM, Armstrong PW, Van de Werf F, et al. Initial aspirin dose and outcome among ST-elevation myocardial infarction patients treated with fibrinolytic therapy. Circulation 2008;117(2):192-9. [DOI:10.1161/CIRCULATIONAHA.107.729558] [PMID]
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