Factors Associated With Pre-hospital Delay In Patients With Acute Coronary Syndrome

BackgroundsFor patients with acute coronary syndrome,especially acute myocardial infarction,early diagnosis and early effective reperfusion therapy are the focus of clinical medical workers.The time from the onset of the patient’s symptoms to the time that the patient reaches the hospital’s office is defined as pre-hospital time.This phase takes up most of the survival chain of patients with acute coronary syndrome.Previous studies have shown that the incidence of prehospital delay has not improved significantly in recent years,and a series of improvement measures have not proven to be significantly effective.ObjectivesThis study aimed to study the status of pre-hospital delay in patients with acute coronary syndrome,and to analyze the related factors,focusing on analysis of influencing factors of patients.MethodsA total of 240 patients aged 18-89 years who were admitted to Wuxi second Hospital from April 2014 to June 2016 were enrolled in the study.Then we collect and record the following information about the patient:the basic situation(age and sex),clinical data,semi-closed survey patients’ reasons for delay to seek medical help and reasons for choice of first medical contact.ResultsIn this study,32.92%of patients had pre-hospital delay,7.9%of patients visited hospital 24 hours after the onset of symptoms.Logistic regression analysis showed that atypical symptoms(OR=2.13,95%CI=1.18-3.82,P=0.01;aOR=2.09,95%CI=1.10-4.00,P=0.025),not to attribute to true cause(OR=2.45,95%CI=1.41-4.26,P=0.001;aOR=1.97,95%CI=1.05-3.68,P=0.03)diabetes mellitus(OR=1.92,95%CI=1.11-3.31,P=0.02;aOR=1.94,95%CI=1.07-3.53,P=0.029)and not called EMS(OR=2.15,95%CI=1.20-3.85,P=0.01;aOR=2.23,95%CI=1.15-4.32,P=0.017)(P<0.05)were risk factors for prehospital delay.Atypical symptoms(OR=2.07,95%CI=1.16-3.68,P=0.013;aOR=2.18,95%CI=1.19-4.00,P=0.01)、and a history of diabetes(OR=1.62,95%CI=0.95-2.74,P=0.07;aOR=1.76,95%CI=1.01-3.06,P=0.046)(P<0.05)were risk factors for incorrect attribution.ConclusionsIn patients with acute coronary syndrome,misinterpretation of symptoms is a common occurrence,and typical symptoms can lead to correct attribution of symptoms and reduce the risk of pre-hospital delay.EMS is the best way to transport patients with acute coronary syndrome,which can shorten the time before admission.The results of this study can be used to guide the development of improvement measures to ultimately improve clinical outcomes in patients withacute coronary syndrome.