Pre-hospital delay in acute myocardial infarction in an urban Indian hospital: A prospective study

Background. Successful treatment of acute myocardial infarction is dependen t on early presentation of the patient to the hospital. The factors that co ntribute to delay in seeking treatment have not been systematically evaluat ed in the Indian milieu, Methods. Patients admitted with acute myocardial infarction to a 125-bed ur ban community hospital were evaluated prospectively, A record of admission characteristics, prior medical history, pre-hospital symptoms and treatment patterns was completed within 48 hours of each admission. Independent pred ictors of delayed admission were identified by logistic regression. Results. Of 144 consecutive admissions with myocardial infarction, 133 had completed data as per the protocol [mean (SD) age 59 (12.7) years; 79.6% me n]. The distribution of presentation times was skewed, with the mode, media n and mean being 1, 3 (interquartile range 1.25-11) and 10.9 (SD 20.5) hour s, respectively, Seventy-nine patients (59.4%) consulted a general practiti oner prior to hospital referral and 48 patients (36.1%) delayed admission t o hospital by more than 6 hours from the onset of symptoms. On multivariate analysis, individuals who were initially seen by a general practitioner (O R 5.57; 95% CI 1.84-16.8) and those over the age of 65 years (OR 3.24; 95% CI 1.06-9.89) were identified as 'delayers', while patients with severe sym ptoms (OR 0.32; 95% CI 0.12-0.87) or prodromal angina (OR 0.25; 95% CI 0.08 -0.82) minimized delay. Conclusion. Though 50% of patients with acute myocardial infarction present to hospital within 3 hours, about 36% delay seeking treatment by more than 6 hours. Besides age and the pattern and severity of symptoms, visits to t he general practitioner were found to be an independent correlate of delay.