BACKGROUND:?There is a critical relationship of time to treatment and myocardial salvage in the patient with acute myocardial infarction (AMI). As the proven beneficial management options for AMI have been extensively studied, the challenge lies in developing a process that minimizes pre-hospital delays, delays in assessment and initiation of reperfusion therapy. A greater emphasis on pre-hospital care has more potential in reducing mortality from acute MI than further development of hospital based treatments.

OBJECTIVE:?This study identifies the socio-demographic risk factors in patients with acute coronary syndrome and correlate them with pre-hospital delay. This response time to treatment is then correlated with the clinical outcome.

STUDY DESIGN:?Clinical Descriptive Study

METHODS:?Adult patients with diagnosis of acute coronary syndrome at the ICU setting of the USTH were sampled. Charts were reviewed and socio-demographic profiles identified. Pre-hospital delay from the onset of chest pain were correlated with these socio-demographic factors using multiple regression logistic regression. Chi square test was used to determine association between pre-hospital delay and clinical outcome.

RESULTS:?The study sample consisted of 220 patients with acute coronary disease. The sample population included 63% Non ST Elevation Myocardial Infarction (NSTEMI), 4% ST Elevation Myocardial Infarction (STEMI) and 33 percent with unstable angina. Male population accounted for 54% of the population. Thirty eight?percent(38%) of the population belonged to the 61.70 age group with mean age of 65 years old. The prevalence of hypertension (70%) and DM (41%) was high and about 30% of the population had prior history of coronary artery disease (CAD). About 35% reported family history of CAD and 41% had family history of DM. More than half of the population are smokers (55%). Majority of the patient population live within 10 kilometers from USTH (70%) while 28 patients (13%) came from the province. Thirty-eight percent (38%) sought consultation after two pain events, while only 4% came after more than 4 chest pain events. A significant number of population in the present series presented to the hospital delayed by more than four hours. Majority of the patients (40%), came in more than 6 hours. Twenty one percent (21%) came 2-4 hours while 30 percent came 4-6 hours from the onset of chest pain. The most common reason for the delay in seeking medical attention is financial limitation (36%), 31% had relief of chest pain by nitrates. Of the 220 included in the group, 50% had morbidity (such as development of acute renal failure, congestive heart failure), 41% had unremarkable outcome while there was 10% mortality noted. However in this study, we were not able to associate any socio-demographlc factors and the delay in time to treatment with the clinical outcome using available data and statistical.

CONCLUSION:?The results of this study demonstrate that patients with acute coronary event continue to exhibit prolonged delay in seeking medical care. This paper, Likewise, demonstrated that certain demographic and socioeconomic characteristics are associated with pre-hospital delay such as age, sex, history of CAD, hypertension and DM, proximity to the hospital, pain events prior to consultation and educational attainment. However, no correlation can be made between delay in time to treatment and clinical outcome.

Human ; Male ; Female ; St Elevation Myocardial Infarction ; Acute Coronary Syndrome ; Coronary Artery Disease ; Myocardial Infarction ; Hypertension ; Heart Failure

This clinical pathway for the diagnosis and risk stratification of patients presenting with acute chest pain, including acute coronary syndromes, provides recommendations and algorithms for clinicians to diagnose, risk stratify, and manage acute chest pain in adult patients. The writing committee reviewed existing international and local guidelines. Modifications to the algorithm following face-to-face and virtual meetings resulted in expert decisions written as recommendations and presented in a flow diagram format. The USTH Chest Pain Pathway provides guidance based on current guidelines and recommendations on assessing and evaluating acute chest pain, tailored to local needs and institution-specific facilities. We recommend its use to ensure quality patient care in the hospital.
Acute Coronary Syndrome|critical Pathways