Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing

Abstract

Background: Cumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group). Methods: Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEMI admitted within 24 hours after onset of symptoms. Results: Among the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n=160) was significantly longer than in the LH group (n=406) (225 vs. 120 minutes, P <0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95% CI: 1.264-3.155), absence of history of myocardial infarction (OR, 1.595; 95% CI: 1.086-3.347), non-health insurance coverage (OR, 1.931; 95% CI: 1.079-3.012) and absence of sense of impending doom (OR, 4.367; 95% CI: 1.279-14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95% CI: 1.182-3.661) less likely to receive primary PCI compared with those in the LH group. Conclusions: Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients' pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI.