Pre-hospital care in stable patients with acute coronary syndrome: Factors and predictors of pre-hospital delays in a tertiary public health institute

Abstract

Background: Incidences of pre-hospital delays (PHDs) remain high and affect the outcomes in acute coronary syndrome (ACS) patients. This study explored the factors associated with, and the predictors of PHD in ACS patients. Methods: Data were collected through interviews and the examination of the hospital records of 299 ACS patients admitted to a hospital between 1 December 2014 and 28 February 2015. Results: The patients were primarily female, and their mean age was 60.9±12.09 years. The mean PHD was 7.5±6.6 hours; this comprised mean delay from symptoms onset to departure, mean travel time from departure time to intermediate care facility, mean length of stay at intermediate care facility, and mean travel time from an intermediate care facility to hospital. The factors associated with delays were ignoring of symptoms (38.8%), indecisiveness and reluctance to seek treatment (16.7%), self-medication (35.5%), being unconvinced that the symptoms were serious (61.2%), and waiting for a worsening of pain (29.1%). The predictors of PHDs were ‘marital status’, ‘fear of having a heart attack’, ‘believing that the symptoms were self-limiting’, and ‘seeking intermediate care’. The predictors of hospital delays were ‘AM or PM occurrence of symptom’, ‘shortness of breath’, ‘having hypertension’, and ‘previous ischaemic heart disease’.Conclusions: Patient delays were high in the case of ACS, but utilization of an intermediate healthcare facility more than doubled the PHD. About two-thirds of the patients had a PHD that exceeded 2 hours.