Interpretation of Symptoms as a Cause of Delays in Patients with Acute Myocardial Infarction, Istanbul, Turkey

By Koc, Sema; Durna, Zehra et al. | The Geographical Review, April 1, 2017 | Go to article overview

Interpretation of Symptoms as a Cause of Delays in Patients with Acute Myocardial Infarction, Istanbul, Turkey


Koc, Sema, Durna, Zehra, Akin, Semiha, The Geographical Review


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ABSTRACT This cross-sectional study aimed to assess interpretation of symptoms as a cause of delays in patients with acute myocardial infarction (AMI). It was conducted at a university hospital in Istanbul, Turkey. The sample included 93 patients: 73 male, mean age 57.89 (12.13) years. Prehospital delay time ranged from 15 minutes to 10 days, with a median of 2 hours (interquartile range: 9.50). Patients waited for pain to go away (48.4%) and tried to calm down (39.8%). Most patients attributed AMI-related symptoms to a reason other than heart disease. In a multivariate logistic regression analysis, the type of AMI was classified based on electrocardiography findings (odds ratio 5.18, 95% confidence interval: 1.69-15.91, P=0.004) and was independently associated with a long prehospital delay time, indicating that patients with ST segment elevation MI would seek early medical care. Misinterpretation of symptoms and misconceptions about emergency treatment during AMI cause delays in admission and may affect treatment.

L'interpretation des symptomes comme cause de delais pour les patients victimes d'un infarctus du myocarde aigu, Istanbul (Turquie)

RESUME La presente etude transversale visait a evaluer l'interpretation des symptomes comme cause de delais pour les patients victimes d'un infarctus du myocarde aigu. Elle a ete conduite dans un centre hospitalier universitaire a Istanbul, en Turquie. L'echantillon incluait 93 patients, dont 73 hommes, d'un age moyen de 57,89 ans (12,13). Le temps d'attente avant de se rendre a l'hopital etait compris entre 15 minutes et 10 jours, avec une mediane de 2 heures (ecart interquartile: 9,50). Les patients attendaient que la douleur disparaisse (48,4 %) et essayaient de se calmer (39,8 %). La majorite des patients attribuaient les symptomes de l'infarctus du myocarde aigu a une autre raison qu'une maladie cardiaque. A l'analyse de regression logistique multivariee, le type d'infarctus du myocarde aigu etait classifie selon les resultats de l'electrocardiographie (odds ratio de 5,18, intervalle de confiance a 95 % = 1,69-15,91, p=0,004) et avaient une association independante avec un temps d'attente prehospitalier long, ce qui indique que les patients subissant un infarctus du myocarde aigu avec elevation du segment ST recouraient rapidement a des soins medicaux. Une mauvaise interpretation des symptomes et des idees recues sur les traitements d'urgence prodigues lors d'un infarctus du myocarde aigu etaient a l'origine de delais d'admission et peuvent affecter le traitement.

Introduction

Mortality associated with acute myocardial infarction (AMI) occurs within the first 2 hours after the onset of symptoms, and common complications include recurrent ischaemia, reinfarction, ventricular arrhythmia and cardiac death (1-3). The time between onset of MI symptoms and initiation of coronary reperfusion is a determining factor of morbidity and mortality (2, 4,5). Early recognition of AMI-related symptoms and strategies for enhancing early diagnosis and treatment avoid fatalities and maintain quality of life by improving coronary reperfusion and reducing the possibility of death from ventricular arrhythmia (2,6,7). Mortality rate from AMI is reported to be high before arriving in hospital (1,8). Many patients with symptoms of AMI wait for a long time before seeking treatment (9). It has been reported that the median delay in patients with AMI ranges between 1.5 and 6.5 hours (10).

Public awareness of symptoms of MI and the importance of seeking immediate treatment is vital for avoiding delays in patients with AMI and preventing associated complications. There are many factors associated with delays in seeking early medical help in patients with AMI. Many patients with MI do not associate chest pain with heart problems, and therefore, admission for treatment is delayed because of the denial of complaints (10-12). …

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