Skip to main content
SpringerLink
Log in

Factors influencing emergency department arrival time and in-hospital management of patients with acute myocardial infarction

  • Published:
Advances in Therapy Aims and scope Submit manuscript

Abstract

Reperfusion of the infarct-related artery in the very first hour (“golden hour”) of acute myocardial infarction (AMI) significantly reduces mortality rates. Several factors may delay the initiation of reperfusion therapy (ie, thrombolytic therapy or primary percutaneous transluminal coronary angioplasty [PCTA]), most of which are related to patients. A total of 520 patients with suspected AMI were evaluated in the emergency department of Dokuz Eylül University Hospital between March 1996 and October 1999. After inclusion criteria were applied, the study consisted of 178 patients with a history of AMI. Analyzed data that affected patients’ arrival to the hospital were obtained from responses to a questionnaire. The Statistical Package for the Social Sciences (SPSS; SPSS Inc., Chicago, Ill), version 11.0, was used for all statistical analyses. The mean “symptom onset-hospital arrival time” was 188±325 min for the entire study group. The median delay was 110 min (∼2 h). Only 39 (22%) patients arrived to the hospital within the first hour. The mean time needed for late responders (n=109, 74%) (hospital arrival later than 1 h after symptom onset) to arrive was 245±363 min. According to the results of this study, many patients with AMI who may be eligible for reperfusion therapy miss the “golden hour” because of late hospital arrival. Some groups of patients (ie, elderly, women, those with diabetes) were especially late in arriving. To reduce such delays, training programs may be advised to focus on these groups of patients. Arrival times to the hospital during AMI can be greatly improved by efficient public education programs targeted to these groups.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1000 patients.Lancet. 1994; 343: 311–322.

    Google Scholar 

  2. Gruppo Italiano per lo studio della Sopravvivienza nell’Infarto Miocardico. GISSI-2: a factorial randomized trial of alteplase vs streptokinase and heparin vs no heparin among 12,490 patients with acute myocardial infarction.Lancet. 1990; 336: 65–71.

    Google Scholar 

  3. The European Myocardial Infarction Project Group. Prehospital thrombolytic therapy in patients with suspected acute myocardial infarction.N Engl J Med. 1993; 329: 383–389.

    Article  Google Scholar 

  4. Lincoff AM, Topol EJ. Illusion of reperfusion. Does anyone achieve optimal reperfusion during acute myocardial infarction?Circulation. 1993; 88: 1361–1374.

    PubMed  CAS  Google Scholar 

  5. Weaver WD. Time to thrombolytic treatment: factors affecting delay and their influence on outcome.J Am Coll Cardiol. 1995; 25: 3S-9S.

    Article  PubMed  CAS  Google Scholar 

  6. Weaver WD, for the National Registry of Myocardial Infarction Investigators (NRMI). Factors influencing the time to hospital administration of thrombolytic therapy: results from a large national registry (abstract).Circulation. 1992; 86(suppl): II-16.

    Google Scholar 

  7. Sheifer SE, Rathore SS, Gersh BJ, et al. Time to presentation with acute myocardial infarction in the elderly: associations with race, sex and socioeconomic characteristics.Circulation. 2000; 102: 1651–1656.

    PubMed  CAS  Google Scholar 

  8. Ritzmann P, Frey R, Ruttimann S. Acute myocardial infarction: time delay from onset of pain to hospital presentation and thrombolysis.Schweiz Med Wochenschr. 2000; 130: 657–663.

    PubMed  CAS  Google Scholar 

  9. Burnett RE, Blumenthal JA, Mark DB, et al. Distinguishing between early and late responders to symptoms of acute myocardial infarction.Am J Cardiol. 1995; 75: 1019–1022.

    Article  PubMed  CAS  Google Scholar 

  10. Ho MT, Eisenberg MS, Litwinn PE, et al. Delay between onset of chest pain and seeking medical care: the effect of public education.Ann Emerg Med. 1989; 18: 721–731.

    Article  Google Scholar 

  11. Meischke H, Eisenberg MS, Larsen MP, et al. Pre-hospital delay interval for patients who use emergency medical services: the effect of heart-related medical conditions and demographic variables.Ann Emerg Med. 1993; 22: 1597–1601.

    Article  PubMed  CAS  Google Scholar 

  12. Clark LT, Bellam SW, Shah AH, et al. Analysis of prehospital delay among inner city patients with symptoms of myocardial infarction: implication for therapeutic intervention.J Natl Med Assoc. 1992; 84: 931–937.

    PubMed  CAS  Google Scholar 

  13. Yarzebski J, Goldberg RJ, Gore JM, Alpert JS. Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: the Worcester Heart Attack Study.Am Heart J. 1994; 128: 255–263.

    Article  PubMed  CAS  Google Scholar 

  14. Goldberg RJ, Gurwitz JH, Gore JM. Duration of, and temporal trends (1994–1997) in, prehospital delay in patients with acute myocardial infarction: the second National Registry of Myocardial Infarction.Arch Intern Med. 1999; 159: 2141–2147.

    Article  PubMed  CAS  Google Scholar 

  15. Ghanima W, Skulstad H, Falk K, Ringstad J. Time delay in the thrombolytic treatment of myocardial infarction.Tidsskr Nor Laegeforen. 2000; 120: 1851–1853.

    PubMed  CAS  Google Scholar 

  16. Castiella J, Valdearcos S, Alquezar ML. Analysis of causes of excessive prehospital delay of patients with acute myocardial infarction in the province of Teruel.Rev Esp Cardiol. 1997; 50: 860–869.

    PubMed  CAS  Google Scholar 

  17. Savas BS, Karahan O, Saka RO.Health Care Systems in Transition: Turkey. Copenhagen, Denmark: European Observatory on Health Care Systems; 2002.

    Google Scholar 

  18. Dracup K, Mc Kinley SM, Moser DK. Australian patients’ delay in response to heart attack symptoms.Med J Aust. 1997; 166: 233–236.

    PubMed  CAS  Google Scholar 

  19. Educational strategies to prevent prehospital delay in patients at high risk for acute myocardial infarction: a report by the National Heart Attack Alert Program.J Thromb Thrombolysis. 1998;6:47–61.

  20. Zahn R, Schiele R, Schneider S, et al. Effect of preinfarction angina pectoris on outcome in patients with acute myocardial infarction treated with primary angioplasty (results from the Myocardial Infarction Registry).Am J Cardiol. 2001; 87: 1–6.

    Article  PubMed  CAS  Google Scholar 

  21. Meischke H, Larsen MP, Eisenberg MS. Gender differences in reported symptoms for acute myocardial infarction: impact on prehospital delay time interval.Am J Emerg Med. 1999; 17: 433.

    Google Scholar 

  22. Meischke H, Dulberg EM, Schaeffer SS, Henwood DK, Larsen MP, Eisenberg MS. “Call fast, call 911”: a direct mail campaign to reduce patient delay in acute myocardial infarction.Am J Public Health. 1997; 87: 1705–1709.

    Article  PubMed  CAS  Google Scholar 

  23. Dempsey SJ, Dracup K, Moser DK. Women’s decisions to seek care for symptoms of acute myocardial infarction.Heart Lung. 1995; 24: 444–456.

    Article  PubMed  CAS  Google Scholar 

  24. Meischke H, Larsen MP, Eisenberg MS. Gender differences in reported symptoms for acute myocardial infarction: impact on prehospital delay time interval.Am J Emerg Med. 1999; 17: 433.

    Google Scholar 

  25. Goldberg RJ, Yarzebski J, Lessard D, Gore JM. Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester Heart Attack study.Arch Intern Med. 2000; 160: 3217–3223.

    Article  PubMed  CAS  Google Scholar 

  26. Zahn R, Schiele R, Seidl K, et al. Daytime and nighttime differences in patterns of performance of primary angioplasty in the treatment of patients with acute myocardial infarction. Maximal Individual Therapy in Acute Myocardial Infarction (MITRA) Study Group.Am Heart J. 1999; 138: 1012–1013.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine Department of Emergency Medicine, Mersin University, 33079, Zeytinlibahce, Mersin, Turkey

    Cuneyt Ayrik MD (Emergency Physician, Assistant Professor)

  2. Celal Bayar University, Izmir, Turkey

    Ulku Ergene MD (Assoc Prof)

  3. Yesilyurt Government Hospital, Izmir, Turkey

    Ozan Kinay MD (Assoc Prof), Cem Nazli MD (Assoc Prof) & Oktay Ergene MD (Prof)

  4. Dokuz Eylül University School of Medicine and Hospital, Izmir, Turkey

    Belgin Unal MD (Assoc Prof)

Authors
  1. Cuneyt Ayrik MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulku Ergene MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Ozan Kinay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Cem Nazli MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Belgin Unal MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Oktay Ergene MD
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Ayrik, C., Ergene, U., Kinay, O. et al. Factors influencing emergency department arrival time and in-hospital management of patients with acute myocardial infarction. Adv Therapy 23, 244–255 (2006). https://doi.org/10.1007/BF02850130

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF02850130

Keywords

Search

Navigation