Abstract 14400: Pre-Hospital Delays in Care for STEMI Patients in Mumbai: Challenges and Opportunities
Introduction: Coronary heart disease is growing at an alarming rate in developing countries. In India, ST-segment elevation myocardial infarction (STEMI) is pervasive and accounts for over 60% of acute coronary syndrome hospitalizations. Reducing the time from symptom onset to effective treatment in STEMI care is critical to improving outcomes and it is known that Indians present late. This study was conducted to measure and characterize pre-hospital behavior and delays to care for STEMI patients and to identify factors associated with delayed presentation.
Methods: We conducted an observational prospective study of pre-hospital delay in the presentation of patients with STEMI to an emergency room in a public hospital in Mumbai, India. Pre-hospital delay time was defined as self-reported acute symptom onset to arrival time at the ER. Patients were included in the study (n=348) only after a confirmed diagnosis of STEMI. Data was collected from the hospital record and the patient using a standardized questionnaire.
Results: The median total pre-hospital delay was 240 minutes. Over half (53.2%) of the patients travelled 5km or more to the ER, and 21.3% travelled more than 20km. Three-quarters (75.0%) travelled via public transportation, 15.2% via personal vehicle, and 9.8% via ambulance. Over two-thirds (69.3%) of patients had monthly incomes at or below Rs. 10,000. Also, 69.8% of patients were of lower Kuppuswamy socioeconomic status. Pre-hospital delays were greater for patients travelling over 10km, patients of lower socioeconomic status, and patients utilizing an ambulance. Additional findings are shown in Table 1.
Conclusions: Logistical and financial barriers were profound for STEMI patients in this study. Given the large pre-hospital delays present in this report and others like it, further efforts are needed to identify unique systems for care that can improve rapid access to effective STEMI treatment in regions with limited care infrastructure.
- Acute coronary syndromes
- Myocardial infarction
- Percutaneous coronary intervention (PCI)
Author Disclosures: F. Noorani: None. M. Runge: None. S. Tripathi: None. D. Patil: None. C. Lanjewar: None. K. Eagle: None. P. Kerkar: None.
- © 2016 by American Heart Association, Inc.