What question did this study set out to answer?

To identify the duration and causes of delay from the onset of chest pain to hospital arrival in patients presenting with acute myocardial infarction.

November 1, 1993Journal of the Royal Society of Medicine

Delay in Presentation after Myocardial Infarction

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Why the study?

Does contacting a general practitioner increase the delay in hospital presentation for patients with acute myocardial infarction compared to going directly to the hospital?

Population

103 patients presenting with acute myocardial infarction (AMI) to two London Hospitals

Comparison

Contacting general practitioner (GP) for help vs Going directly to hospital by ambulance or on…

Design

Cross-sectional

Authors

AHAlexander G. HeriotThe Royal Melbourne Hospital SBStephen BreckerInterventional Cardiology DCD J ColtartGuy's and St Thomas' NHS Foundation Trust

Discussion

Member takes

Implication

Contacting a GP may prolong prehospital delay in AMI; hypothesis-generating for education efforts and requires prospective confirmation.

Key Points

To identify the duration and causes of delay from the onset of chest pain to hospital arrival in patients presenting with acute myocardial infarction.
Conducted structured interviews with 103 consecutive patients presenting with acute myocardial infarction across two London hospitals.
Quantified total presentation time, patient decision time, and transit time based on mode of hospital referral and patient awareness factors.
Forty-nine percent of patients took longer than 2 hours and 21% took longer than 4 hours to arrive at the hospital.
Patients contacting a general practitioner experienced significantly longer total delay (median 160 min, range 65–730) than those arriving directly by ambulance (median 82 min, range 15–395; P < 0.0005) or self-transport (median 90 min, range 15–855; P < 0.005), driven by prolonged post-decision transit time (110 min vs 56 min; P < 0.0001).
Decision time was significantly shortened by recognizing pain as cardiac in origin (15 min vs 45 min; P < 0.05), prior knowledge of thrombolysis (15 min vs 50 min; P < 0.05), and absence of previous cardiac symptoms (18 min vs 42 min; P < 0.05).

Structured PICO

Does contacting a general practitioner increase the delay in hospital presentation for patients with acute myocardial infarction compared to going directly to the hospital?

Population

103 patients presenting with acute myocardial infarction (AMI) to two London Hospitals

Intervention

Contacting general practitioner (GP) for help

Comparator

Going directly to hospital by ambulance or on their own

Outcome

Length and cause of delay from onset of chest pain to arrival at hospital

Contacting a general practitioner significantly delays hospital presentation in patients with acute myocardial infarction, potentially compromising the efficacy of time-sensitive therapies like thrombolysis.

Cite This Study

Heriot et al. (1993) studied this question.

synapsesocial.com/papers/6a9286efe5596d780b1f6032 https://doi.org/10.1177/014107689308601111

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Delay in Presentation after Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Delay in Presentation after Myocardial Infarction

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Also Consider

Also Consider