Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh

Background: Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study thus aims at finding the factors associated with prolonged pre-hospital delay and the impact of this delay on in hospital treatment outcome of MI patients of Northern Bangladesh. Methods: This cross sectional study was conducted in December 2019 in cardiology ward of a 1000 bed tertiary care hospital of Bangladesh. Socio demographic data, clinical features and patients’ health seeking behavior was collected in a structured questionnaire from the patients diagnosed as STEMI or non-STEMI. Median with interquartile range (IQR) of pre hospital delay were calculated and compared between different groups. Patients were classified into two groups, those who admitted within 6 hours and those who admitted after 6 hours. Chi-square (χ²) test and multivariate logistic regression were used to estimate the determinants associated with delayed hospital admission. Effect of pre-hospital delay was determined using univariate and multivariate logistic regression. Results: 337 patients was enrolled in the study and their median (IQR) pre-hospital delay was 9.0 (13.0) hours. 39.5% patients admitted in the specialized hospital within 6 hours. In logistic regression, determinants of pre-hospital delay were patients age (for <40 years aOR 2.43, 95% CI 0.73-8.12; for 40 to 60 years aOR 0.44, 95% CI 0.21-0.93), family income (for lower income aOR 5.74, 95% CI 0.89-37.06; for middle income aOR 14.22, 95% CI 2.15-94.17), distance from primary care center £5 km (aOR 0.42, 95% CI 0.12-0.90), predominant chest pain (aOR 0.15, 95% CI 0.05-0.48), considering symptoms as non-significant (aOR 17.81, 95% CI 5.92-53.48), referral from primary care center (for government hospital aOR 4.45, 95% CI 2.03-9.74; for private hospital OR 98.67, 95% CI 11.87-820.34) and not having family history of MI (aOR 2.65, 95% CI 1.24-5.71). Risk of in hospital death was almost 4 times higher who admitted after 6 hours in multivariate logistic regression (OR 4.64, 95% CI 1.87-11.50). Conclusion: Delayed hospital admission after onset of MI is more common in Bangladesh compared to developed countries. Appropriate measures should be taken by policy makers to improve this situation.