Determinants of Pre-Hospital Delay in Patients with ST-Elevation Myocardial Infarction in Dera Ismail Khan

OBJECTIVE: To assess the association between sociodemographic factors and healthcare-seeking behaviour, and pre-hospital delay (>6 hours) in patients diagnosed with ST-elevation myocardial infarction (STEMI). STUDY DESIGN: An analytical cross-sectional study. Place and Duration of the Study: Department of Cardiology, Gomal Medical College, Dera Ismail Khan, Pakistan, from September 2025 to April 2026. METHODOLOGY: A total of 255 patients diagnosed with STEMI were included using non-probability consecutive sampling. A predesigned pro forma was used to collect data on sociodemographic variables, symptom interpretation, healthcare-seeking behaviour, first medical contact, and distance from the healthcare facility. Pre-hospital delay was defined as presentation to the coronary care unit more than 6 hours after symptom onset. Data were analysed using SPSS version 27. Bivariate analyses were performed using the chi-squared test and independent samples t-test, while multivariable logistic regression was used to identify independent predictors. RESULTS: The mean age of the 255 patients was 58.28 ± 11.2 years; 155 (60.8%) were male. Fifty-nine (23.1%) patients fulfilled the criteria for pre-hospital delay. The strongest independent predictors were misguided healthcare-seeking behaviour (aOR 9.43; 95% CI: 3.33-26.69; p <0.001) and symptom misinterpretation (aOR 3.47; 95% CI: 1.48-8.13; p = 0.004). Reduced delay was observed in patients who were at a shorter distance from the healthcare unit. CONCLUSION: In STEMI, pre-hospital delay is mainly caused by misguided healthcare-seeking behaviour and misinterpreted symptoms. To reduce delays, public awareness and reinforcement of primary healthcare referral systems are essential.