AIMS: To study pre-hospital delay, its components and determinants, in patients with acute coronary syndromes (ACS) admitted to Middlemore Hospital Coronary Care Unit. METHODS: Consecutive ACS patients admitted between January 2009 and July 2010 were included. Pre-hospital delay was defined as the time from onset of worst symptom(s) to defibrillator availability: either ambulance arrival at the scene or time of hospital arrival (non-ambulance patients). RESULTS: For 805 patients the median delay from symptom onset to defibrillator availability was 174 minutes. Half the cohort had a delay to defibrillator availability of >3 hours. The median delay was an hour longer for patients from areas of greatest deprivation compared with less deprived areas, [208 vs 149 min, respectively (p=0.015)], and 7 hours longer for non-ambulance vs ambulance patients, [553 vs 130 min (p<0.001)]. Māori, Pacific, Indian and those from areas of higher deprivation were less likely to travel to hospital by ambulance. Of ST-elevation myocardial infarction patients eligible for reperfusion, over two-thirds of the total delay between symptom onset and reperfusion occurred pre-hospital. CONCLUSION: Community intervention targeted at more disadvantaged communities and higher risk ethnic groups should be considered as part of an overall strategy to reduce disparity and improve cardiac outcomes.
AIMS: To study pre-hospital delay, its components and determinants, in patients with acute coronary syndromes (ACS) admitted to Middlemore Hospital Coronary Care Unit. METHODS: Consecutive ACS patients admitted between January 2009 and July 2010 were included. Pre-hospital delay was defined as the time from onset of worst symptom(s) to defibrillator availability: either ambulance arrival at the scene or time of hospital arrival (non-ambulance patients). RESULTS: For 805 patients the median delay from symptom onset to defibrillator availability was 174 minutes. Half the cohort had a delay to defibrillator availability of >3 hours. The median delay was an hour longer for patients from areas of greatest deprivation compared with less deprived areas, [208 vs 149 min, respectively (p=0.015)], and 7 hours longer for non-ambulance vs ambulance patients, [553 vs 130 min (p<0.001)]. Māori, Pacific, Indian and those from areas of higher deprivation were less likely to travel to hospital by ambulance. Of ST-elevation myocardial infarctionpatients eligible for reperfusion, over two-thirds of the total delay between symptom onset and reperfusion occurred pre-hospital. CONCLUSION: Community intervention targeted at more disadvantaged communities and higher risk ethnic groups should be considered as part of an overall strategy to reduce disparity and improve cardiac outcomes.
Authors: Martha H Mackay; Adam Chruscicki; Jim Christenson; John A Cairns; Terry Lee; Ricky Turgeon; John M Tallon; Jennifer Helmer; Joel Singer; Graham C Wong; Christopher B Fordyce Journal: J Am Coll Emerg Physicians Open Date: 2022-06-08