Background: In myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased\npossibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish\npopulation and identified determinants of a pre-hospital delay ââ?°Â¥2 h.\nMethods: A total of 89 women (mean age 72.6 years) and 176 men (mean age 65.8 years) from a secondary\nprevention study were enrolled in an observational study after first time MI between November 2009 and March\n2012. Total pre-hospital delay was defined as the time from the onset of symptoms suggestive of MI to admission\nto the hospital. Decision time was defined as the time from the onset of symptoms until the call to Emergency\nMedical Services (EMS). The time of symptom onset was assessed during the episode of care, and the time of call\nto EMS and admission to the hospital was based on recorded data. The first medical contact was determined from\na mailed questionnaire. Determinants associated with pre-hospital delay ââ?°Â¥ 2 h were identified by multivariable\nlogistic regression.\nResults: The median total pre-hospital delay was 5.1 h (IQR 18.1), decision time 3.1 h (IQR 10.4), and transport time\n1.2 h (IQR 1.0). The first medical contact was to primary care in 52.3 % of cases (22.3 % as a visit to a general\npractitioner and 30 % by telephone counselling), 37.3 % called the EMS, and 10.4 % self-referred to the hospital.\nDeterminants of a pre-hospital delay ââ?°Â¥ 2 h were a visit to a general practitioner (OR 10.77, 95 % CI 2.39ââ?¬â??48.59), call\nto primary care telephone counselling (OR 3.82, 95 % CI 1.68ââ?¬â??8.68), chest pain as the predominant presenting\nsymptom (OR 0.24, 95 % CI 0.08ââ?¬â??0.77), and distance from the hospital (OR 1.03, 95 % CI 1.02ââ?¬â??1.04). Among patients\nwith primary care as the first medical contact, 67.0 % had a decision time ââ?°Â¥ 2 h, compared to 44.7 % of patients\nwho called EMS or self-referred (p = 0.002).\nConclusions: Pre-hospital delay in patients with first time MI is prolonged considerably, particularly when primary\ncare is the first medical contact. Actions to shorten decision time and increase the use of EMS are still necessary.
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