Garofalo Daniel, Grey Corina, Lee Mildred, Exeter Daniel, Kerr Andrew J
Middlemore Hospital, South Auckland, New Zealand.
N Z Med J. 2012 Jan 20;125(1348):12-22.
To study pre-hospital delay, its components and determinants, in patients with acute coronary syndromes (ACS) admitted to Middlemore Hospital Coronary Care Unit.
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).
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.
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.
研究入住Middlemore医院冠心病监护病房的急性冠状动脉综合征（ACS）患者的院前延误情况、其构成因素及决定因素。
纳入2009年1月至2010年7月期间连续收治的ACS患者。院前延误定义为从最严重症状发作到除颤器可用的时间：即救护车到达现场的时间或医院到达时间（非救护车运送患者）。
805例患者从症状发作到除颤器可用的中位延误时间为174分钟。一半的队列患者除颤器可用的延误时间超过3小时。与贫困程度较低地区的患者相比，贫困程度最高地区的患者中位延误时间长1小时，分别为[208分钟对149分钟（p = 0.015）]，非救护车运送患者比救护车运送患者的中位延误时间长7小时，[553分钟对130分钟（p < 0.001）]。毛利人、太平洋岛民、印度人以及来自贫困程度较高地区的人乘坐救护车前往医院的可能性较小。在符合再灌注条件的ST段抬高型心肌梗死患者中，症状发作至再灌注之间的总延误时间超过三分之二发生在院前。
针对处境更为不利的社区和高风险种族群体的社区干预措施应被视为减少差异和改善心脏疾病治疗结果的总体战略的一部分。
