National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China.
Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, USA.
Eur Heart J Qual Care Clin Outcomes. 2019 Jan 1;5(1):63-71. doi: 10.1093/ehjqcco/qcy022.
Few contemporary studies have reported the time between acute myocardial infarction (AMI) symptoms onset and hospital arrival, associated factors, and patient perceptions of AMI symptoms and care seeking. We sought to study these issues using data from China, where AMI hospitalizations are increasing.
We used data from the China PEACE prospective AMI study of 53 hospitals across 21 provinces in China. Patients were interviewed during index hospitalization for information of symptom onset, and perceived barriers to accessing care. Regression analyses were conducted to explore factors associated with the time between symptom onset and hospital arrival. The final sample included 3434 patients (mean age 61 years). The median time from symptom onset to hospital arrival was 4 h (interquartile range 2-7.5 h). While 94% of patients reported chest pain or chest discomfort, only 43% perceived symptoms as heart-related. In multivariable analyses, time to hospital arrival was longer by 14% and 39% for patients failing to recognize symptoms as cardiac and those with rural medical insurance, respectively (both P < 0.001). Compared with patients with household income over 100 000 RMB, those with income of 10 000-50 000 RMB, and <10 000 RMB had 16% and 23% longer times, respectively (both P = 0.03).
We reported an average time to hospital arrival of 4 h for AMI in China, with longer time associated with rural medical insurance, failing to recognize symptoms as cardiac, and low household income. Strategies to improve the timeliness of presentation may be essential to improving outcomes for AMI in China.
很少有当代研究报告急性心肌梗死（AMI）症状发作与到达医院之间的时间、相关因素以及患者对 AMI 症状和寻求医疗的看法。我们试图利用来自中国的数据研究这些问题，因为中国的 AMI 住院人数正在增加。
我们使用了来自中国 21 个省份 53 家医院的中国 PEACE 前瞻性 AMI 研究的数据。在住院期间，对患者进行了访谈，以获取症状发作和获得医疗服务的障碍等信息。我们进行了回归分析，以探讨与症状发作到医院就诊之间的时间相关的因素。最终样本包括 3434 名患者（平均年龄 61 岁）。从症状发作到医院就诊的中位数时间为 4 小时（四分位距 2-7.5 小时）。尽管 94%的患者报告胸痛或胸部不适，但只有 43%的患者认为症状与心脏有关。在多变量分析中，未能识别症状为心脏相关的患者和农村医疗保险患者到达医院的时间分别延长了 14%和 39%（均 P<0.001）。与家庭收入超过 100000 元人民币的患者相比，收入在 10000-50000 元人民币和<10000 元人民币的患者到达医院的时间分别延长了 16%和 23%（均 P=0.03）。
我们报告了中国 AMI 患者平均 4 小时到达医院，到达时间较长与农村医疗保险、未能识别症状为心脏相关以及家庭收入较低有关。改善就诊及时性的策略可能对改善中国 AMI 的预后至关重要。
