Hussain Madheeh Mohamed, Baharuddin Kamarul Aryffin, Fauzi Mohd Hashairi, Abu Bakar Mimi Azliha, Ziyan Ahmed, Ahmed Aminath Zeyba, Sunil Mohamed
Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives.
Int J Emerg Med. 2023 May 1;16(1):31. doi: 10.1186/s12245-023-00503-2.
Acute myocardial infarction (AMI) is the top cause of death in Maldives. Our study aims to determine the prehospital delay and its associated factors in AMI patients in Maldives.
A cross-sectional study was conducted with 127 patients, divided into early (≤ 6 h) and delayed (> 6 h) presenters to the hospital. The data collection for the study was carried out by interviewing AMI patients, focusing on their socio-demographic characteristics, coronary artery disease risk factors, clinical symptoms, situational factors, and behavioral and cognitive responses to symptoms.
The median onset-to-door time was 230 (IQR 420) minutes. The mean age of AMI patients was 50.9 (SD ± 12.9) years old, and 39.4% of them had delayed presentation to the hospital. Smokers (adj OR = 0.3; 95% CI: 0.1, 0.9; P = 0.047) and those with previous episodes of chest pain or AMI (adj OR = 0.2; 95% CI: 0.03, 0.91; P = 0.038) were significant factors for early presentation to the hospital, while denial of symptoms (adj OR = 29.3; 95% CI: 1.6, 547.2; P = 0.024) and lack of knowledge (adj OR = 7.2; 95% CI: 1.77, 29.43; P = 0.006) led to a delayed decision to seek treatment. Situational factors such as onset at the workplace (adj OR = 5.8; 95% CI: 1.24, 26.83; P = 0.025) had lower odds of delay, whereas referral cases (adj OR = 7.7; 95% CI: 1.9, 30.94; P = 0.004) and use of sea ambulance (adj OR = 11.1; 95% CI: 2.8, 43.8; P = 0.001) were prone to delay in presentation to the hospital.
Sea ambulance, referral cases, lack of knowledge, and denial of symptoms are significant factors associated with prehospital delay among patients with AMI. Public awareness about the benefits of early presentation and improvement of the means of transportation between islands is suggested to improve emergency cardiac care in the country.
急性心肌梗死（AMI）是马尔代夫的首要死因。我们的研究旨在确定马尔代夫AMI患者的院前延误情况及其相关因素。
对127例患者进行了一项横断面研究，将其分为早期（≤6小时）和延迟（>6小时）就诊患者。通过对AMI患者进行访谈来收集研究数据，重点关注他们的社会人口学特征、冠状动脉疾病危险因素、临床症状、情境因素以及对症状的行为和认知反应。
中位发病到入院时间为230（四分位间距420）分钟。AMI患者的平均年龄为50.9（标准差±12.9）岁，其中39.4%的患者延迟就诊。吸烟者（调整后的比值比=0.3；95%置信区间：0.1，0.9；P=0.047）以及既往有胸痛或AMI发作史的患者（调整后的比值比=0.2；95%置信区间：0.03，0.91；P=0.038）是早期就诊的重要因素，而否认症状（调整后的比值比=29.3；95%置信区间：1.6，547.2；P=0.024）和知识缺乏（调整后的比值比=7.2；95%置信区间：1.77，29.43；P=0.006）导致寻求治疗的决定延迟。工作场所发病等情境因素（调整后的比值比=5.8；95%置信区间：1.24，26.83；P=0.025）延误的几率较低，而转诊病例（调整后的比值比=7.7；95%置信区间：1.9，30.94；P=0.004）和使用海上救护车（调整后的比值比=11.1；95%置信区间：2.8，43.8；P=0.001）更容易出现就诊延迟。
海上救护车、转诊病例、知识缺乏和否认症状是与AMI患者院前延误相关的重要因素。建议提高公众对早期就诊益处的认识，并改善岛屿间的交通方式，以改善该国的心脏急救护理。
