Details

Autor(en) / Beteiligte

• Hafiz, Abdul Moiz, MD
• Naidu, Srihari S., MD
• DeLeon, Joshua, MD
• Islam, Shahidul, MPH
• Alkhatib, Basil, MD
• Lorenz, Miguel, MD
• D’Elia, Alexis, MD
• Rosenthal, Barry, MD
• Marzo, Kevin, MD

Titel

Impact of first contact on symptom onset–to-door time in patients presenting for primary percutaneous coronary intervention

Ist Teil von

• The American journal of emergency medicine, 2013-06, Vol.31 (6), p.922-927

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2013

Quelle

MEDLINE

Beschreibungen/Notizen

• Abstract Objectives To determine effect of first medical contact type on symptom onset–to-door time (SODT). Background Shorter total ischemic time is associated with improved outcomes in ST-elevation myocardial infarction. Methods From 2005 to 2009, we reviewed records of all consecutive patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction at our tertiary care teaching hospital (median follow-up 3.85 years). We compared SODT in patients whose first medical contact was a private physician (in person or via telephone) vs patients who presented to the emergency department (ED) directly (in person or via Emergency Medical Services). Results Of 366 patients, 84 (23%) contacted a physician (group A) while 282 (77.6%) did not (group B). Group A had higher median SODT (239.5 vs 130 minutes, P = .0043) and significantly higher mortality (log rank P = .0392, Cox Proportional Hazard Model risk factors: physician contact first [ P < .013], age [ P < .0001] and peripheral vascular disease [ P < .035]). Two factors associated with prolonged SODT: (1) contacting a physician first P = .002 and (2) personal mode of transportation, P = .002. Patients presenting during “on-hours” (weekdays) were more likely to first contact a physician compared with those presenting during “off-hours” (weeknights and weekends) (66.67% in group A vs 45.04% in group B, P < .001). Conclusions Patients whose first medical contact was a physician had greater pre-hospital delays and worse survival compared to those who sought emergent medical care directly. This pattern occurred more often during “on-hours.” Educational efforts aimed at both patient and physician office practices are warranted.