Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome

Abstract

Background: Few studies have had the opportunity to examine a broad range of predictors of pre-hospital delay from a multivariate perspective that includes not only sociodemographic and clinical features but also atypical symptoms, patient appraisal and behavior, across the acute coronary syndrome (ACS) spectrum.

Methods: A total of 1894 hospitalized ACS patients were recruited predischarge after an ACS event. Patients completed a detailed questionnaire and clinical details were verified with their case notes.

Results: The median pre-hospital delay times were, 4.06, 2.70, 4.51 and 5.50h, for all ACS, ST elevated myocardial infarction (STEMI), non-STEMI and unstable angina (UA) subgroups respectively. Multiple regression models examining 33 predictors of pre-hospital delay were significant (p<0.001), accounting for 32%, 42%, 34% and 29% of the variance for all ACS, STEMI, non-STEMI and UA subgroups respectively. The predictors that were singularly significantly associated with longer pre-hospital delay within all ACS were: taking medications, visiting family physician, and symptoms that were intermittent in nature. In the MI subgroups, not using an ambulance and gradual symptom onset, were also associated with longer delay. In STEMI patients non-attribution of symptoms to heart was also associated with longer pre-hospital delay.

Conclusions: Multivariable analyses found that although sociodemographic, clinical history or situational predictors contributed to the variance in pre-hospital delay, the main predictors of pre-hospital delay were behavioral and symptom presentation factors. These factors should therefore be incorporated into patient education and interventions, to further improve patient pre-hospital delay time.

Keywords: Acute coronary syndrome; Factors; MI; Pre-hospital delay; Predictors.