Patient and system delays in the treatment of acute coronary syndrome.

Autor:	Viana M; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal. Electronic address: marta.viana@ispup.up.pt., Laszczyńska O; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal., Araújo C; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal., Borges A; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal., Barros V; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal., Ribeiro AI; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal., Dias P; Serviço de Cardiologia, Centro Hospitalar São João, Porto, Portugal., Maciel MJ; Serviço de Cardiologia, Centro Hospitalar São João, Porto, Portugal., Moreira I; Serviço de Cardiologia, Centro Hospitalar de Trás-os-Montes e Alto Douro, Vila Real, Portugal., Lunet N; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal., Azevedo A; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Porto, Portugal.
Jazyk:	English; Portuguese
Zdroj:	Revista portuguesa de cardiologia [Rev Port Cardiol (Engl Ed)] 2020 Mar; Vol. 39 (3), pp. 123-131. Date of Electronic Publication: 2020 May 06.
DOI:	10.1016/j.repc.2019.07.007
Abstrakt:	Introduction: Early reperfusion for patients with ST-segment elevation myocardial infarction (STEMI) is indicated by the European Society of Cardiology, while a timely invasive strategy is recommended for patients with high-risk and intermediate-risk non-ST-elevation acute coronary syndromes (NSTE-ACS). This study aims to assess patient and system delays according to diagnosis and risk profile, and to identify predictors of prolonged delay. Methods: We assembled a cohort of patients (n=939) consecutively admitted to the cardiology department of two hospitals, one in the metropolitan area of Porto and one in the north-east region of Portugal, between August 2013 and December 2014. Results: The proportion of patients with time from symptom onset to first medical contact (FMC) ≥120 min was highest among high-risk NSTE-ACS (57.7%), followed by intermediate-risk NSTE-ACS (52.1%) and STEMI (43.3%). Regardless of diagnosis and risk stratification, use of own transportation and inability to interpret cardiac symptoms correctly were associated with prolonged delays. Regarding system delays, we found that 78.0% of patients with STEMI and 65.8% of patients with high-risk NSTE-ACS were treated in a timeframe exceeding the recommended limits. Admission to a non-percutaneous coronary intervention-capable hospital, admission on weekends and complications at admission were associated with prolonged delays to treatment. Conclusions: Due to both patient and system delays, a large proportion of STEMI and high-risk NSTE-ACS patients still fail to have access to timely reperfusion. (Copyright © 2020 Sociedade Portuguesa de Cardiologia. Publicado por Elsevier España, S.L.U. All rights reserved.)
Databáze:	MEDLINE
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