Acute Myocardial Infarction and the Search for Health Services

Background: A timely visit to a hospital emergency department can lead to successful therapeutic intervention for acute myocardial infarction (AMI). Aim: The determination of the factors that influence the decision of patients with early AMI to seek hospital health care. Method: A one-year study (December 2006–December 2007) was made of patients with AMI hospitalized in two major General Hospitals in Greece, in which 245 patients participated (186 male, 59 female). Data were collected by use of a questionnaire covering demographic and clinical characteristics, and the time period between the onset of AMI symptoms and the arrival of the patients at the emergency department. Statistical analysis included x2 test, Fisher’s exact test, Mann-Whitney test and multivariate logistic regression using the software package Statistical Package for Social Sciences (SPSS) 14.0 for windows. Results: The median time from the onset of AMI symptoms to the arrival of the patients at the emergency department was 8 hours (interquartile range: 6 hours). Factors found to be correlated with a prolonged time period between the onset of symptoms onset and arrival of the patient to the hospital were: unmarried patients (p=0.008), distance to hospital ≥10 km (p=0.05), absence of activities before AMI (p=0.04), absence of cholesteraemia (p=0.004), absence of dyspepsia as a non-typical symptom of AMI (p=0.001), the low intensity of pain (p=0.01) and lack of knowledge about AMI (p=0.1). Conclusions: A number of factors appear to be associated with delay between the onset of AMI symptoms and the arrival of the patients at the emergency department of a hospital. Among these, one of the modifiable factors is the lack of knowledge about the symptoms of AMI, typical and non-typical. The role of nurses in the education of general population about AMI and its symptoms is important, as it could increase the number of patients who arrive at the emergency department of a hospital early in the course of an episode.