|Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing|
|Song Li1; Yan Hong-bing1; Hu Da-yi2; Yang Jin-gang1; Sun Yi-hong2|
|关键词||acute myocardial infarction care-seeking pre-hospital delay percutaneous coronary intervention|
|刊名||CHINESE MEDICAL JOURNAL|
|WOS标题词||Science & Technology|
|类目[WOS]||Medicine, General & Internal|
|研究领域[WOS]||General & Internal Medicine|
|关键词[WOS]||EMERGENCY MEDICAL-SERVICES ; THROMBOLYTIC THERAPY ; VENTRICULAR-FUNCTION ; PRIMARY ANGIOPLASTY ; TIME ; DELAY ; ASSOCIATION ; REPERFUSION ; PERSPECTIVE ; MANAGEMENT|
Background Cumulative evidence demonstrates that primary percutaneous coronary intervention (PCI) is a reperfusion strategy for ST-elevation myocardial infarction (STEMI). This study was undertaken to evaluate the pre-hospital care-seeking pathway and subsequent care quality in patients with STEMI in the Beijing health care system, which offers patients a choice between seeking care in a small community hospital (SH group) or a large hospital (LH group).
Methods Between January 1 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 11 hospitals qualified as tertiary centers in Beijing and included consecutive patients with STEM! admitted within 24 hours after onset of symptoms.
Results Among the 566 patients interviewed, 28.3% first arrived at a small community hospital and were transferred to large hospitals with the ability to perform primary PCI. The median total pre-hospital delay in the SH group (n=160) was significantly longer than in the LH group (n=406) (225 vs. 120 minutes, P <0.001). Multivariate analysis showed that interpreting symptoms to non-cardiac origin (OR, 1.996; 95% CI: 1.264-3.155), absence of history of myocardial infarction (OR, 1.595; 95% CI: 1.086-3.347), non-health insurance coverage (OR, 1.931; 95% CI: 1.079-3.012) and absence of sense of impending doom (OR, 4.367; 95% CI: 1.279-14.925) were independent predictors for choosing small hospitals. After adjusting for demographics and medical history, patients in the SH group were 1.698 times (95% CI: 1.182-3.661) less likely to receive primary PCI compared with those in the LH group.
Conclusions Above one fourth of the STEMI patients in Beijing experienced inter-hospital transfer. Factors including symptoms interpretation, symptoms, history of myocardial infarction, and insurance coverage were associated with the patients′ pre-hospital care-seeking pathway. The patients who were transferred had longer pre-hospital delays and were less likely to receive primary PCI. Chin Med J 2010;123(6):664-669
|资助机构||Beijing Municipal Science and Technology Commission|
|作者单位||1.Capital Med Univ, Div 28, Beijing Anzhen Hosp, Beijing 100029, Peoples R China|
2.Peking Univ, Peoples Hosp, Ctr Heart, Beijing 100044, Peoples R China
|Song Li,Yan Hong-bing,Hu Da-yi,et al. Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing[J]. CHINESE MEDICAL JOURNAL,2010,123(6):664-669.|
|APA||Song Li,Yan Hong-bing,Hu Da-yi,Yang Jin-gang,&Sun Yi-hong.(2010).Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing.CHINESE MEDICAL JOURNAL,123(6),664-669.|
|MLA||Song Li,et al."Pre-hospital care-seeking in patients with acute myocardial infarction and subsequent quality of care in Beijing".CHINESE MEDICAL JOURNAL 123.6(2010):664-669.|