Assessment of hospital arrival time and associated factors of Cardiovascular emergency patients to introduce thrombolytic therapy At jmc, jimma, southwestern Ethiopia

Abstract

Background: Acute cardiovascular emergencies , includes ST-segment– elevation myocardial infarction (STEMI), non-STEMI/unstable angina, out-of-hospital cardiac arrest (OHCA), acute aortic dissection (AAD), abdominal aortic aneurysm (AAA), stroke, and acute decompensated heart failure/cardiogenic shock. From these ST-segment– elevation myocardial infarction (STEMI) and acute ischemic stroke are treated with thrombolytic agents on top of other reperfusion strategies mainly percutaneous coronary stenting and also other routine treatments. The prevalence estimates suggest that AMI and stroke are the most common cardiovascular emergencies, with a prevalence ranging from 10-20% of all emergency department admissions (1). Another study conducted in Addis Ababa, Ethiopia, found that out of 253 patients admitted with acute coronary syndrome (ACS), 84% presented with ST-segment elevation myocardial infarction (STEMI), while 16% presented with non-ST-segment elevation myocardial infarction (NSTEMI) (2)A study conducted in Jimma, Ethiopia, found that among emergency medical admissions, cardiovascular emergencies accounted for 22.5% of cases (3). While the licensed time window extends to 3h from symptom onset, recent data suggest that the trial window can be extended up to 4.5 h with overall benefit for ischemic stroke and 12 hours for STEMI.So this study will provide information on time of arrival of patients and associated factors for possible timely initiation of thrombolytic therapy. Objective: To assess the time arrival time and associated factors in acute ischemic stroke and STEMI patients to determines need for effectiveness of introducing thrombolytic therapy at JMC. Methodology: Hospital based cross-sectional study was conducted at JMC from September 1st to January 30, 2023.All the patients who visited to the JMC with the diagnosis of STEMI and Stroke during study period were recruited for the study. Convenient sampling technique was used to include patients. Data entered into the Epi-data version 3.1 and was analyzed using SPSS version 25.Cross-tab chi-square test were performed to assess the association of each of the independent and dependent variables. Both bivariate and multivariable logistic regression models were used. Variables which have p-value less than 0.25 in bivariate analysis were considered as candidates for multivariable analysis, while variables which had p-value less than 0.05 in multivariable logistic regression model were considered as statistically significant. Result -The total number of patients was 175(112 acute ischemic stroke and 63 STEMI. For acute ischemic stroke patients findings are- a mean age of 61.75±10.7 (range 31 to 85) years, with 62 men and 50 women. 69.6% of the patients were unable to read and write, 27.7% woke up with a stroke, and 54.5% had health insurance. Only 14% suspected a stroke and sought immediate medical intervention. 6 patients reach our hospital within the 4.5 hour window period after symptom onset. The median time between symptom onset and arrival at the hospital was 33 hours and 29 minutes, with a range of 3 to 75 hours and a standard deviation of 21 hours and 20 minutes. vi In logistic regression, determinants of pre-hospital delay, unable to read and write (aOR: 8.8: 95% CI: 1.6-49.2 p=0.013), misinterpreted the nature of the pain (aOR: 4.53: 95% CI: 1.37-16.75 p=0.001) and lack of health insurance (aOR: 14.4: 95% CI: 2.2-90.9 p=0.005). Sudden type of symptom onset (or: 0.4: 95% CI: 1.081-1.86 p=0.023) and distance from primary care <5 km (aOR: 0.42: 95% CI: 0.12-0.9 p=0.026) were associated with shorter arrival time. For STEMI patients findings are- the majority of participants (42.9%) fall in the 55-64 year old category, followed by those in the 65-74 year old category (19%) and those under 45 years old (3.2%). The sample consists of 57.1% males and 42.9% females.In logistic regression analysis that assesses the association between hospital arrival time and associated factors The results show that the odds of having a longer hospital arrival time are reduced by a factor of 0.011 (AOR) = 0.011) when patients do visit a qualified doctor compared to those who do not (95% confidence interval: 0.000 to 0.449). Conversely, the odds of having a longer hospital arrival time are increased by a factor of 31.730 (AOR = 31.730) in patients with a history of diabetes compared to those without (95% confidence interval: 1.751 to 574.976). Conclusions: The pre-hospital delay of acute ischemic stroke and STEMI is serious. The study highlights the importance of educating patients about the symptoms of cardiovascular emergencies and the need to seek medical attention promptly. Additionally, providing efficient transportation, establishing a health insurance service and ensuring access to qualified medical professionals could help improve timely arrival at the hospital and ultimately improve patient outcomes.