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Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 17-23

Treatment delayed is treatment denied: The tortuous pathway to care for acute coronary syndrome

1 Department of Community Medicine, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
2 Department of Cardiology, Velammal Medical College Hospital and Research Institute, Madurai, Tamil Nadu, India
3 Department of Statistics, Manonmaniam Sundaranar University, Tirunelveli, Tamil Nadu, India

Correspondence Address:
Dr. Rizwan Suliankatchi Abdulkader
Department of Statistics, Manonmaniam Sundaranar University, Abishekapatti, Tirunelveli, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/JICC.JICC_1_19

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Background: Time duration between symptom onset and treatment in acute coronary syndrome (ACS) is important in determining survival outcomes. This study aimed to determine the extent of delays that occur in the pathway to seeking specific treatment among ACS patients and to explore the associated factors. Materials and Methods: This cross-sectional study was conducted in the emergency department of a tertiary care hospital in Madurai, Tamil Nadu, India, among patients with ACS. A questionnaire was used to collect information on demographic details, clinical features, time duration, and health system-related factors. The time delay at various levels was expressed as median and interquartile range (IQR). Nonparametric tests were applied to test for statistical differences in subgroups. Results: Among 232 ACS patients, the median (IQR) delay from symptom onset to decision-making was 30 min (10, 240), from decision-making to arriving at the first facility was 30 min (15, 45), and from decision-making to receiving specific treatment was 23.3 h (1, 170). Nearly 91% of the patients contacted private health facilities first and only 21.1% received any specific treatment at the first facility they contacted. The two most common reasons for referral from a lower level health facility were lack of infrastructure and lack of a specialist. Conclusions: Significant delays occurred in the pathway to receiving specific treatment for ACS, especially due to delays in decision-making and number of facilities contacted in the initial period not being able to provide specific treatment. Private health facilities are more sought after for emergency care of ACS.

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