Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study

Wenchi Guan, Arjun K Venkatesh, Xueke Bai, Si Xuan, Jing Li, Xi Li, Haibo Zhang, Xin Zheng, Frederick A Masoudi, John A Spertus, Harlan M Krumholz, Lixin Jiang, Wenchi Guan, Arjun K Venkatesh, Xueke Bai, Si Xuan, Jing Li, Xi Li, Haibo Zhang, Xin Zheng, Frederick A Masoudi, John A Spertus, Harlan M Krumholz, Lixin Jiang

Abstract

Aims: Few contemporary studies have reported the time between acute myocardial infarction (AMI) symptoms onset and hospital arrival, associated factors, and patient perceptions of AMI symptoms and care seeking. We sought to study these issues using data from China, where AMI hospitalizations are increasing.

Methods and results: We used data from the China PEACE prospective AMI study of 53 hospitals across 21 provinces in China. Patients were interviewed during index hospitalization for information of symptom onset, and perceived barriers to accessing care. Regression analyses were conducted to explore factors associated with the time between symptom onset and hospital arrival. The final sample included 3434 patients (mean age 61 years). The median time from symptom onset to hospital arrival was 4 h (interquartile range 2-7.5 h). While 94% of patients reported chest pain or chest discomfort, only 43% perceived symptoms as heart-related. In multivariable analyses, time to hospital arrival was longer by 14% and 39% for patients failing to recognize symptoms as cardiac and those with rural medical insurance, respectively (both P < 0.001). Compared with patients with household income over 100 000 RMB, those with income of 10 000-50 000 RMB, and <10 000 RMB had 16% and 23% longer times, respectively (both P = 0.03).

Conclusion: We reported an average time to hospital arrival of 4 h for AMI in China, with longer time associated with rural medical insurance, failing to recognize symptoms as cardiac, and low household income. Strategies to improve the timeliness of presentation may be essential to improving outcomes for AMI in China.

Clinical trial registration: https://ichgcp.net/clinical-trials-registry/NCT01624909.

Figures

Figure 1
Figure 1
A flowchart of identifying the study sample.
Figure 2
Figure 2
Distribution of time from symptom onset to hospital arrival.
Figure 3
Figure 3
(A) Factors associated with time from symptom onset to hospital arrival in log-transformed mixed model. Variables associated with longer or shorter time to hospital arrival among patients with acute myocardial infarction are shown along the vertical axis. The percentage of 0 shows no difference in time from symptoms onset to hospital arrival for different subgroups. Each dot represents the point estimate of the effect of that variable in the model; the line shows the 95% confidence interval. (B) Factors associated with extreme delay in hospital arrival (greater than 6 h) in multivariable logistic model. Variables associated with extreme delay in hospital arrival (greater than 6 h) among patients with acute myocardial infarction are shown along the vertical axis. The adjusted odds ratio of 1 shows no difference in time from symptoms onset to hospital arrival for different subgroups. Each dot represents the point estimate of the effect of that variable in the model; the line shows the 95% confidence interval. CI, confidence interval; CVD, cardiovascular disease; PCI, percutaneous coronary intervention.

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