Pre-hospital delays among patients with acute coronary syndrome in the central region of Malaysia and their associated factors

Introduction: Early arrival at the hospital and initiation of reperfusion treatment are critical for improving patient outcomes during cardiac events. Pre-hospital delays remain the most significant barrier to the effective management of acute coronary syndrome (ACS). However, there is a lack of data on pre-hospital delays in Malaysia. Therefore, the study aimed to identify the factors contributing to pre-hospital delays. Materials and methods: This cross-sectional study was conducted in two government hospitals. Patients who developed ACS outside the hospital and had their time of symptom onset and time of arrival at the hospital recorded were recruited using universal sampling. Multiple logistic regression was utilised to determine the factors associated with pre-hospital delays of more than 2 hours. Results: A total of 390 patients were included in this study. The median pre-hospital delay time was 3 (interquartile range=1.72) hours, with 77.2% of the patients experiencing delays. Pre-hospital delays of more than 2 hours were significantly associated with atypical chest pain (adjusted odds ratio [AOR]=3.33; 95% confidence interval [CI]=1.73, 6.41; P<0.001), no history of hyperlipidaemia (AOR=2.03; 95% CI=1.09, 3.80; P= .027), transportation sent by another person (AOR=17.11; 95% CI=8.44, 34.71; P<0.001) and self-driven transportation (AOR=16.93; 95% CI=5.09, 56.30; P<0.001). Conclusion: The majority of the patients with ACS experienced pre-hospital delays of more than 2 hours. Interventions aimed at increasing public awareness about the symptoms of ACS and available modes of transportation are important for improving emergency cardiac care in Malaysia.

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