Study: Delay In Treatment, Primary Cause Of Deaths Due To Acute Cardiac Events

The main cause of a significant number of deaths from acute cardiac events or stroke is delaying receiving appropriate treatment, according to a study published in the Lancet

Only a small percentage of patients experiencing cardiac and stroke emergencies make it to medical facilities in a timely manner, according to a study done at the All India Institute of Medical Sciences (AIIMS) in this city.

It was stated that tackling the factors causing delays at various levels in getting to the facilities could stop such deaths.

“Lack of timely care is a predictor of poor outcomes in acute cardiovascular emergencies, including stroke. Delayed presentation leads to delay or failure to provide the most beneficial therapies like thrombolysis for myocardial infarction/ischemic stroke leading to poorer disease outcomes. It is estimated that interventions that reduce delays in care in patients with myocardial infarction (MI) could decrease risk of mortality by 30 per cent,” the study funded by the Indian Council of Medical Research (ICMR) said.

In a village in northern India, the doctors evaluated whether people who died as a result of cardiac or stroke emergencies delayed in obtaining adequate care and identified the causes and determinants of this delay.

This descriptive study was carried out in Badkhal and Ballabgarh, two of the three tehsils in the Faridabad district of Haryana, which is expected to have a population of 21 lakh by 2020–21.

The district’s acute cardiac event and stroke premature fatalities (30-69 years old) that were civilly registered were all subject to a social audit.

The decision to seek care, travelling to the proper health facility, and starting decisive treatment were all delays that were qualitatively categorised using the three-delays model.

Patients were categorised as early (reached within one hour) or delayed arrivers based on the estimated time between the beginning of symptoms and their arrival to AHF.

To determine the causes of delayed delivery, mixed-effect logistic regression with postal code as a random factor was utilised.

Only 10.8% of the deceased were found to have reached an AHF in the first hour, according to the findings.

“We noted level-1 delay in 38.4 per cent (60 per cent due to non-recognition of seriousness); level-2 delay in 20 per cent (40 per cent due to going to inappropriate facility) and level-3 delay in 10.8 per cent (57 per cent due to lack of affordability),” the study stated.

According to the study, the main cause for delays has been a lack of knowledge about the signs of a MI or stroke, which led to an underestimation of the severity of the patient’s condition.

2,466 verbal autopsies were evaluated as part of the study, and 761 (30.8%) of them were categorised as being caused by cardiovascular illnesses (CVDs).

The study’s findings about delays indicated the need for population- and health-system-level interventions. In India, there have been numerous health system initiatives to shorten wait times for cardiac and stroke care.

These health system reforms should be complemented by initiatives to raise public knowledge of the signs of a heart attack and a stroke, as well as by enhancing insurance coverage for these potentially fatal illnesses. It has been proven that community education efforts to raise symptom awareness to encourage early diagnosis, care seeking, and use of ambulances are successful.

The study also noted that it has been helpful to train both formal and informal primary care professionals to identify these illnesses and direct patients to the proper hospitals.

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