Pre-hospital delay in patients presenting with myocardial infarction in Kingdom of Saudi Arabia

Abstract

Introduction: Pre-hospital delay (onset of symptoms to hospital arrival) has a significant impact on patients’ mortality and morbidity in myocardial infarction (MI). Many factors have been implicated in patients’ decision to seek care in MI, but most research has a Western origin and it is possible that the reasons for delay differ in Arab cultures. This study aimed to explore the factors that contribute to pre-hospital delay among MI patients in Saudi Arabia. It combined quantitative and qualitative methods using sequential explanatory design. Ethical approval was provided by University of Ulster.

Method: This cross sectional study comprised a consecutive sample of research participants (n=311), who presented with a diagnosis of MI to 3 hospitals in Riyadh, from March 2011 to August 2011. Of these, 189 patients met the eligibility criteria and provided quantitative data. A further 18 patients were purposefully selected for semi-structured interviews that were taped and transcribed verbatim prior to thematic analysis.

Findings: The median pre-hospital delay for males was 5 hours and for females it was 12.9 hours. A standard multiple regression determined female gender as the strongest predictor of transfer delay in this sample. Lack of knowledge and Control was the core theme in the thematic content interview analysis and it was evident that cultural issues such as wishing to seek permission to attend hospital from a male relative and inability to travel to hospital without a male escort contributed to female patients’ prehospital delay.

Conclusion: Women’s pre-hospital delay was more than twice that of their male counterparts and the total pre-hospital delay time reported here for both genders is longer than in studies in other settings. Qualitative data indicate that cultural factors are implicated in the prolonged delay experienced by females. Further research to test the generalizability of these findings and to determine any potential impact on female mortality and morbidity for MI is needed. Primary and secondary prevention strategies for potential MI patients in Saudi should consider offering culturally- specific, gender related messages.

Date of Award	Mar 2013
Original language	English
Supervisor	Roy McConkey (Supervisor) & Donna Fitzsimons (Supervisor)