New study says delay in seeking treatment key reason behind deaths due to acute cardiac events

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Delay in seeking proper treatment is the key reason behind a large number of deaths due to acute cardiac events or stroke, according to a study published in the Lancet.

The study, conducted at the All India Institute of Medical Sciences (AIIMS) here, stated that only a small proportion of patients with cardiac and stroke emergencies reach health facilities early. It said addressing the reasons for delays at multiple levels in reaching the facilities could prevent 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.

The doctors assessed the presence of delay in seeking appropriate care among those who died due to cardiac/stroke emergencies in a community in northern India and identified the reasons and determinants of this delay.

This descriptive study was conducted in two out of three tehsils (Badkhal and Ballabgarh) of Faridabad district of Haryana with an estimated population of 21 lakh in 2020-21.

A social audit was conducted among all civil-registered premature (30-69 years) deaths due to acute cardiac event or stroke in the district. The three-delays model was used to qualitatively classify the delays in care seeking -- deciding to seek care, reaching appropriate health facility (AHF) and initiating definitive treatment.

Based on the estimated time from symptom onset to reaching AHF, patients were classified as early (reached within one hour) or delayed arrivers. Mixed-effect logistic regression with postal code was used as a random effect to identify determinants of delayed arrival. Findings showed that only 10.8 per cent of the deceased reached an AHF within one hour.

"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.

The primary reason for delay identified in all studies has been lack of awareness of the symptoms related to MI or stroke resulting in non-recognition of the severity of their illness, the study said.

As part of the study, 2,466 verbal autopsies were assessed, of which 761 (30.8 per cent) autopsies were classified as due to cardiovascular diseases (CVDs).
The delays identified in the study pointed to the need for interventions at population and health system levels. There have been many health system initiatives in India to reduce delays in cardiac and stroke care.

These health system interventions should be supplemented by efforts to create public awareness in recognising symptoms of heart attack and stroke and by improving insurance coverage for these life threatening conditions. Community educational campaigns to improve symptom awareness to promote early recognition and care-seeking and use of ambulances have been shown to be effective.

Training of formal and informal primary care providers to recognise these conditions and refer them to an appropriate hospital has also proved useful, the study added.

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