Predictors of Myocardial Reperfusion in Patients with ST-Elevation Myocardial Infarction Following Thrombolytic Treatment in Rural Community

Patcharaporn  UNTAJA; Siriorn  SINDHU; Patricia Mary  DAVIDSON; Orapan  THOSINGHA; Chukiat  VIWATWONGKASEM

doi:10.48048/wjst.2020.4468

Authors

Patcharaporn UNTAJA Royal Thai Army Nursing College, Bangkok 10400, Thailand http://orcid.org/0000-0001-6315-9332
Siriorn SINDHU Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand
Patricia Mary DAVIDSON Johns Hopkins School of Nursing, Baltimore 21205, United State of America
Orapan THOSINGHA Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand
Chukiat VIWATWONGKASEM Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok 10700, Thailand

DOI:

https://doi.org/10.48048/wjst.2020.4468

Keywords:

Thrombolytic reperfusion, ST-elevation myocardial infarction, rural, clinical guidelines, outcomes, access

Abstract

This cross-sectional study aims to examine patient and hospital factors contributing to reperfusion following thrombolysis in patients with ST-segment elevation myocardial infarction (STEMI) in rural hospitals in Thailand. Access to reperfusion therapy for STEMI patients in rural areas is increasing in Thailand, yet clinical outcomes vary between settings and are inferior to recommended guidelines. Ten years after the introduction of thrombolytic treatment for rural patients undergoing STEMI, there is still a limited description of factors influencing the outcomes of thrombolytic treatment.

Data were collected from 87 acute STEMI patients who had received thrombolytic treatment in 12 thrombolysis-capable hospitals located in rural areas. Demographic and clinical characteristics included patient response and treatment seeking behavior, witness response to the patient symptoms, waiting time for treatment, severity of illness, guideline adherence, and thrombolytic reperfusion. The results were: only 31 of 87 patients (35.63 %) received thrombolytic treatment within 30 min after arrival at the hospital. A total of 42 patients (48.28 %) had successful myocardial reperfusion following thrombolytic treatment. Logistic regression analysis revealed that guideline adherence (OR : 1.58 ; 95 % CI : 1.12 - 2.25), severity of illness (OR : 0.77 ; 95 % CI : 0.64 - 0.94), and patient response and treatment seeking behavior (OR : 1.47 ; 95 % CI : 1.01 - 2.04) were predictors of thrombolytic reperfusion. In rural areas, healthcare resources and transfer facilities are limited. Therefore, the improvement of patient awareness is needed. The clinical practice guidelines and consideration of pre-hospital factors should be promoted and the number of thrombolysis-capable hospitals should be increased.

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Author Biographies

Patcharaporn UNTAJA, Royal Thai Army Nursing College, Bangkok 10400, Thailand

Medical and Surgical nursing department

Siriorn SINDHU, Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand

Associate Professor, Dr.

Surgical nursing

Nursing faculty, Mahidol University

Patricia Mary DAVIDSON, Johns Hopkins School of Nursing, Baltimore 21205, United State of America

Professor, Dr

Dean of Johns Hopkins School of Nursing,

Baltimore, United State of America

Orapan THOSINGHA, Faculty of Nursing, Mahidol University, Bangkok 10700, Thailand

Associate Professor, Dr.

Surgical nursing

Nursing faculty, Mahidol University

Chukiat VIWATWONGKASEM, Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok 10700, Thailand

Associate professor, Dr.

Department of Biostatistics, Faculty of Public Health, Mahidol University, Bangkok, Thailand

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