Cross-sectional study of healthcare accessibility in rural regions among patients with acute myocardial infarction

BackgroundPatients suffering from acute myocardial infarction (AMI), mainly with ST elevation (STEMI), are at a great disadvantage in rural regions due to the lack of nearby hospitals with percutaneous coronary intervention (PCI).ObjectiveThis study aimed to analyse AMI patients’ interhospital referrals in a rural emergency department (ED), as well as the factors contributing to its system delayMethodsA cross-sectional observational study was carried out. An analysis of hospital referral was conducted as well for time intervals: from the first medical contact (FMC), first electrocardiogram (ECG), contact with the PCI hospital, ED exit, and arrival at the catheterization laboratory ward.ResultsOf the 48 eligible patients, 62.5% suffered from STEMI, and 50.0% were transferred to a PCI hospital. The median time to coronary intervention facilities was 214 min. The median time spent in the ED was 131 min, and time spent in transport was 101 min. The time interval to the first ECG was 6 to 10 min.ConclusionsInterhospital referral of AMI patients in rural settings is inconsistent and often not in compliance with international guidelines. A long system delay time is related mainly to organizational issues. STEMI patients still experience significant delays in healthcare accessibility. Nurses’ timely execution and interpretation of ECG can improve healthcare accessibility.