title: High prevalence of lack of knowledge of symptoms of acute myocardial infarction in Pakistan and its contribution to delayed presentation to the hospital.
abstract: BACKGROUND
  We conducted an observational study to determine the delay in presentation to hospital, and its associates among patients experiencing first Acute Myocardial Infarction (AMI) in Karachi, Pakistan.
  
  
  METHODS
  A hospital based cross-sectional study was conducted at National Institute of Cardiovascular Disease (NICVD) in Karachi. A structured questionnaire was used to collect data. The primary outcome was delay in presentation, defined as a time interval of six or more hours from the onset of symptoms to presentation to hospital. Logistic regression analysis was performed to determine the factors associated with prehospital delay.
  
  
  RESULTS
  A total of 720 subjects were interviewed; 22% were females. The mean age (SD) of the subjects was 54 (+/- 12) years. The mean (SE) and median (IQR) time to presentation was 12.3 (1.7) hours and 3.04 (6.0) hours respectively. About 34% of the subjects presented late. Lack of knowledge of any of the symptoms of heart attack (odds ratio (95% CI)) (1.82 (1.10, 2.99)), and mild chest pain (10.05 (6.50, 15.54)) were independently associated with prehospital delay.
  
  
  CONCLUSIONS
  Over one-third of patients with AMI in Pakistan present late to the hospital. Lack of knowledge of symptoms of heart attack, and low severity of chest pain were the main predictors of prehospital delay. Strategies to reduce delayed presentation in this population must focus on education about symptoms of heart attack.
authors.affiliation: Clinical Epidemiology Unit, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan. epidemiologist@gmail.com
authors.forename: Muhammad S
authors.initials: MS
authors.lastname: Khan
authors.forename: Fahim H
authors.initials: FH
authors.lastname: Jafary
authors.forename: Azhar M
authors.initials: AM
authors.lastname: Faruqui
authors.forename: Syed I
authors.initials: SI
authors.lastname: Rasool
authors.forename: Juanita
authors.initials: J
authors.lastname: Hatcher
authors.forename: Nish
authors.initials: N
authors.lastname: Chaturvedi
authors.forename: Tazeen H
authors.initials: TH
authors.lastname: Jafar
mesh_terms: D000208:Acute Disease; D000328:Adult; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data; D002637:Chest Pain / Q000209:etiology / Q000523:psychology; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy; D010154:Pakistan; D010353:Patient Education as Topic; D015995:Prevalence; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome