Factors associated with the delay in informed consent procedures of patients with ST-segment elevation myocardial infarction and its influence on door-to-balloon time: a nationwide retrospective cohort study

Author:

Maimaitiming Mailikezhati12,Ma Junxiong12,Dong Xuejie12,Zhou Shuduo12,Li Na12,Zhang Zheng3,Lu Shijuan4,Chen Lianglong5,Ma Likun6,Yu Bo7,Ma Yitong8,Zhao Xingsheng9,Zheng Zhaofen10,Shi Hong11,Zheng Zhijie12,Jin Yinzi12ORCID,Huo Yong12

Affiliation:

1. Department of Global Health, School of Public Health, Peking University , Beijing , China

2. Institute for Global Health and Development, Peking University , Beijing , China

3. First People’s Hospital of Lanzhou University , Lanzhou , Gansu Province , China

4. Haikou People’s Hospital , Haikou , Hainan Province , China

5. Fujian Medical University Union Hospital , Fuzhou , Fujian Province , China

6. Anhui Provincial Hospital , Hefei , Anhui Province , China

7. Second Affiliated Hospital of Harbin Medical University , Harbin , Heilongjiang Province , China

8. First Affiliated Hospital of Xinjiang Medical University , Urumqi , Xinjiang Uygur Autonomous Region , China

9. Inner Mongolia People’s Hospital , Huhhot , Inner Mongolia Autonomous Region , China

10. Hunan Provincial People’s Hospital , Changsha , Hunan Province , China

11. Chinese Medical Association , Beijing , China

12. Department of Cardiology, Peking University First Hospital , Beijing , China

Abstract

Abstract Background and Objectives ST-segment elevation myocardial infarction (STEMI) is the deadliest and most time-sensitive acute cardiac event. However, failure to achieve timely informed consent is an important contributor to in-hospital delay in STEMI care in China. We investigated the factors associated with informed consent delay in patients with STEMI undergoing percutaneous coronary intervention (PCI) and the association between the delay and door-to-balloon time. Methods We conducted a nationally representative retrospective cohort study using patient data reported by hospital-based chest pain centers from 1 January 2016 to 31 December 2020. We applied generalized linear mixed models and negative binomial regression to estimate factors independently predicting informed consent delay time. Logistic regressions were fitted to investigate the association of the informed consent delay time and door-to-balloon time, adjusting for patient characteristics. Results In total, 257, 510 patients were enrolled in the analysis. Mean informed consent delay time was 22.4 min (SD = 24.0), accounting for 39.3% in door-to-balloon time. Older age (≥65 years) was significantly correlated with informed consent delay time (RR: 1.034, P = 0.001). Compared with ethnic Han patients, the minority (RR: 1.146, P < 0.001) had more likelihood to extend consent giving; compared with patients who were single, longer informed consent time was found in married patients (RR: 1.054, P = 0.006). Patients with intermittent chest pain (RR: 1.034, P = 0.011), and chest pain relief (RR: 1.085, P = 0.005) were more likely to delay informed consent. As for transfer modes, EMS (RR: 1.063, P < 0.001), transfer-in (RR: 1.820, P < 0.001), and in-hospital onset (RR: 1.099, P = 0.002) all had positive correlations with informed consent delay time compared to walk-in. Informed consent delay was significantly associated with prolonged door-to-balloon time (OR: 1.002, P < 0.001). Conclusion Informed consent delay is significantly associated with the door-to-balloon time which plays a crucial role in achieving better outcomes for patients with STEMI. It is essential to shorten the delay time by identifying and intervening modifiable factors that are associated with shortening the informed consent procedure in China and other countries.

Publisher

Walter de Gruyter GmbH

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