Characterization of Patients with Acute Myocardial Infarction in a Rural Hospital in Ecuador as an Example of Health Inequity

Abstract

Objective. To compare the results of the treatment of acute coronary syndrome (ACS) in a rural population in the northwest province of Pichincha in Ecuador, in relation to the interventions assumed as conventional treatment in the first world.

Methodology. We conducted a descriptive study of 316 clinical histories of patients treated in a period of 6 years, from January 2010 to January 2017, in which the diagnosis of acute coronary syndrome or its variants according to the International Classification of Diseases, was published. 10 (ICD-10). A survey was applied that extracted demographic data, previous illnesses, exams performed in the initial diagnosis, treatment received in emergency, average time from the onset of symptoms until entering the coronary care unit, and mortality.

Results. The mean age of the ischemic episode was 62.8 years. The identified risk factors were: hypertension (55%), diabetes (31%), dyslipidemia (4.8%), and smoking (12%). 9.5% reported a history of AMI.

86% presented findings of SCA in the electrocardiogram, 42.8% showed positive troponins; 14.29% (6 patients) presented a fatal outcome in the same emergency room. More than 50% of the patients were referred to a tertiary care facility in Quito (22 patients). The average time between the onset of symptoms and admission to the coronary care unit was 12 hours. The mortality in the first 15 days of the patients referred to the tertiary facility was 10 patients (23.8%).

Conclusions. A contextualized application of the international SCA management standards is required, which includes aspects such as: access and availability to the initial treatment called MONA (morphine, oxygen when necessary, nitrates and aspirin), adequate human resources and equipment in rural and remote hospitals for the timely administration of fibrinolysis, and coordination with the national system of emergency care that allow access to hospitals with availability of coronary care