Assessment of the Timeline from Symptom Onset to Reperfusion in Acute Coronary SyndromePatients Presenting at Georgetown Public Hospital Corporation: A 3-month prospective study
Introduction
Acute Coronary Syndrome (ACS) is a leading cause of morbidity and mortality
worldwide, with timely reperfusion being essential for improved outcomes. In low- and middle-income
countries (LMICs) such as Guyana, systemic barriers and patient-level factors frequently delay
treatment.
Objectives
To evaluate the timelines from symptom onset to reperfusion among ACS patients at GPHC,
identify predictors of delay, and assess associated clinical outcomes.
Method
A prospective cross-sectional study was conducted at GPHC. 18 ACS patients and 57
healthcare providers were recruited using convenience and purposive sampling, respectively. Data were
collected via chart audits, structured questionnaires, and provider surveys. Statistical analyses included
descriptive statistics, logistic regression, and correlation tests, with significance set at α = 0.05 and power
at 80%.
Results
The mean symptom-to-hospital arrival time was 3,174 minutes (~52.9 hours), while door-to-
balloon times averaged 1,239 minutes (~20.6 hours), both far exceeding international benchmarks.
Predictors of delay included female gender, older age, East Indian ethnicity, rural residence, private
transport, and employment status. Provider feedback identified the absence of 24/7 cath lab availability,
lack of standardized protocols, and limited thrombolytic access as major systemic barriers. Despite
profound delays, no in-hospital mortality or complications were observed; however, longer door-to-cath
lab times moderately correlated with increased length of stay (r = 0.27; p-value of 0.287). A key
limitation is the small sample size of ACS patients, largely resulting from frequent secondary transfers,
which limits the generalizability of the findings.
Conclusion
Despite favourable short-term clinical outcomes, this study revealed significant treatment
delays at GPHC, driven by both individual and institutional factors.
Recommendation: Urgent reforms are needed, including 24/7 catheterization lab availability,
standardized ACS care protocols, and targeted community education to improve symptom recognition
and timely care-seeking.
12