Factors associated with delays in seeking medical care among ST elevation myocardial infarction patients: a cross-study in a resource-limited setting

ST elevation myocardial infarction (STEMI) requires prompt reperfusion, and international guidelines emphasize minimizing pre-hospital delays.1 Most evidence on the determinants of pre-hospital delays originates from high-income countries and sub-Saharan African countries, with limited data from the Maghreb region. This study aimed to assess pre-hospital delay and identify associated factors among STEMI patients in a resource-limited region of Tunisia. A cross-sectional study was conducted at the regional hospital of Béja, Northwestern Tunisia, between September 2022 and August 2023. Due to the absence of a catheterization room in the region, fibrinolytic therapy (tenecteplase) was the only reperfusion strategy available. Consecutive patients aged ≥18 years with confirmed STEMI were enrolled. Patients initially admitted to another facility were excluded. The required sample size for finite populations was estimated using the formula described by Serhier et al.2 Hospital records indicated that approximately 100 STEMI cases were managed in 2021. A preliminary survey estimated the prevalence of delayed presentation at 20%. With a margin of error set at 5%, the minimum required sample size was calculated at 71 patients.