# Influence of Organisational-Level Factors on Delayed Door-to-Balloon Time among Patients with ST-Elevation Myocardial Infarction

## TL;DR

This study examines why some heart attack patients in Oman experience delays in receiving critical treatment, focusing on hospital and organizational factors.

## Contribution

The study identifies organizational-level factors, such as atypical symptoms and off-hours presentation, that significantly increase delayed door-to-balloon times in STEMI patients in Oman.

## Key findings

- Patients with atypical symptoms were 3 times more likely to experience delayed DTB times.
- Patients presenting during off-hours were 2 times more likely to experience delayed DTB times.

## Abstract

This study aimed to estimate the door-to-balloon (DTB) time and determine the organisational-level factors that influence delayed DTB times among patients with ST-elevation myocardial infarction in Oman.

A cross-sectional retrospective study was conducted on all patients who presented to the emergency department at Sultan Qaboos University Hospital and Royal Hospital, Muscat, Oman, and underwent primary percutaneous coronary interventions during 2018–2019.

The sample included 426 patients and the median DTB time was 142 minutes. The result of the bivariate logistic regression showed that patients who presented to the emergency department with atypical symptoms were 3 times more likely to have a delayed DTB time, when compared to patients who presented with typical symptoms (odds ratio [OR] = 3.003, 95% confidence interval [CI]: 1.409–6.400; P = 0.004). In addition, patients who presented during off-hours were 2 times more likely to have a delayed DTB time, when compared to patients who presented during regular working hours (OR = 2.291, 95% CI: 1.284–4.087; P = 0.005).

To meet the DTB time recommendation, it is important to ensure adequate staffing during both regular and irregular working hours. Results from this study can be used as a baseline for future studies and inform strategies for improving the quality of care.