 |
 |
|
Home |
Current Issue |
Past Issues |
In the Clinic |
ACP Journal Club |
CME |
Collections |
Audio/Video |
Mobile |
Subscribe |
Tools |
Help |
ACP Online
|
15 April 1997 | Volume 126 Issue 8 | Pages 593-599
Background: In patients who have had acute myocardial infarction, the delay between the onset of symptoms and hospital presentation is a critical factor in determining the initial management strategy and outcomes of treatment.
Objective: To examine the determinants of delayed hospital presentation in patients who have had acute myocardial infarction.
Design: Retrospective chart review.
Setting: 37 hospitals in Minnesota.
Patients: 2409 persons hospitalized with acute myocardial infarction between October 1992 and July 1993.
Main Outcome Measure: Hospital presentation delayed more than 6 hours after the onset of symptoms of acute myocardial infarction.
Results: Information on length of delay was available for 2404 patients. Of these patients, 969 (40%) delayed presentation to the hospital for more than 6 hours after the onset of symptoms. Factors associated with prolonged delay included advanced age and female sex. The presence of chest discomfort and a history of mechanical revascularization significantly reduced the risk for prolonged delay. Risk for delay was greatest during the evening and early morning hours (6:00 p.m. to 6:00 a.m.) Patients with a history of hypertension were more likely to delay presentation. Only 42% of all patients hospitalized with acute myocardial infarction had used emergency medical transport services.
Conclusions: Patients who have had acute myocardial infarction often delay hospital presentation. Educational interventions that encourage the prompt use of emergency medical transport services and target specific patient populations, such as elderly persons, women, and persons with cardiac risk factors, may be most successful in reducing the length of delay and improving the outcomes of patients with acute myocardial infarction.
Author and Article Information
From Harvard Medical School, Harvard Pilgrim Health Care, and Brigham and Women's Hospital, Boston, Massachusetts; University of Massachusetts Medical Center and Fallon Healthcare System, Worcester, Massachusetts; and McMaster University Health Sciences Centre, Hamilton, Ontario, Canada.
ARTICLE
Delayed Hospital Presentation in Patients Who Have Had Acute Myocardial Infarction
Acknowledgments: The authors thank the hospitals participating in the Minnesota Clinical Comparison and Assessment Program; Catherine Borbas, PhD, Barbara McLaughlin, BSN, and Nora Morris, MA, of the Healthcare Education and Research Foundation, St. Paul, Minnesota; and Linda Casey, MS.
Grant Support: In part by a grant from the Agency for Health Care Policy and Research (HSO 7357-03) and the Harvard Community Health Plan Foundation. At the time of this study, Dr. Gurwitz was the recipient of a Clinical Investigator Award (KO8 AG00510) from the National Institute on Aging and Dr. Willison was a doctoral fellow of the Health Research Development Program, Ontario Ministry of Health (no. 10023).
Requests for Reprints: Jerry H. Gurwitz, MD, The Meyers Primary Care Institute, University of Massachusetts Medical Center and the Fallon Healthcare System, 100 Central Street, Worcester, MA 01608.
Current Author Addresses: Dr. Gurwitz: The Meyers Primary Care Institute, University of Massachusetts Medical Center and the Fallon Healthcare System, 100 Central Street, Worcester, MA 01608.
Related articles in Annals:
This article has been cited by other articles:
|
|
 |
|
  S. Noureddine, M. Arevian, M. Adra, and H. Puzantian Response to Signs and Symptoms of Acute Coronary Syndrome: Differences Between Lebanese Men and Women Am. J. Crit. Care., January 1, 2008; 17(1): 26 - 35. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 K. P. Alexander, L. K. Newby, P. W. Armstrong, C. P. Cannon, W. B. Gibler, M. W. Rich, F. Van de Werf, H. D. White, W. D. Weaver, M. D. Naylor, et al. Acute Coronary Care in the Elderly, Part II: ST-Segment-Elevation Myocardial Infarction: A Scientific Statement for Healthcare Professionals From the American Heart Association Council on Clinical Cardiology: In Collaboration With the Society of Geriatric Cardiology Circulation, May 15, 2007; 115(19): 2570 - 2589. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. Noureddine, M. Adra, M. Arevian, N. Y. Dumit, H. Puzantian, D. Shehab, and A. Abchee Delay in seeking health care for acute coronary syndromes in a lebanese sample. J Transcult Nurs, October 1, 2006; 17(4): 341 - 348. [Abstract] [PDF]
|
|
|
|
|
|
D. K. Moser, L. P. Kimble, M. J. Alberts, A. Alonzo, J. B. Croft, K. Dracup, K. R. Evenson, A. S. Go, M. M. Hand, R. U. Kothari, et al. Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke: A Scientific Statement From the American Heart Association Council on Cardiovascular Nursing and Stroke Council Circulation, July 11, 2006; 114(2): 168 - 182. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. D. Banks and K. Dracup Factors Associated With Prolonged Prehospital Delay of African Americans With Acute Myocardial Infarction Am. J. Crit. Care., March 1, 2006; 15(2): 149 - 157. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. P. Wharton Jr, E. C. Keeley, C. L. Grines, T. P. Wharton Jr, E. C. Keeley, and C. L. Grines The Case for Community Hospital Angioplasty Circulation, November 29, 2005; 112(22): 3509 - 3534. [Full Text] [PDF]
|
|
|
|
 |
|
 J S Birkhead, L Walker, M Pearson, C Weston, A D Cunningham, and A F Rickards Improving care for patients with acute coronary syndromes: initial results from the National Audit of Myocardial Infarction Project (MINAP) Heart, September 1, 2004; 90(9): 1004 - 1009. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. A. DeVon, C. J. Ryan, and J. J. Zerwic Is the Medical Record an Accurate Reflection of Patients' Symptoms During Acute Myocardial Infarction? West J Nurs Res, August 1, 2004; 26(5): 547 - 560. [Abstract] [PDF]
|
|
|
|
 |
|
 S. W. Smith, J. H. Gurwitz, T. J. McLaughlin, D. Ross-Degnan, C. L. Christiansen, and S. B. Soumerai Thrombolytics Are Not Contraindicated in the Very Old Arch Intern Med, October 14, 2002; 162(18): 2139 - 2140. [Full Text] [PDF]
|
|
|
|
 |
|
 L. Erhardt, J. Herlitz, L. Bossaert, M. Halinen, M. Keltai, R. Koster, C. Marcassa, T. Quinn, and H. van Weert Task force on the management of chest pain Eur. Heart J., August 1, 2002; 23(15): 1153 - 1176. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Williams, J. L. Fleg, P. A. Ades, B. R. Chaitman, N. H. Miller, S. M. Mohiuddin, I. S. Ockene, C. B. Taylor, and N. K. Wenger Secondary Prevention of Coronary Heart Disease in the Elderly (With Emphasis on Patients >=75 Years of Age): An American Heart Association Scientific Statement From the Council on Clinical Cardiology Subcommittee on Exercise, Cardiac Rehabilitation, and Prevention Circulation, April 9, 2002; 105(14): 1735 - 1743. [Full Text] [PDF]
|
|
|
|
|
|
S. B. Soumerai, T. J. McLaughlin, D. Ross-Degnan, C. L. Christiansen, and J. H. Gurwitz Effectiveness of Thrombolytic Therapy for Acute Myocardial Infarction in the Elderly: Cause for Concern in the Old-Old Arch Intern Med, March 11, 2002; 162(5): 561 - 568. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. C. Wong, L. A. Sleeper, E. S. Monrad, M. A. Menegus, A. Palazzo, V. Dzavik, A. Jacobs, X. Jiang, J. S. Hochman, and for the SHOCK Investigators Absence of gender differences in clinical outcomes in patients with cardiogenic shock complicating acute myocardial infarction: A report from the SHOCK Trial Registry J. Am. Coll. Cardiol., November 1, 2001; 38(5): 1395 - 1401. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. PERRY, K. J PETRIE, C. J ELLIS, R. HORNE, and R. MOSS-MORRIS Symptom expectations and delay in acute myocardial infarction patients Heart, July 1, 2001; 86(1): 91 - 93. [Full Text] [PDF]
|
|
|
|
|
|
S. E. Kimmel, J. A. Berlin, C. Miles, J. Jaskowiak, J. L. Carson, and B. L. Strom Risk of acute first myocardial infarction and use of nicotine patches in a general population J. Am. Coll. Cardiol., April 1, 2001; 37(5): 1297 - 1302. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Sheifer, S. S. Rathore, B. J. Gersh, K. P. Weinfurt, W. J. Oetgen, J. A. Breall, and K. A. Schulman Time to Presentation With Acute Myocardial Infarction in the Elderly : Associations With Race, Sex, and Socioeconomic Characteristics Circulation, October 3, 2000; 102(14): 1651 - 1656. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. G. Shlipak, A. S. Go, P. D. Frederick, J. Malmgren, H. V. Barron, J. G. Canto, and for the National Registry of Myocardial Infarction Treatment and outcomes of left bundle-branch block patients with myocardial infarction who present without chest pain J. Am. Coll. Cardiol., September 1, 2000; 36(3): 706 - 712. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K.A.A Fox, D.V Cokkinos, J Deckers, U Keil, A Maggioni, and G Steg The ENACT study: a pan-European survey of acute coronary syndromes Eur. Heart J., September 1, 2000; 21(17): 1440 - 1449. [Abstract] [PDF]
|
|
|
|
 |
|
 A. Sauaia, D. Ralston, W. W. Schluter, T. A. Marciniak, E. P. Havranek, and T. R. Dunn Influencing Care in Acute Myocardial Infarction: A Randomized Trial Comparing 2 Types of Intervention American Journal of Medical Quality, September 1, 2000; 15(5): 197 - 206. [Abstract] [PDF]
|
|
|
|
|
|
W S Leslie, A Urie, J Hooper, and C E Morrison Delay in calling for help during myocardial infarction: reasons for the delay and subsequent pattern of accessing care Heart, August 1, 2000; 84(2): 137 - 141. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P Marques-Vidal, J-B Ruidavets, J-P Cambou, and J Ferrieres Incidence, recurrence, and case fatality rates for myocardial infarction in southwestern France, 1985 to 1993 Heart, August 1, 2000; 84(2): 171 - 175. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. J. Goldberg, J. H. Gurwitz, and J. M. Gore Duration of, and Temporal Trends (1994-1997) in, Prehospital Delay in Patients With Acute Myocardial Infarction: The Second National Registry of Myocardial Infarction Arch Intern Med, October 11, 1999; 159(18): 2141 - 2147. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J S Birkhead Trends in the provision of thrombolytic treatment between 1993 and 1997 Heart, October 1, 1999; 82(4): 438 - 442. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. B. Soumerai, T. J. McLaughlin, J. H. Gurwitz, S. Pearson, C. L. Christiansen, C. Borbas, N. Morris, B. McLaughlin, X. Gao, and D. Ross-Degnan Timeliness and Quality of Care for Elderly Patients With Acute Myocardial Infarction Under Health Maintenance Organization vs Fee-for-Service Insurance Arch Intern Med, September 27, 1999; 159(17): 2013 - 2020. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. B. Soumerai, T. J. McLaughlin, J. H. Gurwitz, E. Guadagnoli, P. J. Hauptman, C. Borbas, N. Morris, B. McLaughlin, X. Gao, D. J. Willison, et al. Effect of Local Medical Opinion Leaders on Quality of Care for Acute Myocardial Infarction: A Randomized Controlled Trial JAMA, May 6, 1998; 279(17): 1358 - 1363. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. D. Naylor Better Care and Better Outcomes: The Continuing Challenge JAMA, May 6, 1998; 279(17): 1392 - 1394. [Full Text] [PDF]
|
|
|
|
 |
|
 Reducing Delay in Hospitalization for Acute MI Journal Watch Cardiology, May 19, 1997; 1997(519): 6 - 6. [Full Text]
|
|
Article
