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(Circulation. 2000;102:1651.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Time to Presentation With Acute Myocardial Infarction in the Elderly
Associations With Race, Sex, and Socioeconomic Characteristics
From the Division of Cardiology (S.E.S., S.S.R., J.A.B.), Georgetown University Medical Center, Washington, DC; Cardiovascular Diseases and Internal Medicine (B.J.G.), Mayo Clinic, Rochester, Minn; the Center for Clinical and Genetic Economics (K.P.W., K.A.S.), Duke Clinical Research Institute, Durham, NC; Maryland Health Care Associates, LLC (W.J.O.), Clinton, Md; and the Delmarva Foundation for Medical Care, Inc (W.J.O.), Easton, Md. Mr. Rathore is now at the University of North Carolina School of Public Health, Chapel Hill.
Background—Although prompt treatment is a cornerstone of the management of acute myocardial infarction (AMI), prior studies have shown that one fourth of AMI patients arrive at the hospital >6 hours after symptom onset. It would be valuable to identify individuals at highest risk for late arrival, but predisposing factors have yet to be fully characterized.
Methods and Results—Data from the Cooperative
Cardiovascular Project, involving Medicare
beneficiaries aged >65 years hospitalized between January 1994 and
February 1996 with confirmed AMI, were used to identify patients who
presented "late" (
6 hours after symptom onset). Patient
characteristics were tested for associations with late
presentation by use of backward stepwise logistic
regression. Among 102 339 subjects, 29.4% arrived late. Significant
predictors of late arrival (odds ratio, 95% CI) included diabetes
(1.11, 1.07 to 1.14) and a history of angina (1.32, 1.28 to 1.35),
whereas prior MI (0.82, 0.79 to 0.85), prior angioplasty (0.80, 0.75 to
0.85), prior bypass surgery (0.93, 0.89 to 0.98), and cardiac arrest
(0.52, 0.46 to 0.58) predicted early presentation.
Additionally, initial evaluation at an outpatient clinic (2.63, 2.51 to
2.75) and daytime presentation (1.67, 1.59 to 1.72)
predicted late arrival. Finally, female sex, black race, and poverty,
which were evaluated with an 8-level race–sex–socioeconomic status
interaction term, were also risk factors for delay.
Conclusions—Delayed hospital presentation is a common problem among Medicare beneficiaries with AMI. Factors associated with delay include not only clinical and logistical issues but also race, sex, and socioeconomic characteristics. Education efforts designed to hasten AMI treatment should be directed at individuals with risk factors for late arrival.
Key Words: myocardial infarction • sex • risk factors
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