Abstract 3019: Treatment-Seeking Delay Trajectories In Victims Of Out-Of-Hospital Sudden Cardiac Death Due To Presumed Myocardial Infarction
Introduction: Recent studies suggest that victims of out-of-hospital sudden cardiac death (SCD), defined as death within 1 hour of symptom onset, may experience symptoms long enough to seek care. Less is known about the behavior of these victims during symptoms. The purpose of this study was to describe the treatment-seeking delay trajectories–symptoms, decisions, and actions– of victims of out-of-hospital presumed myocardial infarction (MI) death from the onset of symptoms until collapse or death.
Method: Decedents (N=140) age 18 and older with MI listed as the first cause of death (ICD-10 code I21) were identified through Oregon death certificates between April 2004 and March 2005. Decedents died at home (n = 91), in the community (n = 9), or in the ED/DOA (n = 40). Witnesses were located and interviewed by telephone. Narrative analysis was used for qualitative data.
Results: Three trajectory types were identified. Normal Day included victims who were engaging in routine activities when they either collapsed without symptoms or warning or had symptoms < 15 minutes prior to collapse and death. Decedents in the Something Not Right group had symptoms > 15 minutes and recognized them as unusual, yet not necessarily cardiac, or said something was not right; 11 refused medical care; 2 saw their doctor; 4 went to the ED. Thought It Was Something Else included decedents with symptoms > 15 minutes who attributed them to a specific, non-cardiac cause and treated them as such; 6 refused medical care. In all 3 groups, the most frequent decedent actions were resting and self-medicating. In total, 65% of victims delayed or refused medical care and 20 calls to 911 were made prior to collapse.
Conclusions: Three SCD delay trajectories were identified, only 1 of which was truly sudden. Despite having symptoms long enough to seek treatment, victims delayed or refused medical care. Knowledge of what victims are thinking and doing prior to death can be used to shape public health messages to prevent SCD.