Abstract 3523: Factors Associated with Longer Times from Symptom Onset to Hospital Presentation for Patients with ST-Elevation Myocardial Infarction
Background: Longer delay from symptom onset to hospital presentation for STEMI patients is associated with more myocardial damage, adverse outcomes, and decreased effectiveness of reperfusion therapy. Although prior studies have focused on the effect of single factors associated with delays, little information is available about whether there are meaningful differences among subgroups with multiple risk factors for longer delays.
Methods: I We analyzed 482,327 STEMI patients from NRMI from 1995–2004 and constructed multivariable generalized linear models to assess patient and hospital variables associated with delay. We examined 4 risk factors associated with longer delays alone and in combination for the effect on delay: age, gender, race/ethnicity (white, black, Hispanic, and other), and diabetes.
Results: The geometric mean for delay was 114 minutes with a slight decreasing trend from 123 minutes in 1995 to 113 minutes in 2004 (p<0.0001). Nearly half of the patients (45.5%) presented >2 hours and 8.7% presented >12 hours after symptom onset. Among vulnerable patients with documented disparities in healthcare access, a higher proportion presented >12 hours after symptom onset: age 70 –79 (10.1%), age ≥ 80 (12.0%), women (10.5%), black patients (10.9%), Hispanic patients (11.1%), Medicare insurance (10.4%). In multivariable analysis, adjusted delay was longer by 9, 19, and 29 minutes for patients with age 60 – 69, age 70 –79, and age ≥80, respectively as compared to patients with age <60, (p<0.0001). Adjusted delay was longer by 12 minutes for women, 14 minutes for black patients, 11 minutes for Hispanic patients, and 18 minutes for diabetics as compared with respective reference groups (p <0.0001). In patient subgroup analysis, delay was 106 minutes for younger (age<70) white man without diabetes as compared with 166 minutes or 170 minutes for an elderly (age ≥ 70), black, diabetic man or woman, respectively.
Conclusions: Delays in hospital presentation are particularly long in some subgroups including those with a combination of factors including older age, Hispanic or black patients, women, and diabetes that have times up to 60 minutes longer. Improving times merits attention and represents an opportunity to improve quality of care for STEMI patients.