Abstract 6237: Factors Associated with Longer Delays to Hospital Presentation for Patients with Non-ST-Elevation Myocardial Infarction
Background: Patients typically cannot differentiate if their angina symptoms represent ST-elevation myocardial infarction (STEMI) or non-STEMI, making immediate presentation to the hospital after symptom onset critical in both instances. For patients with STEMI, delays to hospital presentation average 2 hours, secular trends have not changed substantially, and factors associated with delays are well characterized. Duration of delays, trends, and factors associated with delays are less understood in non-STEMI.
Methods: We studied 104,622 patients with non-STEMI enrolled in the CRUSADE registry at 538 centers from January 1, 2001, to December 31, 2006. The main outcome measure was delay to hospital presentation, defined as the time from symptom onset to hospital arrival. Using linear generalized estimating equations to account for clustering within hospitals, we evaluated patient and hospital factors associated with longer delays.
Results: Median delay time was 2.6 hours with an interquartile range of 1.3 to 6.0 hours. Secular trend analysis showed no significant change in times from 2001 to 2006. Age groups 65–74, 75–84, and >=85 had 3.9%, 8.1%, and 7.8% longer times as compared with age <55 group, respectively (p<0.0001). Women had 3.5% longer times than men (p<0.0001). Patients who had prior myocardial infarction or percutaneous coronary intervention had 3.6% and 3.9% shorter times than respective reference groups (p<0.0001). Patients presenting during weekday evenings (4PM–12MN), weekday nights (12MN–8AM), weekend daytime (8AM–4PM), weekend evenings (4PM–12MN), and weekend nights (12MN–8AM) had 10.9%, 24.7%, 5.6%, 15.8%, and 24.3% shorter times than weekday daytime (8AM–4PM), respectively (p<0.0001).
Conclusions: Delays to hospital presentation are substantial in non-STEMI and comparable to those noted in STEMI. Elderly and female patients had longer delay times. Time of day and day of week had the largest magnitude of effect with delay times being the shortest during weekday nights (12MN–8AM) and weekend nights (12MN–8AM). Conversely, delay times are the longest during weekday daytime (8AM–4PM) when hospitals typically have the greatest availability of staffing and services.