Abstract 991: Explaining Racial Differences in Delay to Presentation From Symptom Onset in Acute Myocardial Infarction
Background: Delayed presentation for acute myocardial infarction (AMI) leads to delayed treatment and worse outcomes. Although it is known that blacks with AMI present later than whites, potential explanations for this difference are not clear. We hypothesized that worse socioeconomic status (SES) and access to care might mediate race-related differences in delay to seek care for AMI.
Methods: We compared time from symptom onset to hospital arrival between 2555 white and 959 black patients admitted for AMI enrolled in the TRIUMPH registry. Using previously validated measures of access to care (perceived access, availability of primary care, health insurance), SES (financial stress, avoiding care because of cost), psychosocial status (depression and social support), clinical characteristics (comorbidities, clinical severity of AMI), and health status (angina frequency, SF-12), we conducted serial multivariable, ordinal regression analyses for delay in presentation (time from symptom onset to hospital arrival) classified as 2hours (h), >2 to 6h, and >6h.
Results: Blacks had significantly longer delays in presentation as compared with whites ( 2h: 23% vs. 34%; >2 to 6h: 25% vs.23%; and >6h: 47% vs. 40% (p for trend p<0.01)). While access to care and SES attenuated delay differences by 24%, the largest attenuation was due to clinical characteristics (44%).
Conclusion: Racial differences in presentation delay are complex and appear to be mediated by a wide range of patient characteristics. Further investigation is warranted to identify the best opportunity to prevent the significantly longer delay observed in black, as compared with white, patients who have an AMI.