Abstract 12552: Patient and Neighborhood Factors Associated with Presentation Delay in ST-Elevation Myocardial Infarction: Insights from the NCDR®
Background: Early presentation and rapid reperfusion leads to improved outcomes for patients with ST elevation myocardial infarction (STEMI). To date, little is known about the contribution of a neighborhood’s socioeconomic environment to delays in presentation.
Methods: We examined the time from symptom onset to first medical contact for 55,931 STEMI patients in the ACTION Registry®-GWTG™ between Jul ‘08 and Dec ‘10. We used Area Resource File data to summarize neighborhood socioeconomic features stratified by hospital referral region using patient home zip code.
Results: The median time from symptom onset to first medical contact was 75 min (25, 75th percentile 35, 180) with 40% of patients presenting <1 hr and 25% presenting >3 hr after symptom onset. Patients delayed >3 hr were more likely older, female, Black, or Hispanic compared with those who presented earlier (Table). Patients with longer delays were less likely to utilize emergency medical services and had longer delays to hospital arrival despite living only modestly farther from the hospital. Delays to presentation varied across hospital referral regions with geometric mean delays ranging from 30 to 342 min (Table). There was no significant correlation between delay to MI presentation and the proportion of Black (Spearman r=-0.06, p=0.30) or Hispanic patients (r=-0.07, p=0.22) in the community. However, communities with higher poverty rates were associated with greater delays to presentation (r=0.17, p=0.003). Patients who presented >3 hr after symptom onset were less likely to receive reperfusion (84 vs 90%, p<0.001) and had longer door to balloon times (486 vs. 122 min, p<0.001) compared with those who delayed <1 hour.
Conclusion: Marked variation in the time from symptom onset to first medical contact exists for STEMI patients. Neighborhood socioeconomic factors may play a role in explaining this variation and should be further investigated to understand community education and access needs.
- © 2012 by American Heart Association, Inc.