Abstract P451: Correlates of Prehospital Delay in ACS Patients in a Medically Underserved Appalachian Community
Introduction: We evaluated correlates of seeking treatment among ACS patients in a rural, medically underserved community. This study is unique because patient data came from medical records and physician-administered structured interviews and it is the first to evaluate correlates of treatment delay in a rural and medically underserved patients.
Methods: A physician-administered structured interview was administered to 170 consecutive ACS patients. Patients were recruited from June 2010-December 2012. Inclusion criteria were: 1) chest pain or discomfort with onset outside hospital; and 2) fulfilling the criteria for ACS (i.e., chest pain or discomfort, changes on the ECG and/or an increase in at least one biochemical marker. The structured interview was composed of standardized questions with pre-defined answer categories covering 10 domains: 1) Patient demographics; 2) Presenting symptoms (e.g., first symptoms and type of symptom; symptom intensity/progression, symptom description and knowledge, etc.); 3) Responses to symptoms (e.g., informed someone, summoned help); 4) Symptom context (e.g., activity at time of AMI, place it occurred); 5) factors associated with decision to seek help (e.g., distance to hospital, transportation available, how transported, money, etc.); 6) Psychological/Personality factors (e.g., current depression, anxiety, denial patterns, personality types A or B); 8) Technology use (e.g., time spent watching TV or using smart devices/internet, etc.); 9) Prior cardiac history and risk factors (e.g., history of hypertension, diabetes, obesity, hyperlipidemia, medications, ER laboratory data); and 11) Post admission clinical course (e.g., ECG, arrhythmias, lytic therapy, CCU days, PCI, CABG, TIMI score , complications). Late presentation was defined as greater than 90 minutes for STEMI patients and greater than 180 minutes for NSTEMI patients.
Results: Among STEMI patients (n=98), only marital status (currently married vs. not married; OR=0.3; CI=0.1-0.9) and concerns about money (OR =26.3; CI = 1.2-500.0) were significantly associated with late presentation for treatment. For NSTEMI patients (n=73), several presenting symptom variables were associated with seeking treatment early including whether they experienced pain radiating to the arms (OR=0.1; CI=0.0-0.59), describing their chest pain as heavy (OR=0.04; CI=0.0-0.4), and reporting that nitroglycerin relieved chest pain (OR=0.2; CI = 0.1-0.9). One post-admission variable (whether they had Acute PCI post-MI; OR=0.1; CI=0.0-0.7) also was associated with late treatment.
Conclusions: Being unmarried or having concerns about money were associated with delays in treatment for STEMI patients, while mostly symptom-related variables were associated with treatment delays among NSTEMI patients in this cohort of low-income, medically underserved patients.
Author Disclosures: M.A. Abro: None. W. Gharib: None. B. Warden: None. A. Jain: None. K. Bell: None. J. Waters: None. C. Arena: None. D. Long: None. W.S.C. Poston: None. S.B. Schmidt: None.
- © 2014 by American Heart Association, Inc.