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Trends in Prehospital Delay in Patients With Acute Myocardial Infarction (from the Worcester Heart Attack Study)

Published:November 03, 2008DOI:https://doi.org/10.1016/j.amjcard.2008.07.056
      Delay in seeking medical care after symptom onset in patients with an acute myocardial infarction (AMI) is related to increased morbidity and mortality. Duration of prehospital delay in patients hospitalized with AMI has not been well characterized over time, and potentially changing patient characteristics associated with prolonged delay are not well understood. The study sample consisted of 5,967 residents (mean age 76 years; 39% women) of the Worcester, Massachusetts, metropolitan area hospitalized with AMI in 11 annual periods from 1986 to 2005. Mean and median delay times have remained essentially unchanged during the past 2 decades. Mean and median prehospital delay times were 4.1 and 2.0 hours in 1986, 4.7 and 2.2 hours in 1995, and 4.6 and 2.0 hours in 2005, respectively. Approximately 45% of patients with AMI presented within 2 hours of acute symptom onset, whereas an additional one third presented from 2 to 6 hours after the onset of acute coronary symptoms. Advancing age and history of either diabetes or MI were associated with prolonged delay. Compared with patients arriving within 2 hours of symptom onset, those with prolonged prehospital delay were less likely to receive thrombolytic therapy and percutaneous coronary intervention within 90 minutes of hospital arrival. In conclusion, results of this population-based study suggest that a large proportion of patients with AMI continue to show prolonged prehospital delay.
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      References

        • Goldberg R.J.
        • Gore J.M.
        • Alpert J.S.
        • Dalen J.E.
        Recent changes in attack and survival rates of acute myocardial infarction (1975 through 1981).
        JAMA. 1986; 255: 2774-2779
        • Goldberg R.J.
        • Gore J.M.
        • Alpert J.S.
        • Dalen J.E.
        Incidence and case fatality rates of acute myocardial infarction (1975-1984): The Worcester Heart Attack Study.
        Am Heart J. 1988; 115: 761-767
        • Goldberg R.J.
        • Gorak E.J.
        • Yarzebski J.
        • Hosmer Jr., D.W.
        • Dalen P.
        • Gore J.M.
        • Alpert J.S.
        • Dalen J.E.
        A communitywide perspective of sex differences and temporal trends in the incidence and survival rates after acute myocardial infarction and out-of-hospital deaths caused by coronary heart disease.
        Circulation. 1993; 87: 1947-1953
        • Goldberg R.J.
        • Gurwitz J.
        • Yarzebski J.
        • Landon J.
        • Gore J.M.
        • Alpert J.S.
        • Dalen P.M.
        • Dalen J.E.
        Patient delay and receipt of thrombolytic therapy among patients with acute myocardial infarction from a community-wide perspective.
        Am J Cardiol. 1992; 70: 421-425
        • Goldberg R.J.
        • Yarzebski J.
        • Lessard D.
        • Gore J.M.
        Decade-Long Trends and Factors Associated With Time to Hospital Presentation in Patients With Acute Myocardial Infarction: The Worcester Heart Attack Study.
        Arch Intern Med. 2000; 160: 3217-3223
        • Spencer F.A.
        • Gore J.M.
        • Yarzebski J.
        • Lessard D.
        • Jackson E.A.
        • Goldberg R.J.
        Trends (1986 to 1999) in the incidence and outcomes of in-hospital stroke complicating acute myocardial infarction (The Worcester Heart Attack Study).
        Am J Cardiol. 2003; 92: 383-388
        • Goldberg R.J.
        • Yarzebski J.
        • Lessard D.
        • Wu J.
        • Gore J.M.
        Recent trends in the incidence rates of and death rates from atrial fibrillation complicating initial acute myocardial infarction: A community-wide perspective.
        Am Heart J. 2002; 143: 519-527
        • Spencer F.A.
        • Meyer T.E.
        • Goldberg R.J.
        • et al.
        Twenty year trends (1975-1995) in the incidence, in-hospital and long-term death rates associated with heart failure complicating acute myocardial infarction: A community-wide perspective.
        J Am Coll Cardiol. 1999; 34: 1378-1387
        • Goldberg R.J.
        • Samad N.A.
        • Yarzebski J.
        • Gurwitz J.
        • Bigelow C.
        • Gore J.M.
        Temporal Trends in Cardiogenic Shock Complicating Acute Myocardial Infarction.
        N Engl J Med. 1999; 340: 1162-1168
        • Goldberg R.J.
        • Steg P.G.
        • Sadiq I.
        • Granger C.B.
        • Jackson E.A.
        • Budaj A.
        • Brieger D.
        • Avezum A.
        • Goodman S.
        Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry).
        Am J Cardiol. 2002; 89: 791-796
        • Goldberg R.J.
        • Gurwitz J.H.
        • Gore J.M.
        Duration of, and Temporal Trends (1994–1997) in, Prehospital Delay in Patients With Acute Myocardial Infarction: The Second National Registry of Myocardial Infarction.
        Arch Intern Med. 1999; 159: 2141-2147
        • Gibler W.B.
        • Armstrong P.W.
        • Ohman E.M.
        • Weaver W.D.
        • Stebbins A.L.
        • Gore J.M.
        • Newby L.K.
        • Califf R.M.
        • Topol E.J.
        Persistence of delays in presentation and treatment for patients with acute myocardial infarction: The GUSTO-I and GUSTO-III experience.
        Ann Emerg Med. 2002; 39: 123-130
        • McGinn A.P.
        • Rosamond W.D.
        • Goff J.D.C.
        • Taylor H.A.
        • Miles J.S.
        • Chambless L.
        Trends in prehospital delay time and use of emergency medical services for acute myocardial infarction: Experience in 4 US communities from 1987–2000.
        Am Heart J. 2005; 150: 392-400
        • Hasdai D.
        • Behar S.
        • Wallentin L.
        • Danchin N.
        • Gitt A.K.
        • Boersma E.
        • Fioretti P.M.
        • Simoons M.L.
        • Battler A.
        A prospective survey of the characteristics, treatments and outcomes of patients with acute coronary syndromes in Europe and the Mediterranean basin.
        Eur Heart J. 2002; 23 (1990-1201)
        • Mandelzweig L.
        • Battler A.
        • Boyko V.
        • Bueno H.
        • Danchin N.
        • Filippatos G.
        • Gitt A.
        • Hasdai D.
        • Hasin Y.
        • Marrugat J.
        • Van de Werf F.
        • Wallentin L.
        • Behar S.
        • Euro Heart Survey I
        The second Euro Heart Survey on acute coronary syndromes: characteristics, treatment, and outcome of patients with ACS in Europe and the Mediterranean Basin in 2004.
        Eur Heart J. 2006; 27: 2285-2293
        • Ting H.H.
        • Bradley E.H.
        • Wang Y.
        • Lichtman J.H.
        • Nallamothu B.K.
        • Sullivan M.D.
        • Gersh B.J.
        • Roger V.L.
        • Curtis J.P.
        • Krumholz H.M.
        Factors Associated With Longer Time From Symptom Onset to Hospital Presentation for Patients With ST-Elevation Myocardial Infarction.
        Arch Intern Med. 2008; 168: 959-968
        • Berglin B.
        • Hartford M.
        • Karlsson T.
        • Herlitz J.
        Factors associated with pre-hospital and in-hospital delay time in acute myocardial infarction: a 6-year experience.
        J Intern Med. 1998; 243: 243-250
        • Gurwitz J.H.
        • McLaughlin T.J.
        • Willison D.J.
        • Guadagnoli E.
        • Hauptman P.J.
        • Gao X.
        • Soumerai S.B.
        Delayed Hospital Presentation in Patients Who Have Had Acute Myocardial Infarction.
        Ann Intern Med. 1997; 126: 593-599
        • Newby L.K.
        • Rutsch W.R.
        • Califf R.M.
        • Simoons M.L.
        • Aylward P.E.
        • Armstrong P.W.
        • Woodlief L.H.
        • Lee K.L.
        • Topol E.J.
        • Van de Werf F.
        • Investigators G.-I.
        Time from symptom onset to treatment and outcomes after thrombolytic therapy.
        J Am Coll Cardiol. 1996; 27: 1646-1655