Delayed hospital presentation in patients who have had acute myocardial infarction

Jerry H. Gurwitz, Thomas J. McLaughlin, Donald J. Willison, Edward Guadagnoli, Paul Hauptman, Xiaoming Gao, Stephen B. Soumerai

Research output: Contribution to journalArticle

141 Citations (Scopus)

Abstract

Background: In patients who have had acute myocardial infarction, the delay between the onset of symptoms and hospital presentation is a critical factor in determining the initial management strategy and outcomes of treatment. Objective: To examine the determinants of delayed hospital presentation in patients who have had acute myocardial infarction. Design: Retrospective chart review. Setting: 37 hospitals in Minnesota. Patients: 2409 persons hospitalized with acute myocardial infarction between October 1992 and July 1993. Main Outcome Measure: Hospital presentation delayed more than 6 hours after the onset of symptoms of acute myocardial infarction. Results: Information on length of delay was available for 2404 patients. Of these patients, 969 (40%) delayed presentation to the hospital for more than 6 hours after the onset of symptoms. Factors associated with prolonged delay included advanced age and female sex. The presence of chest discomfort and a history of mechanical revascularization significantly reduced the risk for prolonged delay. Risk for delay was greatest during the evening and early morning hours (6:00 p.m. to 6:00 a.m.) Patients with a history of hypertension were more likely to delay presentation. Only 42% of all patients hospitalized with acute myocardial infarction had used emergency medical transport services. Conclusions: Patients who have had acute myocardial infarction often delay hospital presentation. Educational interventions that encourage the prompt use of emergency medical transport services and target specific patient populations, such as elderly persons, women, and persons with cardiac risk factors, may be most successful in reducing the length of delay and improving the outcomes of patients with acute myocardial infarction.

Original languageEnglish (US)
Pages (from-to)593-599
Number of pages7
JournalAnnals of internal medicine
Volume126
Issue number8
DOIs
StatePublished - Apr 15 1997

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Myocardial Infarction
Emergency Medical Services
Thorax
Outcome Assessment (Health Care)
Hypertension
Population

All Science Journal Classification (ASJC) codes

  • Internal Medicine

Cite this

Gurwitz, J. H., McLaughlin, T. J., Willison, D. J., Guadagnoli, E., Hauptman, P., Gao, X., & Soumerai, S. B. (1997). Delayed hospital presentation in patients who have had acute myocardial infarction. Annals of internal medicine, 126(8), 593-599. https://doi.org/10.7326/0003-4819-126-8-199704150-00001

Delayed hospital presentation in patients who have had acute myocardial infarction. / Gurwitz, Jerry H.; McLaughlin, Thomas J.; Willison, Donald J.; Guadagnoli, Edward; Hauptman, Paul; Gao, Xiaoming; Soumerai, Stephen B.

In: Annals of internal medicine, Vol. 126, No. 8, 15.04.1997, p. 593-599.

Research output: Contribution to journalArticle

Gurwitz, JH, McLaughlin, TJ, Willison, DJ, Guadagnoli, E, Hauptman, P, Gao, X & Soumerai, SB 1997, 'Delayed hospital presentation in patients who have had acute myocardial infarction', Annals of internal medicine, vol. 126, no. 8, pp. 593-599. https://doi.org/10.7326/0003-4819-126-8-199704150-00001
Gurwitz, Jerry H. ; McLaughlin, Thomas J. ; Willison, Donald J. ; Guadagnoli, Edward ; Hauptman, Paul ; Gao, Xiaoming ; Soumerai, Stephen B. / Delayed hospital presentation in patients who have had acute myocardial infarction. In: Annals of internal medicine. 1997 ; Vol. 126, No. 8. pp. 593-599.
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