DELAYED HOSPITAL PRESENTATION IN PATIENTS WHO HAVE HAD ACUTE MYOCARDIAL-INFARCTION

Background: In patients who have had acute myocardial infarction, the delay between the onset of symptoms and hospital presentation is a cri tical factor in determining the initial management strategy and outcom es of treatment. Objective: To examine the determinants of delayed hos pital presentation in patients who have had acute myocardial infarctio n. Design: Retrospective chart review. Setting: 37 hospitals in Minnes ota. Patients: 2409 persons hospitalized with acute myocardial infarct ion 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 ag e and female sex. The presence of chest discomfort and a history of me chanical revascularization significantly reduced the risk for prolonge d delay. Risk for delay was greatest during the evening and early morn ing hours (6:00 p.m. to 6:00 a.m.) Patients with a history of hyperten sion were more likely to delay presentation. Only 42% of all patients hospitalized with acute myocardial infarction had used emergency medic al transport services. Conclusions: Patients who have had acute myocar dial infarction often delay hospital presentation. Educational interve ntions that encourage the prompt use of emergency medical transport se rvices and target specific patient populations, such as elderly person s, women, and persons with ca rd iac risk factors, may be most success ful in reducing the length of delay and improving the outcomes of pati ents with acute myocardial infarction.