Prehospital delay time in acute myocardial infarction: An exploratory study on relation to hospital outcomes and cost

Background short prehospital delay is associated with improved outcomes in myocardial infarction, but the impact on cost has not been tested. Shorteni ng delay time could reduce health care expenditures. Methods and Results Two hundred ninety-eight patients were examined with th e use of a historic prospective design at 2 hospital sites. A secondary ana lysis was performed that used patients with confirmed myocardial infarction from the National Register of Myocardial Infarction and direct and indirec t costs from the accounting system at the hospitals. Chi-square, Mann Whitn ey U, and Fisher exact tests were used for comparisons. Delay and 4 sets of variables were regressed on cost with the significant predictors used to c onstruct a final model. The mean age was 71 +/- 14 years old; 62% were men. There were no major differences in demographics, cardiac history, risk fac tors, and admission characteristics between short and long delayers. Resour ce utilization and clinical outcomes were similar between the 2 groups; the re was no difference in cost. Additional diagnostic procedures (odds ratio 2.92; 95% confidence interval 1.65-5.15) and complications (odds ratio 3.43 ; 95% confidence interval 2.03-5.82) were significant predictors of cost. D elay was not a predictor of high cost. Conclusions short prehospital delay was not associated with improved clinic al outcomes, nor did it predict cost. Explanations include (1) the low util ization of early reperfusion therapy in the short delay group, (2) the stud y lacked sufficient power to detect a difference in cost between short and long delayers, and (3) the severity of illness could not be adequately meas ured. This issue warrants further study because of the potential impacts on health care expenditures.