Time to presentation with acute myocardial infarction in the elderly - Associations with race, sex, and socioeconomic characteristics

Background-Although prompt treatment is a cornerstone of the management of acute myocardial infarction (AMI), prior studies have shown that one fourth of AMI patients arrive at the hospital >6 hours after symptom onset. It wo uld be valuable to identify individuals at highest risk for late arrival, b ut predisposing factors have yet to be fully characterized. Methods and Results-Data from the Cooperative Cardiovascular Project, invol ving Medicare beneficiaries aged >65 years hospitalized between January 199 4 and February 1996 with confirmed AMI, were used to identify patients who presented "late" (greater than or equal to 6 hours after symptom onset). Pa tient characteristics were tested for associations with late presentation b y use of backward stepwise logistic regression. Among 102 339 subjects, 29. 4% arrived late. Significant predictors of late arrival (odds ratio, 95% CI ) included diabetes (1.11, 1.07 to 1.14) and a history of angina (1.32, 1.2 8 to 1.35), whereas prior MI (0.82, 0.79 to 0.85), Frier angioplasty (0.80, 0.75 to 0.85), prior bypass surgery (0.93, 0.89 to 0.98), and cardiac arre st (0.52, 0.46 to 0.58) predicted early presentation. Additionally, initial evaluation at an outpatient clinic (2.63, 2.51 to 2.75) and daytime presen tation (1.67, 1.59 to 1.72) predicted late arrival. Finally, female sex, bl ack race, and poverty, which were evaluated with an 8-level race-sex-socioe conomic status interaction term, were also risk factors for delay. Conclusions-Delayed hospital presentation is a common problem among Medicar e beneficiaries with AMI, Factors associated with delay include not only cl inical and logistical issues but also race, sex, and socioeconomic characte ristics. Education efforts designed to hasten AMI treatment should be direc ted at individuals with risk factors for late arrival.