Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction - The Worcester heart attach study

Background: Duration of prehospital delay in patients with acute myocardial infarction (AMI) is receiving increasing attention given the time-dependen t benefits associated with prompt use of coronary reperfusion strategies. Objective: To examine trends (1986-1997) in time to hospital presentation a nd factors associated with prolonged delay in a community-wide study of pat ients with AMI. Methods: Longitudinal study of 3837 residents of the Worcester, Mass, metro politan area hospitalized with AMI in 7 one-year periods between 1986 and 1 997 in whom information about prehospital delay was available. Results: The mean, median, and distribution of delay times exhibited either inconsistent or no changes over time. In 1986, the mean and median prehosp ital delay times were 4.1 and 2.2 hours, respectively; these times were 4.3 and 2.0 hours, respectively, in patients hospitalized in 1997. Overall, wi th no significant differences noted over time, approximately 44% of patient s with AMI presented to area-wide hospitals in less than 2 hours after the onset of acute coronary symptoms. Increasing age, history of angina or diab etes, onset of symptoms in the afternoon or evening, and hospitalization in the most recent study year (1997) were significantly associated with delay s of more than 2 hours in seeking hospital care after controlling for a var iety of factors that might affect delay. Conclusions: The results of this population-based study suggest that a larg e proportion of patients with AMI continue to exhibit prolonged delay. The characteristics of many of these individuals can be identified in advance f or targeted educational efforts.