Time to presentation with acute myocardial infarction in the elderly: associations with race, sex, and socioeconomic
S E Sheifer1, S S Rathore, B J Gersh
1Division of Cardiology, Georgetown University Medical Center, Washington, DC, USA.
Circulation
|October 4, 2000
Summary
Nearly 30% of older adults with acute myocardial infarction (AMI) present late to the hospital. Risk factors for delayed care include diabetes, angina, and socioeconomic status, highlighting the need for targeted education.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Prompt treatment is crucial for acute myocardial infarction (AMI) management.
- Previous studies indicate a significant proportion of AMI patients present late, over 6 hours post-symptom onset.
- Identifying individuals at high risk for late arrival is essential but predisposing factors remain incompletely understood.
Purpose of the Study:
- To identify patient characteristics associated with delayed hospital presentation in Medicare beneficiaries with AMI.
- To characterize risk factors contributing to late arrival for acute myocardial infarction care.
Main Methods:
- Analysis of data from the Cooperative Cardiovascular Project (1994-1996) for Medicare beneficiaries (>65 years) with confirmed AMI.
- Backward stepwise logistic regression was used to identify predictors of late presentation (>/=6 hours symptom onset to hospital arrival).
Main Results:
- 29.4% of 102,339 subjects presented late.
- Predictors of late arrival included diabetes, history of angina, initial evaluation at an outpatient clinic, and daytime presentation.
- Female sex, black race, and poverty were also identified as risk factors for delayed presentation.
Conclusions:
- Delayed hospital presentation is prevalent among Medicare beneficiaries with AMI.
- Factors contributing to delay encompass clinical, logistical, racial, sexual, and socioeconomic characteristics.
- Educational initiatives targeting individuals with identified risk factors are recommended to expedite AMI treatment.
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