Decade Long Trends (2001–2011) in Duration of Pre‐Hospital Delay Among Elderly Patients Hospitalized for an Acute Myocardial Infarction

Abstract

BackgroundEarly intervention with medical and/or coronary revascularization treatment approaches remains the cornerstone of the management of patients hospitalized with acute myocardial infarction (AMI). However, several patient groups, especially the elderly, are known to delay seeking prompt medical care after onset of AMI‐associated symptoms. Current trends, and factors associated with prolonged prehospital delay among elderly patients hospitalized with AMI, are incompletely understood.Methods and ResultsData from a population‐based study of patients hospitalized at all 11 medical centers in central Massachusetts with a confirmed AMI on a biennial basis between 2001 and 2011 were analyzed. Information about duration of prehospital delay after onset of acute coronary symptoms was abstracted from hospital medical records. In patients 65 years and older, the overall median duration of prehospital delay was 2.0 hours, with corresponding median delays of 2.0, 2.1, and 2.0 hours in those aged 65 to 74 years, 75 to 84 years, and in patients 85 years and older, respectively. There were no significant changes over time in median delay times in each of the age strata examined in both crude and multivariable adjusted analyses. A limited number of patient characteristics were associated with prolonged delay in this patient population.ConclusionsThe results of this community‐wide study demonstrate that delay in seeking prompt medical care continues to be a significant problem among elderly patients hospitalized with AMI. The lack of improvement in the timeliness of patients’ care‐seeking behavior during the years under study remains of considerable clinical and public health concern.

Heart Disease and Stroke Statistics—2017 Update: A Report From the American Heart Association

“…In 2009 to 2011, 48.9% of patients reached the hospital within 2 hours of symptom onset compared with 45.8% in 2001 to 2003. 36 …”

Prehospital Delay in Older Adults with Acute Myocardial Infarction: The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction Study

“…Delay was assessed according to report of participant or caregiver at the time of enrollment as a categorical variable with the following categories: less than 1 hour, 1 hour to 5 hours and 59 minutes, 6 hours to 11 hours and 59 minutes, 12 hours to 23 hours and 59 minutes, 1 to 3 days, 3 days to 1 week, or 1 week or longer. The cutoff of 6 hours was chosen given evidence of greater mortality with ischemic times with this duration and significant precedent in prior studies of prehospital delay …”

“…The cutoff of 6 hours was chosen given evidence of greater mortality with ischemic times with this duration 2 and significant precedent in prior studies of prehospital delay. 14,[22][23][24]…”

Is denial a maladaptive coping mechanism which prolongs pre-hospital delay in patients with ST-segment elevation myocardial infarction?

“…Exactly these features are generally known to contribute to early arrival at the hospital (31). This holds true also for a third significant characteristics of deniers; they are less likely to live alone, which likewise contributes to less delay (32,33) .…”