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AP McGinn, WD Rosamond, H Taylor, University of North Carolina,
Chapel Hill
Prolonged delay in accessing treatment for acute myocardial infarction
(AMI) is associated with increased mortality and morbidity. The
time dependent nature of some treatments for AMI underscores the
importance of rapid access to medical care, yet many patients experience
delay from symptom onset to hospital arrival beyond the therapeutic
window for acute therapies. Recent community level campaigns to
increase the general public's awareness of symptoms related to AMI
and to emphasize the importance of seeking immediate medical attention
have had mixed results. Therefore, we evaluated trends in pre-hospital
delay time related to AMI over the eleven-year period of 1987-1997
using data from the Atherosclerosis Risk in the Communities (ARIC)
Study, a community based retrospective surveillance study in four
US communities (370,000 base population, age 35-74 years). Pre-hospital
delay time from symptom onset to arrival at the hospital was abstracted
from patient medical records for 15,006 cases of validated AMI.
Cutpoints of one hour and 12 hours were used to create dichotomous
variables to assess clinically relevant delay time recommendations
for treatment with current thrombolytic therapies. Differences between
blacks and whites and men and women were consistent across all years,
with white women delaying longer than men and blacks delaying longer
than whites. The total percent change of patients arriving in less
than one hour over the study period was non-significant for both
genders and races (2.6% men, 0.2% women, -2.4% whites and 1.0% blacks).
The total percent change of patients arriving in less than 12 hours
over the study period was significantly different for women (9.9%)
and borderline significant for blacks (11.08%) but non-significant
for men (-0.66%) or whites (1.43%). No change in use of emergency
medical services (EMS) was observed over the study period and those
who did not utilize EMS consistently had longer delay times. We
found no improvement in pre-hospital delay time for less than one
hour, and little improvement in certain subgroups for less than
12 hours in the four ARIC Study communities from 1987 to 1997. Future
studies should investigate innovative ways to improve behavior that
will lead to a decrease in delay from symptom onset to arrival at
a hospital for medical treatment of AMI.
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