Clinical InvestigationCongestive Heart FailureTrends in prehospital delay time and use of emergency medical services for acute myocardial infarction: Experience in 4 US communities from 1987-2000
Section snippets
Methods
The ARIC Study includes a community surveillance component, the methods of which have been described in detail elsewhere.16, 17 Briefly, the ARIC study includes a retrospective hospital surveillance program designed to monitor hospitalizations for AMI and deaths due to coronary heart disease (CHD) occurring in or out of the hospital among men and women aged 35 to 74 years in 4 US communities: Forsyth County, North Carolina (n = 136 378), Jackson, Mississippi (n = 71 218), Washington County,
Results
Between 1987 and 2000, 21 551 definite or probable hospitalized myocardial infarctions occurred in the ARIC communities. We excluded 284 events that were transferred from other hospitals, 1993 events without acute cardiac symptoms before arrival at the hospital, and 198 events with missing delay time from the medical record. An additional 148 events occurring in persons of nonwhite and nonblack race were excluded because of representation insufficient for use in examining racial differences in
Discussion
Contrary to our hypothesis, we found prehospital delay did not improve significantly from 1987 to 2000 in 4 US communities. However, consistent with other observational studies, we found that increased age,18, 19, 20, 21, 22, 23, 24, 25 female sex,19, 21, 24, 26 and black ethnicity18, 19, 23, 27, 28 were all associated with longer delay times. Our results also generally agree with the published literature,19, 20, 21, 22, 24, 25, 29 which shows persons with a history of angina, diabetes, and
References (42)
- et al.
Importance of time to reperfusion for 30-day and late survival and recovery of left ventricular function after primary angioplasty for acute myocardial infarction
J Am Coll Cardiol
(1998) Effects of ramipril on mortality and morbidity of survivors of acute myocardial infarction with clinical evidence of heart failure
Lancet
(1993)- et al.
Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3
J Am Coll Cardiol
(2000) - et al.
Community surveillance of coronary heart disease in the Atherosclerotic Risk in Communities (ARIC) Study: methods and initial two years experience
J Clin Epidemiol
(1996) - et al.
Effect of delay on racial differences in thrombolysis for acute myocardial infarction
Am Heart J
(2000) - et al.
Gender differences in reported symptoms for acute myocardial infarction: impact on prehospital delay time interval
Am J Emerg Med
(1998) - et al.
Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: the Worcester Heart Attack Study
Am Heart J
(1994) - et al.
Prehospital delay in patients hospitalized with heart attack symptoms in the United States: the REACT trial
Am Heart J
(1999) - et al.
Pre-hospital delay interval for patients who use emergency medicine services: the effect of heart related medical conditions and demographic variables
Ann Emerg Med
(1993) - et al.
Beyond sociodemographics: factors influencing the decision to seek treatment for symptoms of acute myocardial infarction
Heart Lung
(1997)
Prehospital delay with myocardial infarction: the interactive effect of clinical symptoms and race
Appl Nurs Res
Myocardial infarction triage and intervention project phase 1: patient characteristics and feasibility of prehospital initiation of thrombolytic therapy
J Am Coll Cardiol
Effect of thrombolytic treatment delay on myocardial infarct size
Lancet
Sex differences in symptom presentation associated with acute myocardial infarction: a population based perspective
Am Heart J
Comparison of reported symptoms of acute myocardial infarction in Mexican Americans versus non-Hispanic whites (The Corpus Christi Heart Project)
Am J Cardiol
Components of delay in the pre-hospital phase of acute myocardial infarction
Am J Cardiol
911 and emergency department use for chest pain: results of a media campaign
Ann Emerg Med
Reasons patients with chest pain delay or do not call 911
Ann Emerg Med
National Heart Attack Alert Program Coordinating Committee 60 minutes to treatment working group. Emergency department: rapid identification and treatment of patients with acute myocardial infarction
Ann Emerg Med
GISSI-2; a factorial randomized trial of altaplase versus streptokinase and heparin versus no heparin among 12,490 patients with acute myocardial infarction
Lancet
Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomized trials of more than 1,000 patients
Lancet
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