Delay between onset of chest pain and arrival to the coronary care unit among minority and disadvantaged patients.
Prehospital delay is an important cause of out-of-hospital coronary mortality. To determine the effects of decision time delay in a patient population comprised mainly of blacks and the underprivileged, 74 consecutive patients with acute chest pain necessitating admission to the coronary care unit in a large urban hospital were studied. Delay time from onset of chest pain to the decision to seek medical care was markedly prolonged in patients with myocardial infarction (n = 24; mean time: 11.3 +/- 18 hours) as well as in patients with chest pain who did not develop myocardial infarction (n = 50; mean time: 20.5 +/- 26 hours). In addition, transfer time from the emergency room to the coronary care unit was likewise unduly long (mean time: 4 +/- 3.8 and 4.1 +/- 6 hours for patients with and without myocardial infarction, respectively). This study documents a significant delay in the decision time among patients with low socioeconomic status, mostly inner-city blacks, and in the transfer time from emergency room to the critical care unit in a large public hospital. These findings must be taken into consideration when planning strategies to improve the health-care delivery system to blacks and the underprivileged and further lend support to the practice of initiating thrombolytic therapy in the emergency room.
Ghali
J K
JK
Division of Cardiology, Cook County Hospital, Chicago, Illinois.
Cooper
R S
RS
Kowatly
I
I
Liao
Y
Y
D001741:Black or African American; D000368:Aged; D000789:Angina, Unstable / Q000453:epidemiology*; D003325:Coronary Care Units; D003467:Cultural Deprivation; D004630:Emergencies; D006786:Hospitals, Urban; D006801:Humans; D008297:Male; D008875:Middle Aged; D008913:Minority Groups; D009203:Myocardial Infarction / Q000453:epidemiology*; D012959:Socioeconomic Factors; D013997:Time Factors; D014481:United States