Prehospital delay time in acute myocardial infarction: an exploratory study on relation to hospital outcomes and cost.
BACKGROUND
Short prehospital delay is associated with improved outcomes in myocardial infarction, but the impact on cost has not been tested. Shortening delay time could reduce health care expenditures.


RESULTS
Two hundred ninety-eight patients were examined with the use of a historic prospective design at 2 hospital sites. A secondary analysis was performed that used patients with confirmed myocardial infarction from the National Register of Myocardial Infarction and direct and indirect costs from the accounting system at the hospitals. Chi-square, Mann Whitney U, and Fisher exact tests were used for comparisons. Delay and 4 sets of variables were regressed on cost with the significant predictors used to construct a final model. The mean age was 71 +/- 14 years old; 62% were men. There were no major differences in demographics, cardiac history, risk factors, and admission characteristics between short and long delayers. Resource utilization and clinical outcomes were similar between the 2 groups; there was no difference in cost. Additional diagnostic procedures (odds ratio 2.92; 95% confidence interval 1.65-5.15) and complications (odds ratio 3.43; 95% confidence interval 2.03-5.82) were significant predictors of cost. Delay was not a predictor of high cost.


CONCLUSIONS
Short prehospital delay was not associated with improved clinical outcomes, nor did it predict cost. Explanations include (1) the low utilization of early reperfusion therapy in the short delay group, (2) the study lacked sufficient power to detect a difference in cost between short and long delayers, and (3) the severity of illness could not be adequately measured. This issue warrants further study because of the potential impacts on health care expenditures.
Caldwell
M A
MA
University of California-San Francisco, San Francisco, CA, USA. MCaldw3215@aol.com
Froelicher
E S
ES
Drew
B J
BJ
D000368:Aged; D000369:Aged, 80 and over; D017046:Cost Savings; D004632:Emergency Medical Services / Q000191:economics*; D005260:Female; D017721:Hospital Costs / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000191:economics* / Q000401:mortality / Q000628:therapy; D015425:Myocardial Reperfusion / Q000191:economics; D011446:Prospective Studies; D012042:Registries; D013996:Time and Motion Studies; D016896:Treatment Outcome; D014481:United States