title: Time to presentation with acute myocardial infarction in the elderly: associations with race, sex, and socioeconomic characteristics.
abstract: BACKGROUND
  Although prompt treatment is a cornerstone of the management of acute myocardial infarction (AMI), prior studies have shown that one fourth of AMI patients arrive at the hospital >6 hours after symptom onset. It would be valuable to identify individuals at highest risk for late arrival, but predisposing factors have yet to be fully characterized.
  
  
  RESULTS
  Data from the Cooperative Cardiovascular Project, involving Medicare beneficiaries aged >65 years hospitalized between January 1994 and February 1996 with confirmed AMI, were used to identify patients who presented "late" (>/=6 hours after symptom onset). Patient characteristics were tested for associations with late presentation by use of backward stepwise logistic regression. Among 102 339 subjects, 29.4% arrived late. Significant predictors of late arrival (odds ratio, 95% CI) included diabetes (1.11, 1.07 to 1.14) and a history of angina (1.32, 1.28 to 1.35), whereas prior MI (0.82, 0.79 to 0.85), prior angioplasty (0.80, 0.75 to 0.85), prior bypass surgery (0.93, 0.89 to 0.98), and cardiac arrest (0.52, 0.46 to 0. 58) predicted early presentation. Additionally, initial evaluation at an outpatient clinic (2.63, 2.51 to 2.75) and daytime presentation (1.67, 1.59 to 1.72) predicted late arrival. Finally, female sex, black race, and poverty, which were evaluated with an 8-level race-sex-socioeconomic status interaction term, were also risk factors for delay.
  
  
  CONCLUSIONS
  Delayed hospital presentation is a common problem among Medicare beneficiaries with AMI. Factors associated with delay include not only clinical and logistical issues but also race, sex, and socioeconomic characteristics. Education efforts designed to hasten AMI treatment should be directed at individuals with risk factors for late arrival.
authors.affiliation: Division of Cardiology, Georgetown University Medical Center, Washington, DC, USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Sheifer
authors.forename: S S
authors.initials: SS
authors.lastname: Rathore
authors.forename: B J
authors.initials: BJ
authors.lastname: Gersh
authors.forename: K P
authors.initials: KP
authors.lastname: Weinfurt
authors.forename: W J
authors.initials: WJ
authors.lastname: Oetgen
authors.forename: J A
authors.initials: JA
authors.lastname: Breall
authors.forename: K A
authors.initials: KA
authors.lastname: Schulman
mesh_terms: D000208:Acute Disease; D000368:Aged; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology / Q000235:genetics / Q000503:physiopathology*; D044469:Racial Groups; D012307:Risk Factors; D012737:Sex Factors; D012923:Social Class; D013997:Time Factors