title: Factors predisposing to a nonadmission of patients with acute myocardial infarction.
abstract: Among patients presenting at the hospital with an acute myocardial infarction (AMI), about 2-6% are mistakenly discharged by emergency physicians. The relevance of diagnostic problems in the prehospital period of an AMI is unknown. We prospectively studied 421 patients seen by a primary care physician in the prehospital period of an AMI. Using a standardized interview, data were obtained to identify factors determining nonadmission. Of 421 AMI patients, 327 (77.7%) were directly admitted to hospital after examination by the physician, whereas 94 (22.3%) were not admitted. The median prehospital delay was 240 min in admitted and 2,200 min in nonadmitted patients. Using a stepwise logistic regression model, the following factors were identified as independent contributors to nonadmission: the patient not being much affected by the symptoms (2.48; 1.40-4.39), improvement of symptoms (2.59; 1.46-4.59), the patient not thinking to suffer an AMI (2.33; 1.28-4.17) and the patient being unable to imagine having a heart disease (1.93; 1.07-3.46).
  
  
  CONCLUSIONS
  Nonadmission of AMI patients by health care professionals is a common problem. Several aspects of AMI presentation including the often limited intensity of symptoms and the variability of the clinical course may have to be re-emphasized by cardiologists. Taking a very careful history and being circumspect about the patient's interpretation of symptoms still are the keys to a correct diagnosis of AMI.
authors.affiliation: Department of Internal Medicine, University Teaching Hospital Itzehoe, Itzehoe, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Kentsch
authors.forename: Uwe
authors.initials: U
authors.lastname: Rodemerk
authors.forename: Thomas
authors.initials: T
authors.lastname: Münzel
authors.forename: Gert
authors.initials: G
authors.lastname: Müller-Esch
authors.forename: Thomas-Heinz
authors.initials: TH
authors.lastname: Ittel
authors.forename: Rolf
authors.initials: R
authors.lastname: Mitusch
mesh_terms: D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood; D015984:Causality; D002637:Chest Pain / Q000097:blood / Q000453:epidemiology / Q000628:therapy; D003402:Creatine Kinase / Q000097:blood; D052279:Creatine Kinase, MB Form; D004562:Electrocardiography; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007527:Isoenzymes / Q000097:blood; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000453:epidemiology* / Q000628:therapy*; D010343:Patient Admission; D011446:Prospective Studies; D012307:Risk Factors; D012423:Rural Health; D012720:Severity of Illness Index; D013997:Time Factors; D014504:Urban Health
chemical_list: D015415:Biomarkers; D007527:Isoenzymes; D003402:Creatine Kinase; D052279:Creatine Kinase, MB Form