title: Trajectory of prehospital delay in patients with acute myocardial infarction in the Japanese health care system.
abstract: OBJECTIVE
  The purpose of this study was to understand the trajectory of prehospital delay in patients with acute myocardial infarction (AMI) in the Japanese health care system, which offers patients a choice between seeking treatment in a neighborhood clinic/small hospital (clinic group) or a large hospital with comprehensive cardiac services, including a cardiac catheterization laboratory (hospital group).
  
  
  METHODS
  In this cross sectional study, 155 consecutive patients admitted with AMI to one of 5 urban hospitals in Japan were interviewed within 7 days after admission.
  
  
  RESULTS
  The median total prehospital delay time in the clinic group (n=84) was significantly longer than the hospital group (n=71) (6 h and 48 min vs 2 h and 9 min, p<.001). Patients with severe chest pain were significantly less likely to seek treatment at a clinic/small hospital than at a large hospital compared to patients with mild or moderate symptoms (OR 0.85, 95% CI: 0.75, 0.97). Patients who did not interpret their symptoms as cardiac in origin were significantly more likely to seek treatment at a clinic/small hospital than at a large hospital compared to patients who interpreted their symptoms as cardiac in origin (OR 3.32, 95% CI: 1.56, 7.10). After controlling for demographic and medical history, patients in the clinic group were 3.69 times (95% CI: 1.28, 10.66) less likely to receive any reperfusion therapy compared to patients in the hospital group.
  
  
  CONCLUSIONS
  Findings support the need for public education in Japan that focuses on the appropriate response to AMI symptoms. Moreover, regional AMI networks need to be instituted to provide for early transfer for PCI from clinic/small hospitals to tertiary centers.
authors.affiliation: School of Nursing, University of California San Francisco, 2 Koret Way, Room N611E, San Francisco, CA 94143-0604, USA. hina@itsa.ucsf.edu
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Fukuoka
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
authors.forename: Fumio
authors.initials: F
authors.lastname: Kobayashi
authors.forename: Erika Sivarajan
authors.initials: ES
authors.lastname: Froelicher
authors.forename: Sally H
authors.initials: SH
authors.lastname: Rankin
authors.forename: Miyoshi
authors.initials: M
authors.lastname: Ohno
authors.forename: Haruo
authors.initials: H
authors.lastname: Hirayama
mesh_terms: D000368:Aged; D003430:Cross-Sectional Studies; D003695:Delivery of Health Care / Q000145:classification; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000628:therapy; D015425:Myocardial Reperfusion; D010342:Patient Acceptance of Health Care; D010343:Patient Admission; D011237:Predictive Value of Tests; D012720:Severity of Illness Index; D013997:Time Factors