title: Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome.
abstract: OBJECTIVE
  To define the association between time taken to present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS) and 1-year outcomes. We also determined whether particular patient characteristics are associated with delays in seeking care after symptom onset.
  
  
  METHODS
  We collected data, which included a customised case report form to record symptom onset, on adult patients presenting with suspected ACS to two EDs in Australia and New Zealand. Such patients were followed up prospectively for 1 year. The composite primary endpoint included death, acute myocardial infarction, unstable angina pectoris treated with revascularisation or readmission with heart failure occurring after discharge but within 12 months after the index presentation.
  
  
  RESULTS
  ACS was diagnosed at presentation in 420 (16.8%) of 2515 patients recruited. Cox regression was conducted to assess the relationship between presentation time and the rate of primary endpoints after controlling for age, ethnicity, prior angina, prior coronary artery bypass graft and index diagnosis. Middle (2-6 h) and late presenters (>6 h postsymptom onset) developed the primary endpoint at a rate 1.22 (95% CI 0.80 to 1.85) and 1.57 (1.07 to 2.31) times higher than early presenters. Patients with known risk factors and cardiovascular disease were more likely to present late to the ED.
  
  
  CONCLUSIONS
  There is an independent association between time to presentation and 1-year cardiac outcomes following initial chest pain assessment for ED patients with possible cardiac chest pain in the Australian and New Zealand setting. This association occurred irrespective of the eventual diagnosis. Effective public health campaigns and other measures that facilitate early presentation with symptoms for patients with symptoms suggestive of ACS are justified and may improve prognosis.
  
  
  BACKGROUND
  ACTRN12611001069943.
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Louise
authors.initials: L
authors.lastname: Cullen
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia School of Public Health and Social Work, Queensland University of Technology, Brisbane, Queensland, Australia School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Jaimi H
authors.initials: JH
authors.lastname: Greenslade
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Louven
authors.initials: L
authors.lastname: Menzies
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Ashley
authors.identifier: http://orcid.org/0000-0001-5906-0831
authors.initials: A
authors.lastname: Leong
authors.affiliation: Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Martin
authors.initials: M
authors.lastname: Than
authors.affiliation: Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: Christopher
authors.initials: C
authors.lastname: Pemberton
authors.affiliation: Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand.
authors.forename: Sally
authors.initials: S
authors.lastname: Aldous
authors.affiliation: Department of Emergency Medicine, Christchurch Hospital, Christchurch, New Zealand Department of Medicine, University of Otago, Christchurch, New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Pickering
authors.affiliation: Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: Emily
authors.initials: E
authors.lastname: Dalton
authors.affiliation: National Heart Foundation, Melbourne, Australia.
authors.forename: Bianca
authors.initials: B
authors.lastname: Crosling
authors.affiliation: National Heart Foundation, Melbourne, Australia.
authors.forename: Rachelle
authors.initials: R
authors.lastname: Foreman
authors.affiliation: School of Medicine, The University of Queensland, Brisbane, Queensland, Australia Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.
authors.forename: William A
authors.initials: WA
authors.lastname: Parsonage
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D023381:Endpoint Determination; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors
keywords: acute coronary syndrome; cardiac care, acute coronary syndrome; cardiac care, acute myocardal infarct; cardiac care, diagnosis