title: Comparison of Delay Times from Symptom Onset to Medical Contact in Blacks Versus Whites With Acute Myocardial Infarction.
abstract: Clinical outcomes in acute myocardial infarction (AMI) worsen with increasing delay between symptom onset and clinical presentation. Previous studies have shown that black patients with AMI have longer presentation delays. The objective of this analysis is to explore the potential contribution of community factors to presentation delays in black patients with AMI. We linked clinical data for 346,499 consecutive patients with AMI from Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines™ (2007-2014) to socioeconomic and community information from the American Community Survey. Black patients with AMI had longer symptom onset to first medical contact times than white patients (114 vs 101 minutes, p <0.0001) regardless of ambulance versus self-transport. Compared with white patients, black patients were younger and more likely to have clinical co-morbidities such as hypertension, diabetes, previous heart failure, and stroke. They were also more likely to live in urban communities with lower socioeconomic status, lower rates of long-term residence, and higher proportion of single-person households than white patients. In sequential linear regression models adjusting for patient demographic and clinical characteristics, logistic barriers to prompt presentation, and community socioeconomic and composition factors, black patients had a persistent 9% greater time from symptom onset to presentation compared with white patients (95% CI 8% to 11%, p <0.0001). In conclusion, the longer delay in time to presentation in black patients with AMI compared with white patients persists after accounting for a number of both patient and community factors.
authors.affiliation: Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: almiller@partners.org.
authors.forename: Amy Leigh
authors.initials: AL
authors.lastname: Miller
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: DaJuanicia
authors.initials: D
authors.lastname: Simon
authors.affiliation: Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: Virginia Commonwealth University, Richmond, Virginia.
authors.forename: Michael C
authors.initials: MC
authors.lastname: Kontos
authors.affiliation: University of Texas Southwestern, Dallas, Texas.
authors.forename: Deborah
authors.initials: D
authors.lastname: Diercks
authors.affiliation: University of California, Davis, Sacramento, California.
authors.forename: Ezra
authors.initials: E
authors.lastname: Amsterdam
authors.affiliation: Division of Cardiology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data*; D017677:Age Distribution; D000368:Aged; D015897:Comorbidity; D004632:Emergency Medical Services; D004636:Emergency Service, Hospital; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D009204:Myocardial Revascularization / Q000706:statistics & numerical data; D012042:Registries; D012847:Single Person / Q000706:statistics & numerical data; D012923:Social Class; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D061665:Time-to-Treatment; D014336:Troponin / Q000097:blood; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D014336:Troponin