Vulnerable patients have longest STEMI presentation delays

13 May 2008

MedWire News: ST-elevation myocardial infarction (STEMI) patients with a combination of factors such as older age, female gender, Hispanic or Black race, and diabetes have particularly long delays from symptom onset to presentation, study findings demonstrate.

Henry Ting (Mayo Clinic, Rochester, Minnesota, USA) and colleagues determined the cumulative effect on delay times of having multiple demographic and clinical risk factors that are already known to be individually associated with longer delay times.

"Delays in hospital presentation may be concentrated in vulnerable subgroups in the population and could contribute to disparities in health care," they note.

The researchers found patients with a combination of such factors may have delays as much as 60 minutes longer than those without.

As described in the Archives of Internal Medicine, the study included 482,327 patients with STEMI who were enrolled in the US National Registry of MI between 1 January 1995 and 31 December 2004.

Nearly half the patients arrived at hospital more than 2 hours after symptom onset, while almost 9% presented more than 12 hours after onset, the cutoff point beyond which they would no longer be eligible for reperfusion according to guidelines. The overall mean delay was 114 minutes, with a decrease from 123 minutes in 1995 to 113 minutes in 2004.

Ting et al found that certain patient subgroups had particularly long delays in comparison with the reference group of White men younger than 70 years without diabetes.

Younger (<70 years) men with diabetes who were Black had a 43-minute longer delay while those who were Hispanic had a 47-minute longer delay.

Meanwhile, younger women with diabetes had even more prolonged delay times, at 55 minutes longer among those who were Black and 59 minutes longer among Hispanics.

And among elderly patients aged 70 years or older with diabetes, the delay was on average 60 and 51 minutes longer in Black and Hispanic men, and 63 and 51 minutes longer in Black and Hispanic women, respectively, compared with the reference group.

"Improving patient responsiveness in these subgroups represents an important opportunity to improve quality of care and minimize disparities in care," the team concludes.

Arch Intern Med 2008; 168: 959-968