Author + information
- Wenchi Guana,b,
- Arjun K. Venkatesha,b,
- Xueke Baia,b,
- Si Xuana,b,
- Jing Lia,b,
- Xin Zhenga,b,
- Li Xia,b,
- Haibo Zhanga,b,
- Frederick Masoudia,b,
- John Spertusa,b,
- Harlan Krumholza,b and
- Lixin Jianga,b
Background: Timely presentation is essential for patients with acute myocardial infarction (AMI). Few studies have determined patient-reported factors associated with time to acute care and reasons for delayed presentation in China.
Methods: In the prospective China PEACE study of AMI care, we enrolled 3 249 patients with data for time to care, defined as the time between symptom onset and hospital arrival. Patients were interviewed for information regarding symptom onset, barriers to accessing care, demographics, cardiovascular risk factors, medical history, socioeconomic status, and quality of life. We described the distribution of times to care, patients’ perceptions of symptoms, reasons for delays in seeking care, and used a generalized linear model to identify factors independently associated with longer times to care.
Results: The geometric mean of time to care was 4 hours (SD: 2.58 hours). While 94% of patients reported symptoms of chest pain or chest discomfort, only 44% perceived their symptoms as heart-related; the most common self-reported reasons for delaying seeking care included symptoms not considered severe (27%) and symptoms being intermittent (25%). Compared with those with annual household income greater than 100 000RMB, adjusted time to care was longer by 0.9, 1.6, and 1.0 hours for those with income of 30 000 – 50 000, 10 000 – 30 000, and less than 10 000 RMB, respectively (all P <0.01). Compared with the respective reference groups, adjusted time to care was 0.8 hours longer for those with educational level lower than high school, 0.3 hours for those with moderate to high social support, 0.3 hours for diabetic patients, 0.4 hours for those with prior coronary artery disease (CAD), and 1.1 hours for non-ST segment elevation myocardial infarction (NSTEMI). Failing to recognize symptoms as cardiac was also associated with longer times to care by 0.7 hours. (all P < 0.05).
Conclusions: On average, patients with AMI took 4 hours to present to hospital, the time was even longer in poorer, less educated patients, and those with diabetes, prior CAD and a NSTEMI. Low awareness of AMI symptoms was a major contributor to delays. A comprehensive strategy is needed to improve prompt presentations in AMI.
Poster Hall, Hall C
Saturday, March 18, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Acute Coronary Syndromes, Diagnosis, Management and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1253-332
- 2017 American College of Cardiology Foundation