Epidemiology of avoidable delay in the care of patients with acute myocardial infarction in Italy. A GISSI-generated study. GISSI--Avoidable Delay Study Group.

BACKGROUND

The delay between onset of symptoms and coronary care unit admission is decisive in the outcome of patients with acute myocardial infarction.

OBJECTIVE

To evaluate the influence of the factors that affect the delay in acute myocardial infarction treatment.

METHODS

Multicenter case-control study conducted by 118 coronary care units in Italy. The median and mean times in cases and controls were compared for decision time, home-to-hospital time, and in-hospital time, and the influence of several potential risk factors on the delay was evaluated by comparison of patients admitted more than 6 hours after onset with those admitted within 6 hours after onset.

RESULTS

Among 5301 patients with acute myocardial infarction, 590 who came to a coronary care unit after 12 hours were considered cases. Controls included 600 patients treated within 2 hours, 603 between 2 and 6 hours, and 466 between 6 and 12 hours. The median decision time among cases was 50-fold higher than that of controls who presented within 2 hours. Home-to-hospital time and in-hospital time appeared to play a less important role. Among the patient-related variables, advanced age, living alone, low intensity of initial symptoms, history of diabetes, strong pain at onset of the infarction, occurrence of symptoms at night, and involvement of a general practitioner seemed to affect delay significantly.

CONCLUSION

Interventions aimed at reducing the delay in acute myocardial infarction treatment should primarily focus on the help-seeking behavior of patients.