Factors associated with pre‐hospital and in‐hospital delay time in acute myocardial infarction: a 6‐year experience

Berglin Blohm M, Hartford M, Karlsson T, Herlitz J (Division of Cardiology, Sahlgrenska University Hospital, Göteborg, Sweden). Factors associated with pre‐hospital and in‐hospital delay time in acute myocardial infarction: a 6‐year experience. J Intern Med 1998; 243 : 243–50. Objectives To explore factors associated with delay time prior to hospital admission and in hospital amongst acute myocardial infarction (AMI) patients with particular emphasis on the delay time to the administration of thrombolytic therapy. Methods During a 6‐year period we prospectively computerized pre‐hospital and in‐hospital time intervals for AMI patients admitted to the coronary care unit (CCU) direct from the emergency department (ED) or via paramedics, at Sahlgrenska Hospital, Göteborg, Sweden. Results Pre‐hospital delay: independent predictors of a prolonged delay were increased age ( P< > = 0.0007), female sex ( P< > = 0.02) and a history of hypertension ( P< > = 0.03). For AMI patients who received thrombolytic treatment and the only independent predictor of a prolonged delay was increased age ( P< > = 0.005). In‐hospital delay: for all AMI patients independent predictors of a prolonged delay were prolonged pre‐hospital delay ( P < 0.0001), increased age ( P = 0.03) and a history of angina ( P = 0.002), hypertension ( P = 0.01) and diabetes ( P = 0.01). For thrombolytic treated AMI patients independent predictors of a prolonged delay were prolonged pre‐hospital delay ( P < 0.0001), female sex ( P = 0.02) and a history of diabetes ( P = 0.02). Conclusion Risk factors for both pre‐hospital and hospital delay time could in AMI be defined although slightly different. Two factors appeared for both, i.e. increasing age and a history of hypertension.