Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay

Christel G A Nielsen; Kristina G Laut; Lisette O Jensen; Jan Ravkilde; Christian J Terkelsen; Steen D Kristensen

doi:10.1177/2048872616676570

Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay

Christel G A Nielsen, Kristina G Laut, Lisette O Jensen, Jan Ravkilde, Christian J Terkelsen, Steen D Kristensen

Department of Clinical Medicine - The Department of Cardiological Medicine B

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

31 Citations (Scopus)

Abstract

BACKGROUND AND AIMS: To improve treatment success of ST-elevation myocardial infarction, a minimal delay from symptom onset to reperfusion therapy is crucial. The patient's response to initial symptoms (patient delay) substantially affects the delay. We investigated time patterns of patient delay during a seven-year time period, and aimed to identify key predictors that affect the length of the patient delay.

METHODS: Data on 5848 patients hospitalized with ST-elevation myocardial infarction and treated with primary percutaneous intervention during the period 2003-2009 were obtained from Danish registry databases. The dependent variable was patient delay (<120 and ⩾120 min). Data were analysed for a possible time trend during the seven-year study period using Jonckheere-Terpstra analysis and we also performed multiple logistical regression to identify predictors of a prolonged patient delay.

RESULTS: We observed a decrease in median patient delay from 101 min in 2003 to 85 min in 2009, p=0.018. We identified the age group 55-69 years (odds ratio (OR): 1.27 (95% confidence interval (CI): 1.09-1.47)) and age ⩾70 years (OR: 1.63 (95% CI: 1.40-1.90)), diabetes (OR: 1.26 (95% CI: 1.05-1.50)), female gender (OR: 1.17 (95% CI: 1.03-1.34)) and presentation during the night 22:00-05:59 (OR: 1.92 (95% CI: 1.68-2.20)), as independent risk factors of a patient delay ⩾120 min. Symptom onset between 14:00-21:59 was associated with a shorter patient delay (OR: 0.78 (95% CI 0.68-0.89)).

CONCLUSION: A slight decrease in patient delay during the years from 2003-2009 was observed. High age, diabetes, female gender and symptoms presentation during the night were shown to be independent predictors of prolonged patient delay.

Original language	English
Journal	European Heart Journal: Acute Cardiovascular Care
Volume	6
Issue	7
Pages (from-to)	583-591
Number of pages	9
ISSN	2048-8726
DOIs	https://doi.org/10.1177/2048872616676570
Publication status	Published - Oct 2017

Keywords

Patient delay
acute coronary syndrome
health care organization
primary percutaneous coronary intervention

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10.1177/2048872616676570

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title = "Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay",

abstract = "BACKGROUND AND AIMS: To improve treatment success of ST-elevation myocardial infarction, a minimal delay from symptom onset to reperfusion therapy is crucial. The patient's response to initial symptoms (patient delay) substantially affects the delay. We investigated time patterns of patient delay during a seven-year time period, and aimed to identify key predictors that affect the length of the patient delay.METHODS: Data on 5848 patients hospitalized with ST-elevation myocardial infarction and treated with primary percutaneous intervention during the period 2003-2009 were obtained from Danish registry databases. The dependent variable was patient delay (<120 and ⩾120 min). Data were analysed for a possible time trend during the seven-year study period using Jonckheere-Terpstra analysis and we also performed multiple logistical regression to identify predictors of a prolonged patient delay.RESULTS: We observed a decrease in median patient delay from 101 min in 2003 to 85 min in 2009, p=0.018. We identified the age group 55-69 years (odds ratio (OR): 1.27 (95% confidence interval (CI): 1.09-1.47)) and age ⩾70 years (OR: 1.63 (95% CI: 1.40-1.90)), diabetes (OR: 1.26 (95% CI: 1.05-1.50)), female gender (OR: 1.17 (95% CI: 1.03-1.34)) and presentation during the night 22:00-05:59 (OR: 1.92 (95% CI: 1.68-2.20)), as independent risk factors of a patient delay ⩾120 min. Symptom onset between 14:00-21:59 was associated with a shorter patient delay (OR: 0.78 (95% CI 0.68-0.89)).CONCLUSION: A slight decrease in patient delay during the years from 2003-2009 was observed. High age, diabetes, female gender and symptoms presentation during the night were shown to be independent predictors of prolonged patient delay.",

keywords = "Patient delay, acute coronary syndrome, health care organization, primary percutaneous coronary intervention",

author = "Nielsen, {Christel G A} and Laut, {Kristina G} and Jensen, {Lisette O} and Jan Ravkilde and Terkelsen, {Christian J} and Kristensen, {Steen D}",

note = "{\textcopyright} The European Society of Cardiology 2016.",

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language = "English",

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Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay. / Nielsen, Christel G A ; Laut, Kristina G; Jensen, Lisette O et al.
In: European Heart Journal: Acute Cardiovascular Care, Vol. 6, No. 7, 10.2017, p. 583-591.

Research output: Contribution to journal/Conference contribution in journal/Contribution to newspaper › Journal article › Research › peer-review

TY - JOUR

T1 - Patient delay in patients with ST-elevation myocardial infarction

T2 - Time patterns and predictors for a prolonged delay

AU - Nielsen, Christel G A

AU - Laut, Kristina G

AU - Jensen, Lisette O

AU - Ravkilde, Jan

AU - Terkelsen, Christian J

AU - Kristensen, Steen D

PY - 2017/10

Y1 - 2017/10

N2 - BACKGROUND AND AIMS: To improve treatment success of ST-elevation myocardial infarction, a minimal delay from symptom onset to reperfusion therapy is crucial. The patient's response to initial symptoms (patient delay) substantially affects the delay. We investigated time patterns of patient delay during a seven-year time period, and aimed to identify key predictors that affect the length of the patient delay.METHODS: Data on 5848 patients hospitalized with ST-elevation myocardial infarction and treated with primary percutaneous intervention during the period 2003-2009 were obtained from Danish registry databases. The dependent variable was patient delay (<120 and ⩾120 min). Data were analysed for a possible time trend during the seven-year study period using Jonckheere-Terpstra analysis and we also performed multiple logistical regression to identify predictors of a prolonged patient delay.RESULTS: We observed a decrease in median patient delay from 101 min in 2003 to 85 min in 2009, p=0.018. We identified the age group 55-69 years (odds ratio (OR): 1.27 (95% confidence interval (CI): 1.09-1.47)) and age ⩾70 years (OR: 1.63 (95% CI: 1.40-1.90)), diabetes (OR: 1.26 (95% CI: 1.05-1.50)), female gender (OR: 1.17 (95% CI: 1.03-1.34)) and presentation during the night 22:00-05:59 (OR: 1.92 (95% CI: 1.68-2.20)), as independent risk factors of a patient delay ⩾120 min. Symptom onset between 14:00-21:59 was associated with a shorter patient delay (OR: 0.78 (95% CI 0.68-0.89)).CONCLUSION: A slight decrease in patient delay during the years from 2003-2009 was observed. High age, diabetes, female gender and symptoms presentation during the night were shown to be independent predictors of prolonged patient delay.

AB - BACKGROUND AND AIMS: To improve treatment success of ST-elevation myocardial infarction, a minimal delay from symptom onset to reperfusion therapy is crucial. The patient's response to initial symptoms (patient delay) substantially affects the delay. We investigated time patterns of patient delay during a seven-year time period, and aimed to identify key predictors that affect the length of the patient delay.METHODS: Data on 5848 patients hospitalized with ST-elevation myocardial infarction and treated with primary percutaneous intervention during the period 2003-2009 were obtained from Danish registry databases. The dependent variable was patient delay (<120 and ⩾120 min). Data were analysed for a possible time trend during the seven-year study period using Jonckheere-Terpstra analysis and we also performed multiple logistical regression to identify predictors of a prolonged patient delay.RESULTS: We observed a decrease in median patient delay from 101 min in 2003 to 85 min in 2009, p=0.018. We identified the age group 55-69 years (odds ratio (OR): 1.27 (95% confidence interval (CI): 1.09-1.47)) and age ⩾70 years (OR: 1.63 (95% CI: 1.40-1.90)), diabetes (OR: 1.26 (95% CI: 1.05-1.50)), female gender (OR: 1.17 (95% CI: 1.03-1.34)) and presentation during the night 22:00-05:59 (OR: 1.92 (95% CI: 1.68-2.20)), as independent risk factors of a patient delay ⩾120 min. Symptom onset between 14:00-21:59 was associated with a shorter patient delay (OR: 0.78 (95% CI 0.68-0.89)).CONCLUSION: A slight decrease in patient delay during the years from 2003-2009 was observed. High age, diabetes, female gender and symptoms presentation during the night were shown to be independent predictors of prolonged patient delay.

KW - Patient delay

KW - acute coronary syndrome

KW - health care organization

KW - primary percutaneous coronary intervention

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DO - 10.1177/2048872616676570

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JO - European Heart Journal: Acute Cardiovascular Care

JF - European Heart Journal: Acute Cardiovascular Care

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Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay

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