Factors associated with presenting >12 hours after symptom onset of acute myocardial infarction among Veteran men

Abstract

BackgroundApproximately 2/3 of Veterans admitting to Veterans Health Administration (VHA) facilities present >12 hours after symptom onset of acute myocardial infarction (AMI) (“late presenters”). Veterans admitted to VHA facilities with AMI may delay hospital presentation for different reasons compared to their general population counter parts. Despite the large descriptive literature on factors associated with delayed presentation in the general population, the literature describing these factors among the Veteran AMI population is limited. The purpose of this analysis is to identify predictors of late presentation in the Veteran population presenting with AMI to VHA facilities. Identifying predictors will help inform and target interventions for Veterans at a high risk of late presentation.MethodsIn our cross-sectional study, we analyzed a cohort of 335 male Veterans from nine VHA facilities with physician diagnosed AMI between April 2005 and December 2006. We compared demographics, presentation characteristics, medical history, perceptions of health, and access to health care between early and late presenting Veterans. We used standard descriptive statistics for bivariate comparisons and multivariate logistic regression to identify independent predictors of late presentation.ResultsOur cohort was an average of 64 ± 10 years old and was 88% white. Sixty-eight percent of our cohort were late presenters. Bivariate comparisons found that fewer late presenters had attended at least some college or vocational school (late 53% vs. early 66%, p = 0.02). Multivariate analysis showed that presentation with ST-elevation myocardial infarction (STEMI) was associated with early presentation (OR = 0.4 95%CI [0.2, 0.9]) and ≥2 angina episodes in the prior 24 hours (versus 0-1 episode) was associated with late presentation (OR = 7.5 95%CI [3.6,15.6]).ConclusionsA significant majority of Veterans presenting to VHA facilities with AMI were late presenters. We found few differences between early and late presenters. Having a STEMI was independently associated with early presentation and reporting ≥2 angina episodes in the 24 hours prior to hospital admission was independently associated with late presentation. These independent predictors of early and late presentation are similar to what has been reported for the general population. Despite these similarities to the general population, there may be untapped opportunities for patient education within the VHA to decrease late presentation.

Independent Predictors of Late Presentation in Patients with ST-Segment Elevation Myocardial Infarction

“… 22 In a cross-sectional study that included 335 patients and considered late presentation arriving at the hospital within 12 hours of pain onset, previous STEMI and revascularization did not show a statistically significant association with time of presentation. 23 Our study did not include analyses of the associated mechanisms between the presence of predictors and the occurrence of late presentation, but it could be speculated that patients who had previous cardiac events or were submitted to myocardial revascularization procedures would be more familiarized and conscious about the disease and the need to seek medical attention quickly.…”

Percutaneous cholecystostomy: prognostic factors and comparison to cholecystectomy

“…The major limitations of this study are its retrospective design, propensity to introduce selection bias, a paucity of female subjects, and a tendency toward late presentation at Veterans Health Administration facilities [27]. The high proportion of interval cholecystectomies performed open (18%) or converted to open (21%) underscores the unique nature of our patient population and practice patterns.…”

Preventable delays to intravenous furosemide administration in the emergency department prolong hospitalization for patients with acute heart failure

“…This is limiting because patients may have different thresholds for presenting to the ED and may wait until their condition is more severe, as has been seen in other acute emergencies such as stroke and myocardial infarction. 26–29 Furthermore, discharging a patient with AHF home following an inpatient stay is complex and may be affected by myriad factors not routinely captured such as socioeconomic status, clinical condition, health literacy, and resources available at home including family support. Fourth, approximately one-third of the study population was excluded for discordance between the ED and inpatient diagnosis.…”