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Factors Keeping Older Patients From Presenting to ED With AMI

What older patients are most likely to delay seeking emergency care for acute myocardial infarction (AMI)?

A new study published in the Journal of the American Geriatrics Society sought to answer that question in hopes of better-targeted public health campaigns.

In the cross-sectional analysis of data from the ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI), an observational study of older adults hospitalized for AMI, the researchers found a number of factors predictive for delayed treatment, including nonwhite race, atypical symptoms, and preexisting heart failure.

To determine that, researchers from Yale University conducted a study including 2,500 patients 75 years or older hospitalized for heart attack. They found that prehospital delay, defined as six or more hours before getting to the hospital, was much more likely, 42%, in the older cohort than in research on younger heart attack victims, for whom the reported prevalence ranges from 20% to 25%.

“Delays in presentation can have huge consequences for older adults with heart attacks,” pointed out Gregory Ouellet, MD, of the Yale School of Medicine. “Based on the results of our study, we need to develop better clinical and public health strategies to ensure timely presentation, especially among nonwhite communities, those with atypical symptoms, and those with heart failure.”

Patient factors strongly associated with delay in presentation included nonwhite race (adjusted odds ratio [aOR] of 1.54), atypical symptoms (aOR of 1.41), and preexisting heart failure (aOR of 1.35).

Study authors suggest public health campaigns that target those audiences to encourage early ED presentation.