NSTEMI patients wait too long to go to the hospital after symptoms start

Non-ST-segment-elevation-MI (NSTEMI) patients take too long to get to the hospital once they experience their first symptoms, according to the results of a new analysis. Overall, more than half of the patients took more than two hours to get to the hospital, and investigators say new strategies are needed to get patients to seek care, given that delay times have not improved in recent years.

In a report published in the November 8, 2010 issue of the Archives of Internal Medicine, the researchers, led by Dr Henry Ting (Mayo Clinic, Rochester, MN), studied 104 622 patients with NSTEMI at 568 hospitals enrolled in the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation of the American College of Cardiology/American Heart Association Guidelines (CRUSADE) national-quality improvement initiative. It is recommended that patients experiencing symptoms of an acute coronary syndrome call 911 if the symptoms persist for more than five minutes.

In the registry, the median delay from symptom onset to hospital presentation was 2.6 hours, a time that has been stable from 2001 to 2006, according to investigators. Overall, 59% of patients had delays exceeding two hours, while 11% of patients waited more than 12 hours to get to the hospital. Older patients, women, and nonwhite patients were significantly more likely to delay going to the hospital, multivariate analyses showed. Patients with diabetes and current smokers were also more likely to delay.

In addition, NSTEMI patients who experienced symptoms at night, both during the weekday and weekend, had a 25% shorter delay time when compared with individuals who had symptoms during typical office hours, 8 am to 4 pm, during the week.