Delay to hospital arrival after acute myocardial infarction in a population-based sample of elderly persons

108 Pages·1995·4.5 MB·English

by  Sverha, John Paul, II

YALE MEDICAL LIBRARY
3 9002 08627
YALE
UNIVERSITY
CUSHING/WHITNEY
MEDICAL LIBRARY
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Delay to Hospital Arrival After Acute Myocardial Infarction in a Population-
Based Sample of Elderly Persons
A Thesis Submitted to the Yale University School of Medicine in Partial
Fulfillment of the Requirements for the Degree of Doctor of Medicine
by
John Paul Sverha II
1995
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YALE MEDICAL LIBRARY
Abstract
DELAY TO HOSPITAL ARRIVAL AFTER ACUTE MYOCARDIAL
INFARCTION IN A POPULATION-BASED SAMPLE OF ELDERLY
PERSONS. John P. Sverha, Laura V. Vaccarino, Harlan M. Krumholz.
Section of Cardiology, Department of Internal Medicine, Yale University,
School of Medicine, New Haven, CT.
The purpose of this study was to determine 1) if measures of social isolation,
cognitive function, and functional ability are associated with prolonged delay
to hospital arrival (> 6 hours) in elderly persons with acute myocardial
infarction (AMI) and 2) whether prolonged delay in elderly persons with
AMI is an independent predictor of mortality. The study sample comprised
183 persons aged 65 years or older from the New Haven cohort of the
Established Populations for Epidemiologic Studies of the Elderly program
who had experienced a myocardial infarction between the years 1982 and 1992
and for whom data describing delay time from symptom onset to hospital
arrival was available. Information describing sociodemographic factors and
past medical history were collected at annual interviews preceeding the
myocardial infarction. Information describing clinical presentation,
thrombolytic use, and hospital course following AMI was collected by chart
review. The relationship between prolonged delay and social isolation,
cognitive ability, and functional ability was examined by univariate and
multivariate analysis. The effect of prolonged delay time on inhospita!
complications, 30-day mortality, and 1-year mortality was examined by
univariate analysis and also by multivariate analysis while controlling for
usual predictors of mortality after AMI. Prolonged delay was found to be