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BMC Cardiovascular Disorders

, 12:82



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.

KeywordsVeterans Acute myocardial infarction Time from symptom onset Delayed presentation AbbreviationsACSAcute coronary syndrome

AMIAcute myocardial infarction

CABGCoronary artery bypass grafting

CADCoronary artery disease

CHFCongestive heart failure

CIConfidence interval

CKDChronic kidney disease

COPDChronic obstructive pulmonary disease

DNRDo not resuscitate


NSTEMINon-ST elevated myocardial infarction

OROdds ratio

PCIPercutaneous coronary intervention

PTSDPost traumatic stress disorder

STEMIST elevated myocardial infarction

VHAVeterans Health Administration.

Electronic supplementary materialThe online version of this article doi:10.1186-1471-2261-12-82 contains supplementary material, which is available to authorized users.

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Autor: Kelly McDermott - Charles Maynard - Ranak Trivedi - Elliott Lowy - Stephan Fihn

Fuente: https://link.springer.com/article/10.1186/1471-2261-12-82

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