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Impact of Prehospital Delay in Treatment Seeking on In-Hospital Complications After Acute Myocardial Infarction

Wu, Jia-Rong PhD, RN; Moser, Debra K. DNSc, RN, FAAN; Riegel, Barbara DNSc, RN, FAAN; McKinley, Sharon PhD, RN; Doering, Lynn V. DNSc, RN

The Journal of Cardiovascular Nursing: May-June 2011 - Volume 26 - Issue 3 - p 184-193
doi: 10.1097/JCN.0b013e3181efea66
ARTICLES: Patient Prehospital Delay

Background: Rapid arrival to the hospital for treatment of acute myocardial infarction (AMI) improves long-term outcomes. Whether prehospital delay time is associated with short-term, in-hospital complications remains unknown.

Objective: The purpose of this study was to evaluate the fit of a theoretical model where prehospital delay time was indirectly associated with hospital length of stay through in-hospital complications after AMI considering simultaneously for demographic, clinical, and psychosocial factors using structural equation modeling.

Methods: Acute myocardial infarction patients (N = 536; 66% men; mean age, 62 [SD, 14] years) were enrolled in this prospective study. Demographic and clinical data were obtained by patient interview and medical record review. After patient discharge, complications were abstracted from the medical record.

Results: Prehospital delay, admission Killip class, and in-hospital anxiety were the best predictors of in-hospital complications, including recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death, after AMI (P = .019). The occurrence of in-hospital complications was related to length of stay in the hospital (P < .001).

Conclusion: Prehospital delay in promptly seeking hospital treatment for AMI symptoms, together with state anxiety and worse heart failure, was associated with the occurrence of more frequent serious complications during the hospital stay. It is essential that research and clinical efforts focus on the complex and dynamic issue of improving prehospital delay in AMI patients.

Jia-Rong Wu, PhD, RN Assistant Professor, School of Nursing, University of North Carolina at Chapel Hill.

Debra K. Moser, DNSc, RN, FAAN Professor and Gill Endowed Chair of Nursing, College of Nursing, University of Kentucky, Lexington.

Barbara Riegel, DNSc, RN, FAAN Professor, School of Nursing, University of Pennsylvania, Philadelphia.

Sharon McKinley, PhD, RN Professor, University of Technology, Sydney, and Northern Sydney central Coast Area Health Service, Australia.

Lynn V. Doering, DNSc, RN Associate Professor, School of Nursing, University of California, Los Angeles.

Funding was received from the University of Kentucky Gill Endowment, Faculty Research Support, and American Association of Critical Care Nurses-Sigma Theta Tau International Awards.

Correspondence Jia-Rong Wu, PhD, RN, School of Nursing, University of North Carolina at Chapel Hill, 435 Carrington Hall, CB #7460, Chapel Hill, NC 27599-7460 (

© 2011 Lippincott Williams & Wilkins, Inc.