Factors associated with prolonged prehospital delay of African Americans with acute myocardial infarction

BACKGROUND Delays in seeking treatment for signs and symptoms, of acute myocardial infarction arc longer for African Americans than for whites. OBJECTIVE To determine factors associated with prolonged delay and the extent to which perceived racism influences prehospital delay in African Americans with acute myocardial infarction. METHODS Sixty-one African Americans with acute myocardial infarction were interviewed within 1 month of hospital admission. Delay times were calculated on the basis of the interviews. Independent t tests and chi(2) tests were used to determine factors associated with prolonged delays. RESULTS Median delay was 4.25 hours and did not differ significantly between women and men (4.42 vs 3.50 hours). Most patients (69%) experienced their initial signs, and symptoms at homed often witnessed by family members or friends (70%). Delay was longer for insured patients than for uninsured patients (4.45 vs 0.50 hours). Single, widowed, or divorced patients had longer delay times than did married patients (5.33 vs 2.50 hours), and patients with diabetes delayed longer than did those without diabetes (7.29 vs 3.50 hours). Perceived racism did not differ significantly between patients who delayed seeking treatment and those who did not. CONCLUSIONS Median delay times were substantially longer than the recommended time of less than 1 hour, reducing the benfit from reperfusion therapies. Education and counseling of patients and their families should be a major strategy in optimizing patients' outcomes and decreasing the time to definitive treatment.