Heart attack victims on Medicaid, from poor areas, face longer delays reaching hospital: study

Kathryn Rose, PhD

Researchers at the University of North Carolina at Chapel Hill School of Public Health say patients tend to have better outcomes after an acute myocardial infarction, or heart attack, if they receive medical treatment in a timely manner, according to an article published in the Sept. 22 issue of the Archives of Internal Medicine. That’s because time-dependent treatments, such as clot-dissolving therapy or heart catheterization to reopen blocked arteries, are more likely to be given to patients who arrive at hospital quickly.

However, the study found that “despite efforts to reduce time elapsed between the onset of acute myocardial infarction symptoms and hospital arrival, pre-hospital delay times have not improved over the years.”

Chirayath Suchindran, PhD

The study examined the medical records of 6,746 men and women hospitalized with heart attacks between 1993 and 2002. Researchers determined the pre-hospital delay time, or the time elapsed between the onset of symptoms and arrival at the hospital. Participants’ addresses were linked with 2000 U.S. census socioeconomic data. Median (midpoint) household income for each participant’s area was classified as low (less than $33,533), medium ($33,533 to $50,031) or high ($50,032 or more). Researchers also noted health insurance status and calculated the distance from the home to the hospital.

Thirty-six percent of the patients arrived at the hospital within two hours of developing symptoms (defined as a short delay); 42 percent arrived between two hours and 12 hours (medium delay); and 22 percent arrived between 12 and 72 hours (long delay).

Eric Whitsel, M.D.

Researchers found patients from areas in the low household income group were more likely to have long or medium delays, regardless of age, sex, race and study community. The likelihood persisted after researchers factored in other aspects, including health insurance status, diabetes, hypertension, emergency medical services (EMS) use, chest pain, year of acute myocardial infarction event and distance from residence to hospital.

The study also found patients with Medicaid were more likely to have a long or medium delay than those with prepaid insurance or with prepaid insurance plus Medicare.

“It’s critical to reduce socioeconomic and insurance disparities in pre-hospital delays for heart attack victims, because excess delays may hinder effective care,” said study lead author, Randi E. Foraker, a predoctoral fellow in epidemiology in the School of Public Health. “Prolonged delays among patients from low neighborhood income areas and Medicaid recipients suggest a need for increased recognition of – and rapid response to – heart attack symptoms within these populations.”

Foraker said interventions such as community education and awareness campaigns, targeted interventions by health-care professionals aimed at reducing pre-hospital delays among patients with known coronary heart disease, and promoting EMS use throughout the community could be considered.

Wayne Rosamond, PhD

Other study authors from UNC were: Kathryn Rose, Ph.D., research associate professor of epidemiology; Chirayath Suchindran, Ph.D., professor of biostatistics; Eric Whitsel, M.D., research assistant professor of epidemiology; Joy Wood, epidemiology applications specialist; and Wayne Rosamond, Ph.D., epidemiology professor. Aileen McGinn, Ph.D., Albert Einstein College of Medicine, and David Goff Jr., M.D., Ph.D., Wake Forest University School of Medicine, were also co-authors.

The study was supported by a contract from the National Heart, Lung and Blood Institute and also funded in part by a National Research Service Award training grant from the institute and the National Institutes of Health.

Note: Foraker can be reached at (919) 966-1407 or randi_foraker@unc.edu.

School of Public Health contact: Ramona DuBose, (919) 966-7467, ramona_dubose@unc.edu