Comparison of Delay Times from Symptom Onset to Medical Contact in Blacks Versus Whites With Acute Myocardial Infarction

Amy Leigh Miller, Da Juanicia Simon, Matthew T. Roe, Michael C. Kontos, Deborah Diercks, Ezra Amsterdam, Deepak L. Bhatt

Research output: Contribution to journalArticlepeer-review

20 Scopus citations


Clinical outcomes in acute myocardial infarction (AMI) worsen with increasing delay between symptom onset and clinical presentation. Previous studies have shown that black patients with AMI have longer presentation delays. The objective of this analysis is to explore the potential contribution of community factors to presentation delays in black patients with AMI. We linked clinical data for 346,499 consecutive patients with AMI from Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines™ (2007-2014) to socioeconomic and community information from the American Community Survey. Black patients with AMI had longer symptom onset to first medical contact times than white patients (114 vs 101 minutes, p <0.0001) regardless of ambulance versus self-transport. Compared with white patients, black patients were younger and more likely to have clinical co-morbidities such as hypertension, diabetes, previous heart failure, and stroke. They were also more likely to live in urban communities with lower socioeconomic status, lower rates of long-term residence, and higher proportion of single-person households than white patients. In sequential linear regression models adjusting for patient demographic and clinical characteristics, logistic barriers to prompt presentation, and community socioeconomic and composition factors, black patients had a persistent 9% greater time from symptom onset to presentation compared with white patients (95% CI 8% to 11%, p <0.0001). In conclusion, the longer delay in time to presentation in black patients with AMI compared with white patients persists after accounting for a number of both patient and community factors.

Original languageEnglish (US)
Pages (from-to)1127-1134
Number of pages8
JournalAmerican Journal of Cardiology
Issue number8
StatePublished - Apr 15 2017

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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