Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome

Cullen, Louise, Greenslade, Jaimi H., Menzies, Louven, Leong, Ashley, Than, Martin, Pemberton, Christopher, Aldous, Sally, Pickering, John, Dalton, Emily, Crosling, Bianca, Foreman, Rachelle and Parsonage, William A. (2016) Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome. Emergency Medicine Journal, 33 6: 390-395. doi:10.1136/emermed-2015-204978


Author Cullen, Louise
Greenslade, Jaimi H.
Menzies, Louven
Leong, Ashley
Than, Martin
Pemberton, Christopher
Aldous, Sally
Pickering, John
Dalton, Emily
Crosling, Bianca
Foreman, Rachelle
Parsonage, William A.
Title Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome
Journal name Emergency Medicine Journal   Check publisher's open access policy
ISSN 1472-0213
1472-0205
Publication date 2016-06
Year available 2016
Sub-type Article (original research)
DOI 10.1136/emermed-2015-204978
Open Access Status Not Open Access
Volume 33
Issue 6
Start page 390
End page 395
Total pages 6
Place of publication London, United Kingdom
Publisher B M J Group
Collection year 2017
Language eng
Formatted abstract
Objective: To define the association between time taken to present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS) and 1-year outcomes. We also determined whether particular patient characteristics are associated with delays in seeking care after symptom onset.

Methods: We collected data, which included a customised case report form to record symptom onset, on adult patients presenting with suspected ACS to two EDs in Australia and New Zealand. Such patients were followed up prospectively for 1 year. The composite primary endpoint included death, acute myocardial infarction, unstable angina pectoris treated with revascularisation or readmission with heart failure occurring after discharge but within 12 months after the index presentation.

Results: ACS was diagnosed at presentation in 420 (16.8%) of 2515 patients recruited. Cox regression was conducted to assess the relationship between presentation time and the rate of primary endpoints after controlling for age, ethnicity, prior angina, prior coronary artery bypass graft and index diagnosis. Middle (2-6 h) and late presenters (>6 h postsymptom onset) developed the primary endpoint at a rate 1.22 (95% CI 0.80 to 1.85) and 1.57 (1.07 to 2.31) times higher than early presenters. Patients with known risk factors and cardiovascular disease were more likely to present late to the ED.

Conclusions: There is an independent association between time to presentation and 1-year cardiac outcomes following initial chest pain assessment for ED patients with possible cardiac chest pain in the Australian and New Zealand setting. This association occurred irrespective of the eventual diagnosis. Effective public health campaigns and other measures that facilitate early presentation with symptoms for patients with symptoms suggestive of ACS are justified and may improve prognosis.

Trial registration number: ACTRN12611001069943
Keyword Emergency department (ED)
Acute coronary syndrome (ACS)
Cox regression
ST-elevation myocardial infarction (STEMI)
1-year outcomes
Delays in seeking care
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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