Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry)☆
Section snippets
Methods
A total of 18 cluster sites in 14 countries in North and South America, Europe, Australia, and New Zealand are currently collaborating in GRACE. Clusters were chosen based on local demographic characteristics and hospital facilities to ensure a representative sample of patients with acute coronary syndromes from each country and hospital systems of different sizes and treatment and diagnostic capabilities.1 Patients hospitalized at 94 hospitals with acute coronary syndromes are included in the
Results
The study sample consisted of a total of 10,582 patients with acute coronary disease in whom information was available about prehospital delay as ascertained through the review of medical records. This sample included 3,693 patients with ST-segment elevation AMI, 2,935 with non–ST-segment elevation AMI, and 3,954 with unstable angina. Patients were hospitalized between April 1999 and March 2001.
Discussion
The results of this large multihospital multinational study demonstrate that patients with acute coronary disease continue to exhibit prolonged delay in seeking medical care after the onset of acute coronary symptoms. Whereas patients most likely to benefit from the use of coronary reperfusion strategies, namely patients with ST-segment elevation AMI, delayed seeking care less than patients with other manifestations of acute coronary disease, patients with ST-segment elevation AMI also delayed
Acknowledgements
We would like to express our gratitude to the physicians and nurses participating in GRACE, whose continuing involvement is essential to the success of the study. Further information about the project, along with a complete list of participants, can be found at www.outcomes.org/grace.
References (15)
- et al.
Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarctionThe Worcester Heart Attack Study
Am Heart J
(1994) - et al.
Prehospital delay in patients with acute coronary heart diseaseconcordance between patient interviews and medical records
Am Heart J
(1998) - et al.
Comparison of delay times to hospital presentation for physicians and nonphysicians with acute myocardial infarction
Am J Cardiol
(1992) - et al.
Prehospital delay in patients hospitalized with heart attack symptoms in the United Statesthe REACT trial
Am Heart J
(1999) - et al.
Causes of delay in seeking treatment for heart attack symptoms
Soc Sci Med
(1995) - et al.
Implications for acute intervention related to time of hospital arrival in acute myocardial infarction
Am J Cardiol
(1986) Rationale and design of the GRACE (Global Registry of Acute Coronary Events) Projecta multinational registry of patients hospitalized with acute coronary syndromes
Am Heart J
(2001)
Cited by (256)
Late presentation ST-elevation myocardial infarction: Is revascularisation suitable?
2022, Archives des Maladies du Coeur et des Vaisseaux - PratiqueSymptom Perception and Interpretation
2022, Comprehensive Clinical Psychology, Second EditionImpedance humidity sensors based on metal oxide semiconductors: Characteristics and mechanism
2022, Modeling, Characterization, and Production of Nanomaterials: Electronics, Photonics, and Energy Applications, Second EditionPercutaneous Myocardial Revascularization in Late-Presenting Patients With STEMI
2021, Journal of the American College of CardiologyTemporal association of contamination obsession on the prehospital delay of STEMI during COVID-19 pandemic
2021, American Journal of Emergency MedicineCitation Excerpt :Patients admitted to the emergency department without an ambulance were categorized as self-transported and those arriving by ambulance were categorized as ambulance transported. If the time interval between the estimated onset of symptoms and admission to the emergency room was >120 min, it was described (categorized) as a prehospital delay [14,15]. The application of primary percutaneous intervention during the pandemic period was not changed.
- ☆
Grace is supported by an unrestricted educational grant from aventis pharma, bridgewater, new jersey.