Open Access Research article

Longer pre-hospital delay in first myocardial infarction among patients with diabetes: an analysis of 4266 patients in the Northern Sweden MONICA Study

Karin Hellström Ängerud1*, Christine Brulin2, Ulf Näslund3 and Mats Eliasson4

Author Affiliations

1 Cardiology, Heart Centre and Department of Nursing, Umeå University, Umeå, Sweden

2 Department of Nursing, Umeå University, Umeå, Sweden

3 Cardiology, Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

4 Internal Medicine, Sunderbyn, Luleå, and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden

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BMC Cardiovascular Disorders 2013, 13:6  doi:10.1186/1471-2261-13-6

Published: 29 January 2013

Abstract

Background

Reperfusion therapy reduces both morbidity and mortality in myocardial infarction, but the effectiveness depends on how fast the patient receives treatment. Despite the time-dependent effectiveness of reperfusion therapy, many patients with myocardial infarction have delays in seeking medical care. The aim of this study was to describe pre-hospital delay in a first myocardial infarction among men and women with and without diabetes and to describe the association between pre-hospital delay time and diabetes, sex, age, symptoms and size of residential area as a proxy for distance to hospital.

Methods

This population based study was based on data from 4266 people aged 25–74 years, with a first myocardial infarction registered in the Northern Sweden MONICA myocardial infarction registry between 2000 and 2008.

Results

The proportion of patients with delay times ≥ 2 h was 64% for patients with diabetes and 58% for patients without diabetes. There was no difference in delay time ≥ 2 h between men and women with diabetes. Diabetes, older age and living in a town or rural areas were factors associated with pre-hospital delay times ≥ 2 h. Atypical symptoms were not a predictor for pre-hospital delay times ≥ 2 h, OR 0.59 (0.47; 0.75).

Conclusions

A higher proportion of patients with diabetes have longer pre-hospital delay in myocardial infarction than patients without diabetes. There are no differences in pre-hospital delay between men and women with diabetes. The largest risk difference for pre-hospital delay ≥ 2 h is between women with and without diabetes. Diabetes, older age and living in a town or rural area are predictors for pre-hospital delay ≥ 2 h.

Keywords:
Myocardial infarction; Diabetes mellitus; Pre-hospital delay; Sex differences