Low Neighborhood Income, Medicaid Linked to Delays in Reaching Hospital After Heart Attack

Individuals with Medicaid insurance and those who live in neighborhoods with lower household incomes appear less likely than others to reach the hospital within two hours of having a heart attack, according to a report in the September 22 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Patients tend to have better outcomes after an acute myocardial infarction (heart attack) if they receive medical treatment in a timely manner, according to background information in the article. 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 the hospital quickly. “Despite efforts to reduce time elapsed between the onset of acute myocardial infarction symptoms and hospital arrival, prehospital delay times have not improved over the years,” the authors write.

Randi E. Foraker, M.A., of the University of North Carolina, Chapel Hill, and colleagues examined the medical records of 6,746 men and women hospitalized with heart attack between 1993 and 2002. From the records, the researchers determined the prehospital delay time, or the time elapsed between the onset of symptoms and arrival at the hospital. Participants’ addresses were geocoded and 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). Health insurance status was noted and the distance from the residence to the hospital was calculated.