Factors Predisposing to a Nonadmission of Patients with Acute Myocardial Infarction

Abstract

Among patients presenting at the hospital with an acute myocardial infarction (AMI), about 2–6% are mistakenly discharged by emergency physicians. The relevance of diagnostic problems in the prehospital period of an AMI is unknown. We prospectively studied 421 patients seen by a primary care physician in the prehospital period of an AMI. Using a standardized interview, data were obtained to identify factors determining nonadmission. Of 421 AMI patients, 327 (77.7%) were directly admitted to hospital after examination by the physician, whereas 94 (22.3%) were not admitted. The median prehospital delay was 240 min in admitted and 2,200 min in nonadmitted patients. Using a stepwise logistic regression model, the following factors were identified as independent contributors to nonadmission: the patient not being much affected by the symptoms (2.48; 1.40–4.39), improvement of symptoms (2.59; 1.46–4.59), the patient not thinking to suffer an AMI (2.33; 1.28–4.17) and the patient being unable to imagine having a heart disease (1.93; 1.07–3.46). Conclusion: Nonadmission of AMI patients by health care professionals is a common problem. Several aspects of AMI presentation including the often limited intensity of symptoms and the variability of the clinical course may have to be re-emphasized by cardiologists. Taking a very careful history and being circumspect about the patient’s interpretation of symptoms still are the keys to a correct diagnosis of AMI.