anxiety, in-hospital complication, MI, outcomes, prehospital delay, structural equation modeling



  1. Wu, Jia-Rong PhD, RN
  2. Moser, Debra K. DNSc, RN, FAAN
  3. Riegel, Barbara DNSc, RN, FAAN
  4. McKinley, Sharon PhD, RN
  5. Doering, Lynn V. DNSc, RN


Background: Rapid arrival to the hospital for treatment of acute myocardial infarction (AMI) improves long-term outcomes. Whether prehospital delay time is associated with short-term, in-hospital complications remains unknown.


Objective: The purpose of this study was to evaluate the fit of a theoretical model where prehospital delay time was indirectly associated with hospital length of stay through in-hospital complications after AMI considering simultaneously for demographic, clinical, and psychosocial factors using structural equation modeling.


Methods: Acute myocardial infarction patients (N = 536; 66% men; mean age, 62 [SD, 14] years) were enrolled in this prospective study. Demographic and clinical data were obtained by patient interview and medical record review. After patient discharge, complications were abstracted from the medical record.


Results: Prehospital delay, admission Killip class, and in-hospital anxiety were the best predictors of in-hospital complications, including recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death, after AMI (P = .019). The occurrence of in-hospital complications was related to length of stay in the hospital (P < .001).


Conclusion: Prehospital delay in promptly seeking hospital treatment for AMI symptoms, together with state anxiety and worse heart failure, was associated with the occurrence of more frequent serious complications during the hospital stay. It is essential that research and clinical efforts focus on the complex and dynamic issue of improving prehospital delay in AMI patients.