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Lack of Influence on Incidence of Sudden Death

Richard F. Gillum, MD; Manning Feinleib, MD; James R. Margolis, MD; Richard R. Fabsitz, MA; Robert C. Brasch, MD

Arch Intern Med. 1976;136(6):649-654.

Abstract
Prehospital delay is considered to be an important cause of out-of-hospital coronary mortality. Behavior of patients and physicians in response to the symptoms of myocardial infarction (MI) or impending out-of-hospital death (OHD) was studied for 107 consecutive acute coronary events in Framingham, Mass. Delay due to inappropriate patient behavior was the most important component of total delay. Delay related to patient-physician contact occurred in two thirds of MI cases and was more than 30 minutes in half of these. Office visits and inappropriate triage by nurses and receptionists were important factors in physician delay. However, 60% to 75% of OHDs occur so rapidly that their prevention by reduction of prehospital delay seems impossible. A strategy for reduction of delay that might be of benefit in preventing some of the remaining OHDs is described.

(Arch Intern Med 136:649-654, 1976)

Author Affiliations
From the Department of Medicine, Peter Bent Brigham Hospital, Boston (Dr Gillum), the National Institutes of Health, National Heart and Lung Institute, Division of Heart and Vascular Diseases, Epidemiology Branch Bethesda, Md (Dr Feinleib and Mr Fabsitz), the Department of Medicine, Duke University Medical Center, Durham, NC (Dr Margolis), and the Department of Radiology, Moffitt Hospital, San Francisco (Dr Brasch).

Footnotes
Submitted for publication Sept 17, 1975; accepted Dec 8.

Reprint requests to National Institutes of Health, National Heart and Lung Institute, Division of Heart and Vascular Diseases, Landow Building, Room C-825, Bethesda, MD 20014 (Dr Feinleib).

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