TY - JOUR T1 - Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome JF - Emergency Medicine Journal JO - Emerg Med J SP - 390 LP - 395 DO - 10.1136/emermed-2015-204978 VL - 33 IS - 6 AU - Louise Cullen AU - Jaimi H Greenslade AU - Louven Menzies AU - Ashley Leong AU - Martin Than AU - Christopher Pemberton AU - Sally Aldous AU - John Pickering AU - Emily Dalton AU - Bianca Crosling AU - Rachelle Foreman AU - William A Parsonage Y1 - 2016/06/01 UR - http://emj.bmj.com/content/33/6/390.abstract N2 - Objective To define the association between time taken to present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS) and 1-year outcomes. We also determined whether particular patient characteristics are associated with delays in seeking care after symptom onset.Methods We collected data, which included a customised case report form to record symptom onset, on adult patients presenting with suspected ACS to two EDs in Australia and New Zealand. Such patients were followed up prospectively for 1 year. The composite primary endpoint included death, acute myocardial infarction, unstable angina pectoris treated with revascularisation or readmission with heart failure occurring after discharge but within 12 months after the index presentation.Results ACS was diagnosed at presentation in 420 (16.8%) of 2515 patients recruited. Cox regression was conducted to assess the relationship between presentation time and the rate of primary endpoints after controlling for age, ethnicity, prior angina, prior coronary artery bypass graft and index diagnosis. Middle (2–6 h) and late presenters (>6 h postsymptom onset) developed the primary endpoint at a rate 1.22 (95% CI 0.80 to 1.85) and 1.57 (1.07 to 2.31) times higher than early presenters. Patients with known risk factors and cardiovascular disease were more likely to present late to the ED.Conclusions There is an independent association between time to presentation and 1-year cardiac outcomes following initial chest pain assessment for ED patients with possible cardiac chest pain in the Australian and New Zealand setting. This association occurred irrespective of the eventual diagnosis. Effective public health campaigns and other measures that facilitate early presentation with symptoms for patients with symptoms suggestive of ACS are justified and may improve prognosis.Trial registration number ACTRN12611001069943. ER -