Predictors of Delayed Hospital Presentation for Myocardial Infarction Among Diabetic Patients: A Retrospective Study.
Cureus · 2026-07-01 · Observational study
Abstract
Background Myocardial infarction (MI) is a major cause of cardiovascular morbidity and mortality, and early hospital presentation is crucial for timely reperfusion and improved outcomes. Diabetic patients are particularly prone to delayed presentation due to atypical symptoms. Despite this increased risk, limited data are available from developing countries such as Egypt regarding factors associated with delayed hospital presentation. This study aimed to identify predictors of delayed presentation among diabetic patients with MI in Egypt. Methods This retrospective study was conducted among 286 diabetic patients with a diagnosis of MI who were admitted to a tertiary care hospital affiliated with Al-Azhar University in Cairo, Egypt. Patients aged ≥30 years with complete records of symptom onset and hospital arrival times were included. MI was diagnosed according to American College of Cardiology/American Heart Association criteria. Patients were classified as early presenters (≤12 hours) or delayed presenters (>12 hours). Sociodemographic and clinical data were collected from medical records. Data were analyzed using the IBM SPSS Statistics for Windows, Version 25 (Released 2017; IBM Corp., Armonk, New York, United States). Chi-square test and multivariable logistic regression analysis were performed, with a p-value ≤0.05 considered statistically significant. Results Among 286 diabetic patients with MI, 170 (59.44%) presented late to the hospital, while 116 (40.56%) presented early. On initial analysis, several sociodemographic and clinical factors were significantly associated with delayed presentation, including age ≥60 years, rural residence, low educational level, distance ≥10 km from the hospital, atypical symptom presentation, poor glycemic control (HbA1c ≥7%), and diabetes duration ≥10 years (all p<0.05). On multivariable logistic regression analysis, age ≥60 years (adjusted odds ratio (AOR)=2.43, p=003), rural residence (AOR=1.96, p=0.026), low educational level (AOR=2.18, p=0.010), distance ≥10 km from the hospital (AOR=3.87, p=<0.001), atypical symptoms (AOR=3.15, p=<0.001), HbA1c ≥7% (AOR=2.26, p=0.007), and diabetes duration ≥10 years (AOR=1.84, p=0.039) remained independent predictors of delayed hospital presentation. Conversely, gender, family history of coronary artery disease, hypertension, dyslipidemia, and smoking were not independently associated with delayed presentation of MI. Conclusion Delayed hospital presentation among diabetic patients with MI is independently associated with age ≥60 years, rural residence, low educational level, longer distance from the hospital, atypical symptoms, poor glycemic control, and longer diabetes duration. Targeted health education initiatives, improved healthcare accessibility, and enhanced recognition of atypical MI symptoms may help reduce prehospital delays and improve outcomes in this high-risk population.
Tags
Equity & disparities · Older adults · Rural & remote · Time intervals