Delays by patients in seeking treatment for acute chest pain: implicationsfor achieving earlier thrombolysis

A study was set up to identify why patients delay seeking medical assistanc e after myocardial infarction. The study was performed in 100 consecutive p atients with suspected acute myocardial infarction admitted to either the U niversity Hospital of Wales, Cardiff, UK, or the Royal Jubilee Hospital, Vi ctoria, British Columbia, Canada (50 patients from each centre). The main o utcome measure was the delay from the onset of symptoms to admission to hos pital. The mean total delay before admission was 385 minutes (SEM 45). The mean delay incurred by the patient in seeking assistance was 172 minutes (S EM 27), representing 45% of the total. Delay was longer in patients with cr escendo angina and shorter in those later confirmed to have myocardial infa rction. Patients with prior ischaemic heart disease (74% of patients) prese nted later than those with no such history. No other demographic or clinica l factors predicted early or late presentation. Delays in seeking medical assistance after the onset of severe chest pain c ontribute significantly to total delays in patients' hospital admission and thrombolysis. The unexpected observation that patients with known ischaemi c heart disease delay longer before seeking help in spite of their frequent contact with doctors, suggests that opportunities for educating patients a re being wasted. Major efforts are needed to understand and modify behaviou r of patients with chest pain to further reduce delays in treatment.