Longer pre-hospital delay in acute myocardial infarction in women because of longer doctor decision time

Study objective-To measure the prehospital delay times in patients with pro ven acute myocardial infarction (AMI) and to identify possibilities for red uction of treatment delay. Design-Descriptive three centre study. Setting-One university teaching hospital and two regional hospitals in Gron ingen, the Netherlands. Patients-400 consecutive confirmed AMI patients, age below 75 years, admitt ed to coronary care departments. Main results-Mean age was 59 years and 78% of patients were men. Within two hours after onset of symptoms half of the patients with AMI arrived at the hospital. Patient, doctor, and ambulance delay times (median values) were 30, 38, and 35 minutes respectively. Calling the personal general practitio ner (GP) or the locum tenens and whether or not the AMI occurred during a w eekend or on a working day had no consequences for prehospital delay times. At night patients waited longer before calling a GP than in the daytime. T here was a positive correlation between patient and doctor delay. Twenty tw o per cent of AMI patients waited two hours or more before calling a GP. To tal pre-hospital delay times differed between men and women. Longer doctor delay in women (36 minutes for men and 52 minutes for women) was caused by displacement of specific symptoms, in particular in women. AMI patients who were alone during onset of symptoms showed higher patients delay (72 compa red with 23 minutes). Conclusion-In hospital admitted patients younger than 75 years pre-hospital delay times are within acceptable limits. In some subgroups further reduct ion is attainable, for example in patient delay outside office hours and wh en patients are alone during onset of symptoms, in doctor delay in cases wh ere women present with symptoms suggestive for AMI. Improvement of faciliti es for prehospital electrocardiographic diagnosis may facilitate decision m aking by GPs. Good opportunities for further reduction of treatment delay e xist in shortening of hospital delay.