Patient delay in seeking care for heart attack symptoms: Findings from focus groups conducted in five US regions

Background. Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States. Methods. Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multicenter randomized community trial (the REACT Project). Target group s included adults with previous heart attacks, those at higher risk for hea rt attack, and bystanders to heart attacks. There were also subgroups refle cting gender and ethnicity (African-American, Hispanic-American, White). Findings. Patients, bystanders, and those at higher risk expected heart att ack symptoms to present as often portrayed in the movies, that is, as sharp , crushing chest pain rather than the more common onset of initially ambigu ous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little ab out the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the "permiss ion" of health care providers or family to act. Moreover, participants repo rted rarely discussing heart attack symptoms and appropriate responses in a dvance with health care providers, spouses, or family members. Women often described heart attack as "male problem," an important aspect of their unde restimation of personal risk. African-American participants were more likel y to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice. Conclusions. Interventions to reduce patient delay need to address expectat ions about heart attack symptoms, educate about benefits and appropriate ac tions, and provide legitimacy for taking specific health care-seeking actio ns. In addition, strategy development must emphasize the role of health car e providers in legitimizing the need and importance of taking rapid action in the first place. (C) 2000 American Health Foundation and Academic Press.