Factors influencing prehospital delay in patients experiencing chest pain

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Abstract
BACKGROUND: Patients experiencing chest pain (or other cardiac symptoms) in the community delay hours, even days, in seeking medical care. Given the potential effectiveness of thrombolytic therapy, it is important to determine patterns of patient delay. OBJECTIVES: A descriptive study was conducted to determine the amount of time patients delayed in seeking medical care when experiencing chest pain and the characteristics of patients delaying longer than 3 hours. METHODS: Adult patients (N = 77) admitted to an emergency department with chest pain participated. Data were obtained using the Response to Symptoms Questionnaire and chart review. RESULTS: The mean prehospital delay times (ie, symptom onset to hospital arrival) was 25.4 hours (+/- 46.5), and the median was 5 hours. Delay groups were divided into those arriving less than 3 hours (n = 31 or 40%) and those arriving more than 3 hours (n = 46 or 60%) after symptom onset. Three hours was chosen based on a mean time, taken from the literature, of 84 minutes spent in the emergency department so that patients in the first group would be able to receive thrombolysis within 4 hours. Univariate statistical analyses revealed that advanced age, symptom onset with a family member present, and self-determination of symptoms as not being serious in nature all contributed to a delay of longer than 3 hours. CONCLUSIONS: Critical care nurses and physicians should focus on patients at high risk for prolonged delay and educate the public about action to take if a family member experiences cardiac symptoms.

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