Reasons patients with chest pain delay or do not call 911.
OBJECTIVE
To determine the reasons patients with suspected acute myocardial infarction (AMI) delay seeking medical care or do not call 911.


METHODS
Telephone interview of patients hospitalized with suspected AMI.


METHODS
Nine hospitals in King County, Washington.


METHODS
Patients admitted to a CCU or ICU between October 1, 1986, and December 31, 1987, with suspected AMI occurring out-of-hospital. Spouses of patients who met criteria but died during the hospitalization also participated.


METHODS
Hospital records were reviewed, and a 20-minute telephone interview was conducted of patients who reside in King County but do not live in an extended care facility.


METHODS
Patient demographics, cardiac history, symptoms, time of acute symptom onset, time of emergency department arrival, method of transportation, discharge diagnosis, and hospital outcome were abstracted from hospital records. Circumstances leading to the hospitalization, reasons for delay in seeking care, and reasons for not calling 911 were determined in the telephone interview.


RESULTS
In a 15-month period, 5,207 patients were hospitalized for suspected AMI in King County, Washington. Twenty-seven percent had AMI. Median patient delay between symptom onset and hospital arrival was 2 hours. Paramedics transported 45% of all patients. A representative subset of patients (2,316) were interviewed. The main reasons for delay were because the patient thought that the symptoms would go away, because the symptoms were not severe enough, and because the patient thought that the symptoms were caused by another illness. The main reasons for not calling 911 were because the symptoms were not severe enough, because the patient did not think of calling 911, and because the patient thought that self-transport would be faster because of his or her close location to the hospital.


CONCLUSIONS
Maximal benefit from thrombolytic therapy is not realized in a substantial proportion of patients with AMI because of delays in seeking medical care. Knowledge of the reasons patients delay or do not call 911 can help focus efforts on achieving more rapid treatment of patients with AMI.
Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle.
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H
Meischke
M T
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Ho
M S
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Eisenberg
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SM
Schaeffer
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Larsen
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000523:psychology* / Q000628:therapy; D003625:Data Collection; D004631:Emergency Medical Service Communication Systems / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011159:Population Surveillance; D013997:Time Factors; D014861:Washington