title: Australian patients' delay in response to heart attack symptoms.
abstract: OBJECTIVE
  To examine delay in seeking treatment among patients with an evolving acute myocardial infarction (MI), and to identify factors which contributed to this delay.
  
  
  METHODS
  Patient interview combined with medical record review.
  
  
  METHODS
  317 patients with confirmed diagnosis of acute MI interviewed within 72 hours of admission to three hospitals.
  
  
  METHODS
  Delay from onset of symptoms to arrival at hospital, and cognitive, emotional, sociodemographic and clinical factors which contributed to increased prehospital delay.
  
  
  RESULTS
  Median prehospital delay was 6.4 hours; 41% of patients delayed less than four hours, while 28% delayed less than two hours. Prehospital delay was increased in patients with fewer years of education (P = 0.001), lower income (P = 0.003) and transportation to the hospital by private car rather than ambulance (P = 0.02). Delay time was increased by several cognitive and emotional processes (P < 0.001), such as waiting to see if symptoms would go away, being too embarrassed to ask for assistance, and not recognising the importance of symptoms. Delay time was increased with heartburn, breathlessness or intermittent symptoms and decreased with sweating and dizziness (P < 0.05). Independent predictors of increased prehospital time (P < or = 0.01) were fewer than 10 years of education, not wanting to trouble anyone, failing to recognize the symptoms of delay, and the intermittent nature of symptoms.
  
  
  CONCLUSIONS
  Over 50% of acute MI patients delay seeking treatment by six hours or more. Many factors related to cognitive and social processes that contribute to this delay may be remediable with appropriate patient and community education.
authors.affiliation: University of California, Los Angeles, USA.
authors.forename: K
authors.initials: K
authors.lastname: Dracup
authors.forename: S M
authors.initials: SM
authors.lastname: McKinley
authors.forename: D K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology* / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D012307:Risk Factors; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014187:Transportation of Patients