title: Acute coronary syndrome--factors causing delayed presentation at the Emergency Department.
abstract: BACKGROUND
  The aim of the study was to identify factors that contributed to delays in presentation of patients with acute coronary syndrome (ACS) at the Emergency Department (ED).
  
  
  METHODS
  The study population comprised patients presenting with the signs and symptoms of ACS at the ED of 5 government and restructured hospitals in Singapore from 1 April to 31 May 1999. These patients were interviewed with a structured questionnaire which explored patient demographic data, risk factors, prehospital symptomatology, timing of chest pain, patient response to chest pain and mode of transport to the hospital.
  
  
  RESULTS
  Three hundred and two patients who made 307 visits were recruited. More than three-quarters of the patients presented with central or left-sided chest pain. Forty-seven per cent had breathlessness and 42% had sweating. The commonest day of presentation was Monday. It took patients a median time of 2.1 hours from their worst chest pain to arrive at the ED. Past history of diabetes mellitus was associated with a longer delay in presentation. Most of the delay was due to patients awaiting symptom resolution. Forty per cent came by emergency ambulances to hospital.
  
  
  CONCLUSIONS
  Our findings identified various patient characteristics that contributed to delay in presentation to hospital which should be addressed in future education campaigns.
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608.
authors.forename: K K
authors.initials: KK
authors.lastname: Ho
authors.forename: S W
authors.initials: SW
authors.lastname: Lee
authors.forename: S B S
authors.initials: SB
authors.lastname: Ooi
authors.forename: F
authors.initials: F
authors.lastname: Lateef
authors.forename: S H
authors.initials: SH
authors.lastname: Lim
authors.forename: V
authors.initials: V
authors.lastname: Anantharaman
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D002637:Chest Pain / Q000209:etiology; D003327:Coronary Disease / Q000150:complications / Q000503:physiopathology / Q000523:psychology*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D019538:Health Care Surveys; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology* / Q000706:statistics & numerical data; D011446:Prospective Studies; D012307:Risk Factors; D012846:Singapore; D011795:Surveys and Questionnaires; D013997:Time Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data