Prehospital delay in acute coronary syndrome--an analysis of the components of delay.
BACKGROUND
Prompt hospital admission is essential when treating acute coronary syndrome. Delay prior to admission is unnecessarily long. Therefore, a thorough scrutiny of the influence of characteristics, circumstantial and subjective variables on elements of prehospital delay among patients admitted with acute coronary syndrome is warranted.


METHODS
A structured interview was conducted on 250 consecutive patients admitted alive with acute coronary syndrome.


RESULTS
Median prehospital, decision, physician and transportation delays were 107, 74, 25 and 22 min, respectively. Women (n=77) had more frequently atypical symptoms and increased prehospital delay caused by prolonged physician and transportation delay. Physician delay among women and men were 69 and 16 min, respectively. Patients with prior myocardial infarction had reduced prehospital delay, which was caused by shorter decision and physician delay; whereas patients with prior mechanical revascularisation or typical symptoms had prolonged prehospital delay due to long decision delay. When symptoms were interpreted as cardiac the decision and prehospital delay were reduced.


CONCLUSIONS
The medical profession underestimates the risk of acute coronary syndrome among women, and thereby contributes to unnecessary long delay to treatment. The patient's prior experience and interpretation has a significant influence on behaviour.
Ottesen
Michael Mundt
MM
Department of Cardiology, University Hospital of Copenhagen County, Hellerup, Gentofte, 2900 Copenhagen, Denmark. michael.8sen@dadlnet.dk
Dixen
Ulrik
U
Torp-Pedersen
Christian
C
Køber
Lars
L
D000208:Acute Disease; D000368:Aged; D000787:Angina Pectoris / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003657:Decision Making; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D010342:Patient Acceptance of Health Care; D010343:Patient Admission; D010819:Physician's Role; D011446:Prospective Studies; D013577:Syndrome; D013997:Time Factors; D014187:Transportation of Patients