Early recognition and early access for acute coronary syndromes in New Zealand: key links in the chain of survival.
OBJECTIVE
We studied the behaviour of patients prior to admission to hospital with symptoms of acute coronary syndromes, and what barriers may exist to early recognition of these symptoms and to early activation of emergency medical services.


METHODS
Over a 7-week period, we interviewed 100 patients admitted to the Cardiac Care Unit in Wellington Hospital with suspected acute coronary syndromes.


RESULTS
Within 5 minutes of symptom onset, 46 of 100 patients believed they were having a heart attack. Sixty-two of the patients believed that they had a cardiac-related problem. Patients took a median time of 90 minutes (range 0-9600 minutes) to contact a health professional from the time of symptom onset; and a median time of 228 minutes (range 33-9633 minutes) to arrive at hospital. We observed significant differences in both these end-points according to which health professional was contacted first. Patients who presented directly to hospital arrived significantly faster (median 72 minutes) than those who first called an ambulance (180 minutes) or contacted a general practitioner (485 minutes) (p=0.001, Kruskal Wallis test).


CONCLUSIONS
Considerable delays exist in the presentation of patients with symptoms of ACS to hospital. These delays are multifactorial, but the psychological intimidation of the 111 telephone system and delays incurred by inappropriate out-of-hospital management of patients with chest pain are probably significant. It is likely that these delays contribute to mortality from acute coronary syndromes.
Tanner
Helen
H
Department of Surgery and Anaesthesia, Wellington School of Medicine, Wellington.
Larsen
Peter
P
Lever
Nigel
N
Galletly
Duncan
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000789:Angina, Unstable / Q000175:diagnosis / Q000453:epidemiology; D002300:Cardiac Care Facilities / Q000706:statistics & numerical data; D003937:Diagnosis, Differential; D004415:Dyspepsia / Q000175:diagnosis / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000175:diagnosis / Q000453:epidemiology; D009203:Myocardial Infarction / Q000175:diagnosis / Q000453:epidemiology; D017202:Myocardial Ischemia / Q000175:diagnosis* / Q000453:epidemiology; D009520:New Zealand / Q000453:epidemiology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010343:Patient Admission / Q000706:statistics & numerical data; D012017:Referral and Consultation / Q000706:statistics & numerical data; D016019:Survival Analysis; D013577:Syndrome