title: Factors associated with delay in seeking health care for hospitalized patients with acute coronary syndromes: the GREECS study.
abstract: OBJECTIVE
  To examine the particular features that characterized patients who arrived in the hospital relatively early compared to those who arrived relatively late after the onset of cardiac symptoms.
  
  
  METHODS
  A sample of 6 hospitals located in Greek urban and rural regions was selected. In these hospitals we recorded almost all non-fatal admissions with first event an acute coronary syndrome, from October 2003 to September 2004. 2172 patients were included in the study (76% men, 24% women). The time delay from symptom onset to hospitalization was recorded. Socio-demographic, clinical, dietary and other lifestyle characteristics were also recorded.
  
  
  RESULTS
  The overall median (25th, 75th percentiles) delay time was 3.5 (2, 8) h. Patients with a history of hypertension or diabetes mellitus, as well as those receiving diuretics and calcium antagonists, were more likely to seek medical care more than 6 h after the onset of symptoms. Patients who died in hospital had sought medical care later than those who survived (p = 0.008). Moreover, the administration of thrombolytic therapy was inversely related with the time interval between the onset of symptoms and presentation to hospital. Median (25th, 75th percentiles) delay time was 2 (1, 4) h for patients who received such therapy and 4 (2, 11) h for those who did not (p < 0.001).
  
  
  CONCLUSIONS
  Our findings indicate the need for developing community-wide educational approaches to reduce delay.
authors.affiliation: First Cardiology Clinic, School of Medicine, University of Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Pitsavos
authors.forename: Georgia
authors.initials: G
authors.lastname: Kourlaba
authors.forename: Demosthenes B
authors.initials: DB
authors.lastname: Panagiotakos
authors.forename: Christodoulos
authors.initials: C
authors.lastname: Stefanadis
mesh_terms: D000368:Aged; D003695:Delivery of Health Care / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000401:mortality / Q000628:therapy; D005260:Female; D006115:Greece; D006302:Health Services Research / Q000379:methods / Q000706:statistics & numerical data; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000401:mortality / Q000628:therapy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D012042:Registries; D013577:Syndrome; D015912:Thrombolytic Therapy / Q000706:statistics & numerical data; D013997:Time Factors