title: Delays in seeking medical care in hospitalized patients with decompensated heart failure.
abstract: OBJECTIVE
  The magnitude of, and factors associated with, prolonged delay in seeking medical care in patients with acute myocardial infarction has been well described. It is unknown, however, what the extent of, and factors associated with, prehospital delay are in patients hospitalized with acute heart failure. The purpose of this study was to examine patterns of prehospital delay, and factors associated with delay in seeking medical care, in patients hospitalized with acute heart failure at all 11 medical centers in the Worcester, Massachusetts metropolitan area.
  
  
  METHODS
  The medical records of 2587 greater Worcester residents with decompensated heart failure who were hospitalized in 2000 were reviewed for the collection of information about prehospital delay and demographic and clinical factors associated with extent of delay.
  
  
  RESULTS
  Information about acute symptom onset and duration of delay in seeking medical care was available in only 44% of the hospital charts of patients with heart failure. The average delay time was 13.3 hours, while the median was 2.0 hours. Male sex, multiple presenting symptoms, absence of a history of heart failure, and seeking medical care between midnight and 6:00 am were associated with prolonged prehospital delay.
  
  
  CONCLUSIONS
  The results of this study in residents of a large New England metropolitan area suggest that patients hospitalized with acute heart failure exhibit considerable delays in seeking medical care. Several demographic and clinical characteristics were associated with prolonged delay. More research is needed to better understand the reasons why patients with this serious and increasingly prevalent clinical syndrome delay seeking medical care in a timely fashion.
authors.affiliation: Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA. robert.goldberg@umassmed.edu
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
authors.forename: Jordan H
authors.initials: JH
authors.lastname: Goldberg
authors.forename: Sean
authors.initials: S
authors.lastname: Pruell
authors.forename: Jorge
authors.initials: J
authors.lastname: Yarzebski
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Joel M
authors.initials: JM
authors.lastname: Gore
mesh_terms: D000368:Aged; D005260:Female; D006333:Heart Failure / Q000628:therapy*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D013997:Time Factors