Acute coronary syndrome--how to reduce the time from the onset of chest pain to treatment?
BACKGROUND
Enormous progress in treating acute coronary syndrome (ACS) and shortening the time between the onset of pain and intervention has been made in recent years. However, the time from the beginning of pain to the call for help is still too long.


OBJECTIVE
To establish the causes of delayed call for help by ACS patients and to answer the question how to shorten that time. An additional aim was to examine the knowledge about myocardial infarction (MI) among patients with ACS.


METHODS
The study group consisted of 349 patients treated for ACS at the CCU. Nurses interviewed the patients using a questionnaire focused on demographic data, ACS characteristics, risk factors and situations which occurred between pain onset and arrival at the CCU. The data were analysed in relation to sex, place of living, education level, professional activity, history of MI, diabetes, and hypertension.


RESULTS
The time between the onset of symptoms and the call for medical help ranged from 4 to 1140 min. The longest delay was reported by patients aged 56-70 years. Half of them called for help later than after 3 hours. Women waited longer than men. They also waited longer for an ambulance - 20 vs. 15 min (p <0.01). Professionally active patients called for help sooner: 82.7 vs. 120.2 min (p=0.02). Warsaw inhabitants waited longer than those living in other towns and in rural areas (p=0.04). The main causes of delay were: being confident that symptoms would subside (201 patients - 57.6%), or that the symptoms were not associated with heart disease (45 patients - 12.9%). The 41.5% of patients knew what MI was, 37.2% were familiar with features of ischaemic chest pain. Symptoms of pain were known to 44.4% of patients with ACS history vs. 32.2% of previously untreated (p=0.02), blood pressure levels were known to 51.4 vs. 45.4% (NS), and cholesterol to 29.9 vs. 20.0% (p=0.03). A general practitioner was mentioned as the source of information by 44.4% of patients and a nurse - by 11.5%.


CONCLUSIONS
The main cause of delayed call for help in ACS patients was a poor level of knowledge about MI, risk factors and management at the time of chest pain onset. Education concerning these issues should be started at school. Physicians, nurses and media should participate in the education.
Walkiewicz
Maria
M
Institute of Cardiology, ul. Alpejska 42, 04-628 Warszawa. maryla.w1@wp.pl
Krówczyńska
Dorota
D
Kuchta
Urszula
U
Kmiecicka
Mariola
M
Kurjata
Paweł
P
Stepińska
Janina
J
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D000328:Adult; D017668:Age of Onset; D000368:Aged; D002637:Chest Pain / Q000453:epidemiology*; D015897:Comorbidity; D042241:Early Diagnosis; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D011159:Population Surveillance; D012307:Risk Factors