title: The causes of prehospital delay in myocardial infarction.
abstract: BACKGROUND
  The elapsed time between the onset of symptoms and reperfusion is a critical determinant of the clinical course of patients with myocardial infarction. The patients' own decision time is the most important component of prehospital delay.
  
  
  METHODS
  Selective literature review based on the references in a meta-analysis, complemented by a PubMed search on the expression "prehospital delay" in combination with "myocardial infarction," "acute coronary syndrome," "psychological factors," "gender," and "public campaign." A total of 73 papers addressing factors that influence prehospital delay were selected.
  
  
  RESULTS
  The reasons for delays of more than 120 minutes in a patient with symptoms of myocardial infarction reaching the hospital are still not sufficiently elucidated. Patients' uncertainty about their symptoms, advanced age, and female sex are three factors that appear to be associated with longer delays.
  
  
  CONCLUSIONS
  Factors influencing prehospital delay operate at the following levels: the perception of acute symptoms, the recognition of the importance of these symptoms, and the decision to call for help. Intervention trials should consider these levels in meeting the needs of clinically relevant subpopulations.
authors.affiliation: Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie des Klinikums rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Cornelia
authors.initials: C
authors.lastname: Gärtner
authors.forename: Linda
authors.initials: L
authors.lastname: Walz
authors.forename: Eva
authors.initials: E
authors.lastname: Bauernschmitt
authors.forename: Karl-Heinz
authors.initials: KH
authors.lastname: Ladwig