title: Factors influencing arrival of patients with acute myocardial infarction at emergency departments: implications for community nursing interventions.
abstract: OBJECTIVE
  This paper identifies the characteristics of Greek patients with acute myocardial infarction who have long prehospital delays and identifies the factors that are specifically associated with these delays.
  
  
  BACKGROUND
  The time between the first appearance of symptoms until the hospitalization of the patient with myocardial infarction correlates statistically significantly with in-hospital and long-term mortality.
  
  
  METHODS
  The study took place in two Greek coronary care units from 1 June 2007 to 31 July 2008. From 232 consecutive patients with myocardial infarction, 160 were enrolled. Data were collected by a trained hospital staff nurse, who interviewed all patients within 48 hours of hospital admission.
  
  
  RESULTS
  Smokers arrived statistically significantly sooner at the hospital than non-smokers [smokers' prehospital time delay: 78.9 (sd = 3.2) minutes vs. non-smokers' prehospital time delay: 98.2 (sd = 4.1) minutes, Mann-Whitney U-test, Z = -2.5, P < 0.05]. Patients with hyperlipidaemia arrived with a mean delay of 13 minutes less than normolipidaemic patients. Those with inferior ST segment elevation myocardial infarction exhibited statistically significantly shorter delay times than those with anterior or lateral (inferior vs. anterior, P = 0.003, inferior vs. lateral, P = 0.024, anova with Bonferroni-Holm post hoc test, F = 7.5, P = 0.001).
  
  
  CONCLUSIONS
  Community nurses should educate all patients about myocardial infarction, not only those at high risk but also those without known risk factors for ischaemic heart disease.
authors.affiliation: Department of Experimental Surgery and Surgical Research, Medical School, University of Athens, Greece. theodorosxanthos@yahoo.com
authors.forename: Theodoros
authors.initials: T
authors.lastname: Xanthos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pantazopoulos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Vlachos
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stroumpoulis
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Barouxis
authors.forename: Vassiliki
authors.initials: V
authors.lastname: Kitsou
authors.forename: Katerina
authors.initials: K
authors.lastname: Marathias
authors.forename: Andreas
authors.initials: A
authors.lastname: Karabinis
authors.forename: Lila
authors.initials: L
authors.lastname: Papadimitriou
mesh_terms: D000208:Acute Disease; D000368:Aged; D016507:Cardiology Service, Hospital; D003152:Community Health Nursing / Q000379:methods; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005260:Female; D006115:Greece; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D013997:Time Factors