title: Length of delay in seeking medical care by patients with heart failure symptoms and the role of symptom-related factors: a narrative review.
abstract: OBJECTIVE
  The delay in seeking timely medical care by patients with acute coronary syndrome and stroke is well established. Less is known about the delay in patients with heart failure (HF). Reducing the delay in seeking care and the early initiation of treatment is associated with improved outcomes in patients with HF. The purpose of this narrative review was to describe the length of the delay in seeking care for HF symptoms and identify symptom-related factors that contribute to the delay in seeking medical care.
  
  
  RESULTS
  A literature search was conducted to identify English language studies that (i) describe the length of care-seeking delay for HF symptoms and/or (ii) identify symptom-related factors that contribute to delay in seeking medical care. The results of this review demonstrate that upon hospital admission patients report wide variations in median symptom time course from 2 h to 7 days from the onset of symptoms to hospital admission. The ability of patients to recognize, interpret, and appraise HF symptoms has been demonstrated to be limited. Symptom characteristics such as dyspnoea, oedema, orthopnoea, higher somatic awareness, higher symptom distress, nocturnal symptom onset, and the pattern of symptom onset were related to longer delay in care-seeking for HF symptoms. Furthermore, cognitive responses to HF may also play an important role in symptom appraisal.
  
  
  CONCLUSIONS
  Delays in seeking care for HF symptoms have been shown to range from hours to days from symptom onset to hospital admission. Healthcare professionals should therefore be more vigilant in identifying high-risk individuals and educating them about the warning signs of HF. Moreover, access to outpatient chronic disease management programmes may have the potential to reduce these delays.
authors.affiliation: York University, Faculty of Health, Norman Bethune College 368, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3.
authors.forename: Shannon
authors.initials: S
authors.lastname: Gravely-Witte
authors.forename: Corrine Y
authors.initials: CY
authors.lastname: Jurgens
authors.forename: Hala
authors.initials: H
authors.lastname: Tamim
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D000368:Aged; D016001:Confidence Intervals; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006333:Heart Failure / Q000150:complications / Q000503:physiopathology / Q000523:psychology* / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D010353:Patient Education as Topic; D012307:Risk Factors; D013997:Time Factors