Impact of patients' symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction.
BACKGROUND
Delay in seeking medical care in patients with acute myocardial infarction (AMI) is receiving increasing attention. This study aimed to examine the association between expected symptoms and experienced symptoms of AMI and its effects on care-seeking behaviors of patients with AMI.


METHODS
Between November 1, 2005 and December 31, 2006, a cross-sectional and multicenter survey was conducted in 19 hospitals in Beijing and included 799 patients with ST-elevation myocardial infarction (STEMI) admitted within 24 hours after onset of symptoms. Data were collected by structured interviews and medical record review.


RESULTS
The median (25%, 75%) prehospital delay was 140 (75, 300) minutes. Only 264 (33.0%) arrived at the hospital by ambulance. The most common symptoms expected by patients with STEMI were central or left chest pain (71.4%), radiating arm or shoulder pain (68.7%), shortness of breath or dyspnea (65.5%), and loss of consciousness (52.1%). The most common symptoms experienced were central or left chest pain (82.1%), sweats (71.8%), shortness of breath or dyspnea (43.7%), nausea or vomiting (32.3%), and radiating pain (29.4%). A mismatch between symptoms experienced and those expected occurred in 41.8% of patients. Patients who interpreted their symptoms as noncardiac in origin were more likely to arrive at the hospital by self-transport (86.5% vs. 52.9%, P < 0.001) and had longer prehospital delays (medians, 180 vs. 120 minutes, P < 0.001) compared to those who interpreted their symptoms as cardiac in origin.


CONCLUSIONS
Symptom interpretation influenced the care-seeking behaviors of patients with STEMI in Beijing. A mismatch between expectation and actual symptoms was associated with longer prehospital delay and decreased use of emergency medical service (EMS).
Song
Li
L
The 28th Division, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Yan
Hong-Bing
HB
Yang
Jin-Gang
JG
Sun
Yi-Hong
YH
Hu
Da-Yi
DY
D000368:Aged; D002637:Chest Pain / Q000175:diagnosis / Q000473:pathology; D003430:Cross-Sectional Studies; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000473:pathology; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D013997:Time Factors