title: Non-symptom-related factors contributing to delay in seeking medical care by patients with heart failure: a narrative review.
abstract: BACKGROUND
  Delay in seeking timely medical care by patients with acute coronary syndrome and stroke has been well established in the literature, but less is known about delay in care-seeking behavior by patients with heart failure (HF). The purpose of this narrative review was to synthesize the literature regarding non-symptom-related factors that contribute to delay in seeking medical care for HF symptoms.
  
  
  RESULTS
  A literature search of Scopus, Medline, and Pubmed was conducted for published articles from database inception to July 2009. Available evidence has shown that non-symptom-related factors, such as HF severity, HF history, age, and ethnocultural background, were related to delay in certain studies; however, null results have also been reported. Other non-symptom-related factors, such as male gender, initial contact with a primary care physician, arriving in the emergency department by means other than ambulance, and patient responses such as self-care, low anxiety, and hopelessness, may play a role in longer delay.
  
  
  CONCLUSIONS
  Although this review identified several non-symptom-related factors that may be implicated in care-seeking delay, health care professionals should be vigilant in identifying all high-risk individuals and educating them about warning signs of HF. Moreover, access to outpatient chronic disease management programs that may have potential to reduce care-seeking delay behavior should be explored.
authors.affiliation: York University Faculty of Health, Toronto, Ontario, Canada.
authors.forename: Shannon
authors.initials: S
authors.lastname: Gravely
authors.forename: Hala
authors.initials: H
authors.lastname: Tamim
authors.forename: Judy
authors.initials: J
authors.lastname: Smith
authors.forename: Tamara
authors.initials: T
authors.lastname: Daly
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Grace
mesh_terms: D006333:Heart Failure / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy*; D006801:Humans; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D012648:Self Care / Q000379:methods / Q000523:psychology*; D013997:Time Factors