title: Pre-hospital delay in acute coronary syndromes: PREDICT CVD-18.
abstract: OBJECTIVE
  To study pre-hospital delay, its components and determinants, in patients with acute coronary syndromes (ACS) admitted to Middlemore Hospital Coronary Care Unit.
  
  
  METHODS
  Consecutive ACS patients admitted between January 2009 and July 2010 were included. Pre-hospital delay was defined as the time from onset of worst symptom(s) to defibrillator availability: either ambulance arrival at the scene or time of hospital arrival (non-ambulance patients).
  
  
  RESULTS
  For 805 patients the median delay from symptom onset to defibrillator availability was 174 minutes. Half the cohort had a delay to defibrillator availability of >3 hours. The median delay was an hour longer for patients from areas of greatest deprivation compared with less deprived areas, [208 vs 149 min, respectively (p=0.015)], and 7 hours longer for non-ambulance vs ambulance patients, [553 vs 130 min (p<0.001)]. Māori, Pacific, Indian and those from areas of higher deprivation were less likely to travel to hospital by ambulance. Of ST-elevation myocardial infarction patients eligible for reperfusion, over two-thirds of the total delay between symptom onset and reperfusion occurred pre-hospital.
  
  
  CONCLUSIONS
  Community intervention targeted at more disadvantaged communities and higher risk ethnic groups should be considered as part of an overall strategy to reduce disparity and improve cardiac outcomes.
authors.affiliation: Middlemore Hospital, South Auckland, New Zealand.
authors.forename: Daniel
authors.initials: D
authors.lastname: Garofalo
authors.forename: Corina
authors.initials: C
authors.lastname: Grey
authors.forename: Mildred
authors.initials: M
authors.lastname: Lee
authors.forename: Daniel
authors.initials: D
authors.lastname: Exeter
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Kerr
mesh_terms: D054058:Acute Coronary Syndrome / Q000208:ethnology / Q000401:mortality / Q000628:therapy*; D000552:Ambulances / Q000706:statistics & numerical data; D016009:Chi-Square Distribution; D003325:Coronary Care Units; D047548:Defibrillators / Q000706:statistics & numerical data; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009520:New Zealand; D010043:Outcome and Process Assessment, Health Care; D010343:Patient Admission / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data*; D012307:Risk Factors; D013997:Time Factors