title: Delayed hospital presentation in acute decompensated heart failure: clinical and patient reported factors.
abstract: BACKGROUND
  Patients with acute decompensated heart failure (ADHF) often wait a considerable amount of time before going to the hospital. Prior studies have examined the reasons why such delays may occur, but additional studies are needed to identify modifiable factors contributing to these delays.
  
  
  OBJECTIVE
  To describe care-seeking delay times, factors associated with prolonged delay, and patient's thoughts and actions in adult men and women hospitalized with ADHF.
  
  
  METHODS
  We surveyed 1271 patients hospitalized with ADHF at 8 urban medical centers between 2007 and 2010.
  
  
  RESULTS
  The average age of our study population was 73 years, 47% were female, and 72% had prior heart failure. The median duration of pre-hospital delay prior to hospital presentation was 5.3 h. Patients who delayed longer than the median were older, more likely to have diabetes, peripheral edema, to have symptoms that began in the afternoon, and to have contacted their medical provider(s) about their symptoms. Prolonged care seekers were less likely to have attributed their symptoms to ADHF, less likely to want to have bothered their doctor or family, and were more likely to be concerned about missing work due to their illness (all p values < 0.05).
  
  
  CONCLUSIONS
  Care-seeking delays are common among patients with ADHF. A variety of factors contribute to these delays, which in some cases may represent efforts to manage ADHF symptoms at home. More research is needed to better understand the detrimental effects of these delays and how best to encourage timely care-seeking behavior in the setting of ADHF.
authors.affiliation: Department of Emergency Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA.
authors.forename: Chad
authors.initials: C
authors.lastname: Darling
authors.forename: Jane S
authors.initials: JS
authors.lastname: Saczynski
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Darleen
authors.initials: D
authors.lastname: Lessard
authors.forename: Frederick A
authors.initials: FA
authors.lastname: Spencer
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Goldberg
mesh_terms: D000208:Acute Disease; D000368:Aged; D005260:Female; D006333:Heart Failure / Q000628:therapy; D006801:Humans; D008297:Male; D010342:Patient Acceptance of Health Care; D061665:Time-to-Treatment
keywords: ADHF; CI; COPD; Care seeking behavior; ED; HF; Heart failure; OR; acute decompensated heart failure; chronic obstructive pulmonary disease; confidence interval; emergency department; heart failure; odds ratio