title: Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome.
abstract: BACKGROUND
  Few studies have had the opportunity to examine a broad range of predictors of pre-hospital delay from a multivariate perspective that includes not only sociodemographic and clinical features but also atypical symptoms, patient appraisal and behavior, across the acute coronary syndrome (ACS) spectrum.
  
  
  METHODS
  A total of 1894 hospitalized ACS patients were recruited predischarge after an ACS event. Patients completed a detailed questionnaire and clinical details were verified with their case notes.
  
  
  RESULTS
  The median pre-hospital delay times were, 4.06, 2.70, 4.51 and 5.50h, for all ACS, ST elevated myocardial infarction (STEMI), non-STEMI and unstable angina (UA) subgroups respectively. Multiple regression models examining 33 predictors of pre-hospital delay were significant (p<0.001), accounting for 32%, 42%, 34% and 29% of the variance for all ACS, STEMI, non-STEMI and UA subgroups respectively. The predictors that were singularly significantly associated with longer pre-hospital delay within all ACS were: taking medications, visiting family physician, and symptoms that were intermittent in nature. In the MI subgroups, not using an ambulance and gradual symptom onset, were also associated with longer delay. In STEMI patients non-attribution of symptoms to heart was also associated with longer pre-hospital delay.
  
  
  CONCLUSIONS
  Multivariable analyses found that although sociodemographic, clinical history or situational predictors contributed to the variance in pre-hospital delay, the main predictors of pre-hospital delay were behavioral and symptom presentation factors. These factors should therefore be incorporated into patient education and interventions, to further improve patient pre-hospital delay time.
authors.affiliation: School of Nursing and Midwifery, Trinity College Dublin, Ireland. Electronic address: gmckee@tcd.ie.
authors.forename: Gabrielle
authors.initials: G
authors.lastname: McKee
authors.forename: Mary
authors.initials: M
authors.lastname: Mooney
authors.forename: Sharon
authors.initials: S
authors.lastname: O'Donnell
authors.forename: Frances
authors.initials: F
authors.lastname: O'Brien
authors.forename: Martha J
authors.initials: MJ
authors.lastname: Biddle
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D054058:Acute Coronary Syndrome / Q000628:therapy*; D000328:Adult; D004636:Emergency Service, Hospital; D005260:Female; D005544:Forecasting; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D061665:Time-to-Treatment / Q000706:statistics & numerical data*
keywords: Acute coronary syndrome; Factors; MI; Pre-hospital delay; Predictors