title: Risk factors of delayed pre-hospital treatment seeking in patients with acute coronary syndrome: A prospective study.
abstract: OBJECTIVE
  Despite enormous efforts in public education, treatment seeking time still remains more than optimal in patients with acute coronary syndrome. This prospective study tries to determine the risk factors of pre-hospital delay in patients with acute coronary syndrome.
  
  
  METHODS
  Descriptive data of 190 patients with diagnosis of acute coronary syndrome attending in 2 tertiary level teaching hospital emergency departments were analyzed to determine risk factors of delayed pre-hospital treatment seeking. Demographic, social and clinical characteristics of patients were obtained and they were asked to fully describe their symptoms and the actions they had done after their symptoms onset.
  
  
  RESULTS
  Thirty nine (20.52%) of patients were arrived in emergency department in <1 h of their symptoms onset, 73 (38.43%) were arrived between 1 and 6 h and 78 (41.05%) were arrived in >6 h. Sex, route of transport, scene-to-hospital distance, attributing the symptoms to non-cardiac causes and outpatient physician consultation and cigarette smoking were the risk factors of delayed treatment seeking in our studied patients with acute coronary syndrome. Patients with previous history of ischemic heart disease and Coronary Care Unit admission and patients with underlying diseases like diabetes mellitus, hypertension and hyperlipidemia showed a trend to have more delayed treatment seeking behavior but not with a statistically significant difference. Patients with positive family history of acute coronary syndrome arrived in emergency department earlier than other patients but again with not a statistically significant difference.
  
  
  CONCLUSIONS
  Most patients with acute coronary syndrome arrived in emergency department in >6 h of their symptoms onset. Sex, route of transport, scene-to-hospital distance, attributing the symptoms to non-cardiac origins, outpatient physician consultation and cigarette smoking were risk factors of delayed treatment seeking in studied patients.
authors.affiliation: Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Marzieh
authors.initials: M
authors.lastname: Fathi
authors.affiliation: Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Aysan
authors.initials: A
authors.lastname: Rahiminiya
authors.affiliation: Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Mohammad Amin
authors.initials: MA
authors.lastname: Zare
authors.affiliation: Department of Emergency Medicine, Iran University of Medical Sciences, Tehran, Iran.
authors.forename: Nader
authors.initials: N
authors.lastname: Tavakoli
keywords: Acute coronary syndrome; Pre-hospital delay; Risk factors