title: Congruence of the Medical Record and Subject Interview on Time of Symptom Onset in Patients Diagnosed With Acute Coronary Syndrome.
abstract: BACKGROUND
  Past research has shown discrepancies between the time of symptom onset for patients with acute coronary syndrome (ACS) as documented in the medical record (MR) and patients' recall of the time assessed through subject interviews done later by researchers.
  
  
  OBJECTIVE
  The aim of this study is to determine if there were differences between the time of symptom onset documented in the MR and subject interview taking into consideration sex, age group, and recall period for patients admitted to the emergency department for symptoms suggestive of ACS.
  
  
  METHODS
  A secondary analysis was conducted on data from the PROMOTION (Patient Response to Myocardial Infarction Following a Teaching Intervention Offered by Nurses) trial, a multicenter randomized clinical trial to reduce patient prehospital delay to treatment in ACS.
  
  
  RESULTS
  Of the 3522 subjects with CAD enrolled into the trial, 3087 subjects completed 2-year follow-up. Of these, 331 subjects sought treatment in the emergency department for ACS symptoms and 276 patients (83%) had complete information on the time of symptom onset from both sources. Of the 276 patients, 25 (9%) had differing times more than 48 hours and were thus excluded. The median difference between the 2 sources was 45.0 minutes. When both times were examined, there were no significant differences in time by sex (P = .720) or by age group (P = .188). The median number of days between the interview and the date of symptom onset was 29.5 days. There was a significant correlation between differences in the time of symptom onset and the length of recall period (rs = 0.148, P = .023). In multivariable modeling, a longer recall period was associated with greater median differences in the symptom onset time (b = 13.2, P = .023).
  
  
  CONCLUSIONS
  These results suggest that the time of symptom onset obtained at the time of the index event and documented in the MR is not interchangeable with data obtained later by research staff, especially if the interview is not conducted near the time of the index event.
authors.affiliation: Leslie L. Davis, PhD, RN, ANP-BC, FAANP, FAHA, is an assistant professor of nursing at the School of Nursing, University of North Carolina, Greensboro. She conducts research related to the behavioral aspects of cardiovascular symptom management in women. Thomas P. McCoy, PhD, PStat, is a statistician and clinical associate professor at the School of Nursing, University of North Carolina, Greensboro. Barbara Riegel, PhD, RN, FAHA, FAAN, is the edith clemmer steinbright professor of Gerontology at the University of Pennsylvania School of Nursing. Dr. Riegel is an established nurse scientist studying adults with cardiovascular disease. Her primary research interest is self-care of older adults with chronic heart failure. Sharon McKinley, PhD, RN, is from Deakin University, Victoria, Australia. Her research interests include delay in response to ACS symptoms and sleep in critically ill patients. Lynn V. Doering, RN, PhD, FAAN, is from the University of California, Los Angeles. She is a professor and associate dean in Academic and Student Affairs, UCLA School of Nursing. Kathleen Dracup, RN, FNP, PhD, FAAN, is a dean emerita and professor emerita at the University of California, San Francisco. Debra K. Moser, PhD, RN, FAAN, is from the University of Kentucky, Lexington, and University of Ulster, Newtownabbey, UK. She is a professor and Linda C. Gill Chair of Cardiovascular Nursing, where she conducts research related to self-care among individuals with or at risk for cardiac disease and heart failure.
authors.forename: Leslie L
authors.initials: LL
authors.lastname: Davis
authors.forename: Thomas P
authors.initials: TP
authors.lastname: McCoy
authors.forename: Barbara
authors.initials: B
authors.lastname: Riegel
authors.forename: Sharon
authors.initials: S
authors.lastname: McKinley
authors.forename: Lynn V
authors.initials: LV
authors.lastname: Doering
authors.forename: Kathleen
authors.initials: K
authors.lastname: Dracup
authors.forename: Debra K
authors.initials: DK
authors.lastname: Moser
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis*; D000368:Aged; D000369:Aged, 80 and over; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009203:Myocardial Infarction; D016032:Randomized Controlled Trials as Topic; D013997:Time Factors