Factors of importance for patients' decision time in acute coronary syndrome
Introduction
During the last few decades, we have learned that, in the setting of an acute coronary syndrome (ACS), time means saved myocardium [1]. The meaning behind this statement is that, the earlier this treatment is initiated, the greater the likelihood that myocardial damage will be limited and myocardial function will be maintained. A number of factors are involved in the delay between the onset of ACS and the start of various treatments. The most important one is most probably the patient him/herself.
Over the years, patient delay has generally been defined as the time between the onset of symptoms and arrival at hospital [2]. However, the transport time is an important part of the pre-hospital delay and, among patients transported by ambulance, the time between the onset of symptoms and the arrival of the ambulance and the time the rescue team stays on the scene (electrocardiogram (ECG) recording and transmission, administration of medication and so on) is also important. In terms of patient delay, it might therefore be more appropriate to determine the patient's decision time, i.e. the time between the onset of symptoms and the time the patient decides to seek medical attention.
This survey aims to describe the patient decision time in ACS and various factors associated with patients' decision time including age, sex, previous history, education, place at onset of symptoms, experience of symptoms and the interpretation of symptoms.
Section snippets
Study population
The study population consisted of patients hospitalised with ACS at 11 small, medium-sized and large hospitals in different regions of Sweden between April 2001 and February 2003. The hospitals were chosen to provide geographical diversity and different hospital sizes, where the smallest hospital (115 beds) serves 40,000 inhabitants and the largest (2000 beds) serves 250,000 inhabitants. However, the largest catchment population for a single hospital was 500,000 inhabitants. In all, these
Results
In all, 1939 patients fulfilled the inclusion criteria and had no exclusion criteria. Information on the delay between symptom onset and decision to seek medical care (any of the two definitions) was available in 1879 patients (97%). In the remaining part of the survey, only these patients will be included in the analyses.
Among the patients for whom information was available on the delay to seek help (n = 1800; only 1800 of the 1879 patients had information on this variable), the percentage that
Discussion
We found that about half the patients with ACS decided to call for medical attention within 1 h after the onset of symptoms. The data are in agreement with one previous study evaluating patient decision time in a smaller number of patients suffering from AMI [6]. A number of factors were associated with the patients' decision time.
The strongest factor both when evaluating all patients and when evaluating patients who called for an ambulance was the type of symptom onset, i.e. when the pain
Clinical implications
It is a challenge for health care providers/professionals to influence patients with symptoms of a suspected ACS to act quickly and appropriate. The findings in the present study suggest that it is important to inform patients and the public about the various symptoms of ACS and that it not necessarily have to be severe. The information should contain a new picture of a “heart attack”, a less dramatic and a more informative message. It is also of importance to highlight the time factor in ACS
Limitation
- 1.
We did not include two aspects of the inquiry in the analysis i.e. behavioural response and response of approached people. This was done in order to limit the number of variables included in the analyses and to avoid too complicated analyses.
- 2.
It is important to stress that time to call for ambulance and time to decision to seek help may not be exactly the same. Therefore, one should not, a priori, expect the two analyses to give exactly the same results. The time of a call is a hard data point,
Conclusion
A number of factors, including the type of ACS, the type and localisation of symptoms, the place where symptoms took place, patients' interpretation of symptoms and knowledge were all associated with patients' decision time in ACS. These findings should be considered when planning educational and information programmes in order to decrease patients' decision time. Future research should focus on developing methods to decrease the time between onset of symptoms and decision to seek medical care
Acknowledgements
The authors of this manuscript have certified that they comply with the Principles of Ethical Publishing in the International Journal of Cardiology [16].
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