[Minimizing the prehospital delay in patients with acute myocardial infarct]

Despite the known importance of early intervention, delays between symptoms onset and manifestation of acute myocardial infarction (AMI) in the hospital are common. Most of the prehospital delay consists of the interval between the onset of symptoms and the decision to seek medical help. The aim of this paper is to review the factors associated with the long duration of patient delay (patient time delay). The media campaigns designed to reduce the delay between the onset of AMI have so far not been proved to be worthwhile and it is not certain that further campaigns will be more successful. Physicians and other health care professionals play an important role in reducing the delay to treatment in patients with evolving AMI. Patients with some cardiovascular disease are at high risk for AMI. High-risk patients have to be educated about the symptoms they may develop during a coronary occlusion, what steps to take if symptoms occur, and the importance of contacting emergency medical services immediately. These instruction need to be reviewed frequently and reinforced with appropriate printed material. The situational and psychological variables are important determinants of the length of decision delays in response to symptoms of AMI. No single intervention, no matter how carefully designed and implemented, will alter the patient's propensity to delay. However, consistent, regularly delivered information may be helpful. Family members should participate in all instructions because they play an important role in increasing or decreasing the delay to treatment in patients with AMI.