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Treatment-seeking delays in heart failure patients
L S Evangelista1, K Dracup, L V Doering
1California State University, Los Angeles, Department of Nursing, Los Angeles, California, USA. levengel@ucla.edu
Background:
Patients having cardiac symptoms often delay for hours before seeking treatment. Delay time is usually defined as the amount of time between the patient's first awareness of symptoms and arrival at the hospital. Excessive delays in seeking medical care for heart failure (HF) symptoms may influence patient outcomes. However, the treatment-seeking patterns of HF patients are not well understood.
Methods:
We obtained data through a retrospective chart audit to describe the treatment-seeking behaviors of 753 HF patients, at a Veterans Administration facility, and to identify predictors of delay in seeking medical care for HF symptoms. Using univariate and multivariate analyses, we assessed relationships among delay time, presenting symptoms, and patient characteristics.
Results:
The mean delay time was 2.93 +/- 0.68 days. The most common symptoms on admission were dyspnea (76%), edema (66%), fatigue (37%), and angina (25%). Variables negatively affecting delay time included presence of dyspnea and edema (odds ratio [OR], 2.10 and 1.82; confidence interval [CI], 1.38 to 3.19 and 1.17 to 2.82, respectively), care by a primary care physician (OR, 2.04; CI, 1.45 to 2.88), and higher New York Heart Association (NYHA) Class (OR, 1.96; CI, 1.47 to 2.61). Variables positively affecting delay time were the presence of chest pain (OR, 0.42; CI, 0.29 to 0.62) and a history of previous admission for HF (OR, 0.42; CI, 0.28 to 0.62).
Conclusions:
Delays in seeking treatment for HF symptoms are significantly high. This study supports the need for interventions that will increase early symptom recognition and management on the part of patients and their families.