Patient delay and use of ambulance by patients with chest pain

To identify the reasons why patients with chest pain delay in seeking hospital medical care and do or do not use an ambulance.

One hundred and fifty-one patients with an ED diagnosis of acute myocardial infarction or angina were interviewed about demographic characteristics, medical history, symptom onset, time taken before deciding to call an ambulance or go to hospital (delay time) and transport used. Multiple logistic regression determined independent predictors of late presentation (delay time>30 min) and ambulance use.

One hundred and twelve (74.2%, 95% CI 67.0-81.0%) patients delayed more than 30 min. Independent predictors of late presentation were: seeing a general practitioner (GP) (P=0.001), having prior heart problems (P=0.009) and symptoms occurring at night (P=0.036). Eighty-one (54.7%, 95% CI 47.0-63.0%) patients used an ambulance. Predictors of ambulance use were increased age (P=0.025) and having ambulance insurance (P=0.018), although there was interaction between these variables.

Education programmes should continue to emphasize that chest pain is a potential medical emergency and an ambulance should be called. GPs should consider developing an action plan to manage patients presenting with chest pain.