Understanding delays in care-seeking behavior in heart failure: a comprehensive scoping review

Delayed care-seeking in heart failure patients is associated with adverse clinical outcomes, yet the factors contributing to such delays remain inconsistently defined and poorly understood. This scoping review aimed to systematically summarize existing evidence regarding definitions, durations, and influencing factors of delays in seeking medical care among heart failure patients, thereby providing a foundation for future intervention research.

A systematic search was conducted across eight electronic databases, including PubMed, Embase, Web of Science, Cochrane Library, China National Knowledge Infrastructure (CNKI), Wanfang, China Biomedical Literature Database (CBM), and VIP Database, from database inception to May 1, 2023. Additional studies were identified by manually screening reference lists. Articles were selected based on predefined inclusion and exclusion criteria. Thematic analysis was performed to extract and categorize definitions of delay, reported delay durations, and associated influencing factors.

Fifteen studies, published between 1997 and 2021, comprising 7,303 patients with HF were identified as eligible. They were predominantly conducted in the United States (10/15), with the remainder from China, Canada, Japan, the Netherlands, and Sweden. The study designs included cross-sectional (n = 7), retrospective (n = 5), descriptive (n = 2), and prospective (n = 1) approaches. Definitions of delay varied, most commonly describing the interval from symptom onset or exacerbation to hospital arrival. The median delay time ranged from 2 to 168 h, while the average delay time spanned 13.3 to 392.2 h. Thematic analysis identified five major categories of influencing factors: (1) sociodemographic factors (e.g., age, sex, ethnicity); (2) environmental factors (e.g., geographic location, time of symptom onset); (3) psychological factors (e.g., depression, anxiety); (4) disease-related factors (e.g., comorbidities, symptom burden); and (5) symptom experience (e.g., perception, evaluation, and response to symptoms). Considerable variability in definitions of delay, measurement tools, and analytic methods contributed to inconsistencies across studies.

Delays in seeking medical care are common among patients with HF and are shaped by multiple interacting factors. Future studies should adopt standardized definitions, apply validated assessment tools, and utilize longitudinal designs to clarify causal relationships. Interventions targeting symptom awareness, health literacy, and psychological support-particularly among older adults and those in rural areas-may help reduce avoidable delays and improve clinical outcomes.