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Reasons patients with chest pain delay or do not call 911
H Meischke1, M T Ho, M S Eisenberg
1Department of Health Services, School of Public Health and Community Medicine, University of Washington, Seattle.
Insights
Patients experiencing acute myocardial infarction (AMI) symptoms often delay seeking emergency care because they underestimate symptom severity or believe it is not serious. Understanding these delays is crucial for improving timely treatment of AMI.
Area of Science:
- Cardiology
- Emergency Medicine
- Public Health
Background:
- Delays in seeking medical care for acute myocardial infarction (AMI) significantly hinder the effectiveness of time-sensitive treatments like thrombolysis.
- Identifying patient-specific reasons for delayed treatment is essential for developing targeted interventions.
Purpose of the Study:
- To investigate the primary reasons behind patient delays in seeking emergency medical care or calling 911 when experiencing symptoms suggestive of acute myocardial infarction (AMI).
Main Methods:
- A telephone interview methodology was employed with patients hospitalized for suspected AMI in King County, Washington.
- Data collection included patient demographics, cardiac history, symptom details, and reasons for delayed care or not calling emergency services.
- Hospital records were reviewed to supplement interview data.
Main Results:
- The median delay between symptom onset and hospital arrival for suspected AMI was 2 hours.
- Key reasons for delay included underestimation of symptom severity, belief that symptoms would resolve, and attribution of symptoms to other conditions.
- Patients also cited not considering emergency services or believing self-transport was faster as reasons for not calling 911.
Conclusions:
- Patient-related delays in seeking care for suspected AMI prevent optimal utilization of life-saving therapies such as thrombolytics.
- Addressing patient perceptions regarding symptom severity and promoting prompt emergency medical service utilization are critical for improving outcomes in AMI patients.
Study Objective:
To determine the reasons patients with suspected acute myocardial infarction (AMI) delay seeking medical care or do not call 911.
Design:
Telephone interview of patients hospitalized with suspected AMI.
Setting:
Nine hospitals in King County, Washington.
Participants:
Patients admitted to a CCU or ICU between October 1, 1986, and December 31, 1987, with suspected AMI occurring out-of-hospital. Spouses of patients who met criteria but died during the hospitalization also participated.
Interventions:
Hospital records were reviewed, and a 20-minute telephone interview was conducted of patients who reside in King County but do not live in an extended care facility.
Measurements:
Patient demographics, cardiac history, symptoms, time of acute symptom onset, time of emergency department arrival, method of transportation, discharge diagnosis, and hospital outcome were abstracted from hospital records. Circumstances leading to the hospitalization, reasons for delay in seeking care, and reasons for not calling 911 were determined in the telephone interview.
Results:
In a 15-month period, 5,207 patients were hospitalized for suspected AMI in King County, Washington. Twenty-seven percent had AMI. Median patient delay between symptom onset and hospital arrival was 2 hours. Paramedics transported 45% of all patients. A representative subset of patients (2,316) were interviewed. The main reasons for delay were because the patient thought that the symptoms would go away, because the symptoms were not severe enough, and because the patient thought that the symptoms were caused by another illness. The main reasons for not calling 911 were because the symptoms were not severe enough, because the patient did not think of calling 911, and because the patient thought that self-transport would be faster because of his or her close location to the hospital.
Conclusion:
Maximal benefit from thrombolytic therapy is not realized in a substantial proportion of patients with AMI because of delays in seeking medical care. Knowledge of the reasons patients delay or do not call 911 can help focus efforts on achieving more rapid treatment of patients with AMI.