Factors that impact upon the time to hospital presentation following the onset of chest pain.

Introduction: Although morbidity and mortality associated with chest pain are related to time to intervention, many patients have delayed ED presentations. We aimed to assess the extent of and reasons for prehospital delay, and identify patient subgroups more at risk of delayed presentation.

Methods: This was an analytical, cross-sectional survey of patients with undifferentiated, potentially ischaemic chest pain, at a tertiary referral ED. Data were collected on the circumstances surrounding the chest pain incident (including components of total prehospital time) and the proportion of delayed presentations (defined as >3 h). Multiple linear regression determined variables significantly associated with prehospital time.

Results: One hundred and fifty patients were enrolled. Mean age was 51.9+/-15.9 years and 90 (60.0%, 95% CI 51.7-67.8) were male. The mean total prehospital time was 6.38 h (median 3.17). Seventy-nine (52.7%, 95% CI 44.4-60.8) patients had a delayed presentation (>3 h) and those most at risk of this were those at home at pain onset and those with a history of AMI. The decision time (from onset of pain to decision to present) comprised the majority (82.8%) of total prehospital time. Factors positively associated with decision time were: waiting to see if symptoms resolved (P<0.0001), seeking GP advice (P<0.0001), fluctuating symptoms (P=0.02), embarrassment (P=0.01) and attributing symptoms to muscle problems (P=0.04). Nine patients diagnosed with AMI had a mean total prehospital time of 10.2 h.

Conclusion: Intensified efforts are required to promote awareness of the need to present directly to the ED upon the onset of chest pain. The factors associated with decision delay may help to inform revisions in public education initiatives.