Patient and doctor delay in acute myocardial infarction: a study in Rotterdam, The Netherlands.

Background: Early thrombolytic therapy for patients having a myocardial infarct size and improves survival.

Aim: A study was undertaken to examine the components of pre-hospital delay in patients with retrospectively proven myocardial infarction.

Method: Data were gathered from 300 patients with a documented myocardial infarction admitted to three hospitals in Rotterdam, the Netherlands. Interviews were carried out with patients, questionnaires were given to their spouses or significant others, medical information was provided by cardiologists, and logbook information was gathered from the ambulance service.

Results: Half of all patients (51%) called for medical help within 30 minutes of symptom onset. General practitioners arrived within 11 minutes in half of the 257 cases to which they were called. However, in half of the 257 cases, decision making by the general practitioner before the patient was sent to a hospital took more than 82 minutes. The ambulance arrived within 15 minutes in 90% of all 242 cases, while the time required for stabilization of the patient by the ambulance staff and transport to the hospital took a median of 15 minutes.

Conclusion: Compared with earlier studies, patients with a myocardial infarction called for help sooner. However, it may take a considerable time before the general practitioner refers the patient to hospital. Further research is needed to design measures which will improve the diagnostic power of the general practitioner in order to further reduce pre-hospital delay.