Dracup Kathleen, Moser Debra K, McKinley Sharon, Ball Carol, Yamasaki Keiko, Kim Cho-Ja, Doering Lynn V, Caldwell Mary A
School of Nursing, University of California, 2 Koret Ave., Rm N319, Box 0604, San Francisco, CA 94143-0604, USA.
J Nurs Scholarsh. 2003;35(4):317-23. doi: 10.1111/j.1547-5069.2003.00317.x.
To compare delay and circumstances of decisions to seek care in patients with acute myocardial infarction (AMI) in the United States (US), England, Australia, South Korea, and Japan.
Comparative prospective design.
Patients diagnosed with AMI (N = 913) were interviewed within 72 hours of hospital admission for confirmed AMI using the Response to Symptoms Questionnaire. Delay times were calculated from review of emergency room records and patients' interviews. Analysis of variance was used to test differences in delay time among countries.
Median delay ranged from 2.5 hours in England to 6.4 hours in Australia, with the three Pacific Rim countries reporting median delay times > 4 hours. The majority of patients experienced initial symptoms at home (range: 56% in Japan to 73% in the US) with the most common witness being a family member (32% in South Korea to 48% in England). Ambulance use was widely divergent with the highest use in England (85%) and the lowest use in the US (42%).
In all countries, median delay was too long to obtain maximum benefit from AMI therapies, particularly thrombolysis. Education and counseling of patients and families to reduce prehospital delay in AMI episodes might be more effective if the various factors influencing patients' first responses to symptoms are considered, as well as differences in health care systems.
比较美国、英国、澳大利亚、韩国和日本急性心肌梗死（AMI）患者寻求治疗的延迟情况及决定因素。
比较性前瞻性设计。
使用症状反应问卷，在确诊AMI的患者入院72小时内对913例诊断为AMI的患者进行访谈。通过查阅急诊室记录和患者访谈来计算延迟时间。采用方差分析来检验各国延迟时间的差异。
中位数延迟时间从英国的2.5小时到澳大利亚的6.4小时不等，三个环太平洋国家报告的中位数延迟时间>4小时。大多数患者在家中出现初始症状（范围：日本为56%，美国为73%），最常见的目击者是家庭成员（韩国为32%，英国为48%）。救护车使用率差异很大，英国最高（85%），美国最低（42%）。
在所有国家，中位数延迟时间过长，无法从AMI治疗中获得最大益处，尤其是溶栓治疗。如果考虑影响患者对症状的首次反应的各种因素以及医疗保健系统的差异，对患者及其家属进行教育和咨询以减少AMI发作时的院前延迟可能会更有效。
