Early recognition and early access for acute coronary syndromes in New Zealand: key links in the chain of survival.

AIMS

We studied the behaviour of patients prior to admission to hospital with symptoms of acute coronary syndromes, and what barriers may exist to early recognition of these symptoms and to early activation of emergency medical services.

METHODS

Over a 7-week period, we interviewed 100 patients admitted to the Cardiac Care Unit in Wellington Hospital with suspected acute coronary syndromes.

RESULTS

Within 5 minutes of symptom onset, 46 of 100 patients believed they were having a heart attack. Sixty-two of the patients believed that they had a cardiac-related problem. Patients took a median time of 90 minutes (range 0-9600 minutes) to contact a health professional from the time of symptom onset; and a median time of 228 minutes (range 33-9633 minutes) to arrive at hospital. We observed significant differences in both these end-points according to which health professional was contacted first. Patients who presented directly to hospital arrived significantly faster (median 72 minutes) than those who first called an ambulance (180 minutes) or contacted a general practitioner (485 minutes) (p=0.001, Kruskal Wallis test).

CONCLUSIONS

Considerable delays exist in the presentation of patients with symptoms of ACS to hospital. These delays are multifactorial, but the psychological intimidation of the 111 telephone system and delays incurred by inappropriate out-of-hospital management of patients with chest pain are probably significant. It is likely that these delays contribute to mortality from acute coronary syndromes.