York University, Faculty of Health, Norman Bethune College 368, 4700 Keele Street, Toronto, Ontario, Canada M3J 1P3.
Eur J Heart Fail. 2010 Oct;12(10):1122-9. doi: 10.1093/eurjhf/hfq122. Epub 2010 Aug 3.
The delay in seeking timely medical care by patients with acute coronary syndrome and stroke is well established. Less is known about the delay in patients with heart failure (HF). Reducing the delay in seeking care and the early initiation of treatment is associated with improved outcomes in patients with HF. The purpose of this narrative review was to describe the length of the delay in seeking care for HF symptoms and identify symptom-related factors that contribute to the delay in seeking medical care.
A literature search was conducted to identify English language studies that (i) describe the length of care-seeking delay for HF symptoms and/or (ii) identify symptom-related factors that contribute to delay in seeking medical care. The results of this review demonstrate that upon hospital admission patients report wide variations in median symptom time course from 2 h to 7 days from the onset of symptoms to hospital admission. The ability of patients to recognize, interpret, and appraise HF symptoms has been demonstrated to be limited. Symptom characteristics such as dyspnoea, oedema, orthopnoea, higher somatic awareness, higher symptom distress, nocturnal symptom onset, and the pattern of symptom onset were related to longer delay in care-seeking for HF symptoms. Furthermore, cognitive responses to HF may also play an important role in symptom appraisal.
Delays in seeking care for HF symptoms have been shown to range from hours to days from symptom onset to hospital admission. Healthcare professionals should therefore be more vigilant in identifying high-risk individuals and educating them about the warning signs of HF. Moreover, access to outpatient chronic disease management programmes may have the potential to reduce these delays.
急性冠状动脉综合征和中风患者寻求及时医疗的延迟是众所周知的。对于心力衰竭（HF）患者的延迟情况了解较少。减少寻求医疗护理的延迟和早期开始治疗与 HF 患者的改善结局相关。本叙述性综述的目的是描述 HF 症状寻求护理的延迟时间，并确定与延迟寻求医疗护理相关的症状相关因素。
进行了文献检索，以确定描述 HF 症状寻求护理延迟时间的英语语言研究，和/或识别导致延迟寻求医疗护理的症状相关因素的研究。本综述的结果表明，患者在入院时报告的中位症状时间从症状发作到入院的 2 小时到 7 天不等，存在广泛的差异。患者识别、解释和评估 HF 症状的能力已被证明是有限的。症状特征，如呼吸困难、水肿、端坐呼吸、更高的躯体意识、更高的症状困扰、夜间症状发作和症状发作模式，与 HF 症状的寻求护理的延迟更长有关。此外，对 HF 的认知反应也可能在症状评估中起重要作用。
HF 症状的寻求护理延迟时间从症状发作到入院时间从几小时到几天不等。因此，医疗保健专业人员应更加警惕地识别高风险个体，并对他们进行 HF 的警告信号教育。此外，获得门诊慢性病管理计划可能有潜力减少这些延迟。
