Factors influencing the time from onset of chest pain to arrival at hospital.

One hundred patients who were admitted to a coronary-care unit were interviewed to determine the time interval from the onset of chest pain to their arrival at the Emergency Department of Royal Prince Alfred Hospital. Forty-nine per cent of patients took longer than two hours and 29% took longer than four hours to arrive at hospital; the patient who reported the longest time interval reached hospital 72 h after the onset of chest pain. Most of the delay between the onset of symptoms and arrival at hospital was a result of the time that the patients took to decide to seek medical attention. Once this decision was made, there was relatively-little delay before hospital presentation in patients who went directly to hospital. However, those patients who contacted a doctor rather than going directly to hospital took significantly longer to arrive at hospital, with a median total time to reach hospital of 212 min compared with 85 min for those who went directly to hospital (P = 0.002). Time delays of this magnitude compromise the efficacy of interventions such as thrombolytic therapy. There should be continuing public education to encourage patients with chest pain to seek early medical attention and, in metropolitan areas, patients with chest pain should be advised to proceed directly to hospital.