Dracup K, McKinley S M, Moser D K
University of California, Los Angeles, USA.
Med J Aust. 1997 Mar 3;166(5):233-6. doi: 10.5694/j.1326-5377.1997.tb140101.x.
To examine delay in seeking treatment among patients with an evolving acute myocardial infarction (MI), and to identify factors which contributed to this delay.
Patient interview combined with medical record review.
317 patients with confirmed diagnosis of acute MI interviewed within 72 hours of admission to three hospitals.
Delay from onset of symptoms to arrival at hospital, and cognitive, emotional, sociodemographic and clinical factors which contributed to increased prehospital delay.
Median prehospital delay was 6.4 hours; 41% of patients delayed less than four hours, while 28% delayed less than two hours. Prehospital delay was increased in patients with fewer years of education (P = 0.001), lower income (P = 0.003) and transportation to the hospital by private car rather than ambulance (P = 0.02). Delay time was increased by several cognitive and emotional processes (P < 0.001), such as waiting to see if symptoms would go away, being too embarrassed to ask for assistance, and not recognising the importance of symptoms. Delay time was increased with heartburn, breathlessness or intermittent symptoms and decreased with sweating and dizziness (P < 0.05). Independent predictors of increased prehospital time (P < or = 0.01) were fewer than 10 years of education, not wanting to trouble anyone, failing to recognize the symptoms of delay, and the intermittent nature of symptoms.
Over 50% of acute MI patients delay seeking treatment by six hours or more. Many factors related to cognitive and social processes that contribute to this delay may be remediable with appropriate patient and community education.
研究急性心肌梗死（MI）病情进展期患者寻求治疗的延迟情况，并确定导致这种延迟的因素。
患者访谈与病历审查相结合。
317例确诊为急性MI的患者，于入院72小时内接受了三家医院的访谈。
从症状发作到入院的延迟时间，以及导致院前延迟增加的认知、情感、社会人口统计学和临床因素。
院前延迟的中位数为6.4小时；41%的患者延迟时间少于4小时，而28%的患者延迟时间少于2小时。受教育年限较少（P = 0.001）、收入较低（P = 0.003）以及乘坐私家车而非救护车前往医院的患者（P = 0.02），院前延迟时间更长。几种认知和情感过程会增加延迟时间（P < 0.001），例如等待症状是否会自行消失、因尴尬而不愿寻求帮助以及未认识到症状的重要性。伴有烧心、呼吸急促或间歇性症状时延迟时间会增加，而伴有出汗和头晕时延迟时间会减少（P < 0.05）。院前时间增加的独立预测因素（P ≤ 0.01）包括受教育年限不足10年、不想麻烦任何人、未认识到延迟症状以及症状的间歇性。
超过50%的急性MI患者延迟寻求治疗6小时或更长时间。许多与导致这种延迟的认知和社会过程相关的因素，通过适当的患者和社区教育可能是可以纠正的。
