DELAY IN SEEKING MEDICAL HELP

Predictors of delay in seeking medical help in patients with suspected heart attacks, and intervention to reduce delay: a systematic review

Background

Coronary heart disease (CHD) is the major cause of morbidity and mortality in the UK for both men and women, with acute myocardial infarction (AMI) being the most frequently identified cause of mortality. The effectiveness of thrombolytic therapy for AMI is dependent on prompt administration. The time from onset of signs and symptoms of an AMI to the time when medical assistance is sought by a patient has been found to be a major delaying factor. The subject of this systematic review were the reasons for delay and interventions to reduce delay in seeking medical help.

Findings

There is some evidence that a number of factors might be related to longer delay time. However, due to the poor quality of the studies and the small number of studies that investigated each factor, it is difficult to draw any firm conclusions. There is very limited evidence that community interventions may be successful in reducing delay time. Evidence also suggests that interventions may result in an increase in emergency calls, emergency department visits and use of lysis. However, due to the methodological deficiencies of these studies, it is unclear how much weight can be given to these findings, particularly as evidence to support a reduction in delay time comes mainly from before-and-after studies.

Conducted by: A Kainth1, A Hewitt1, A Sowden1, S Duffy1, J Pattenden2, R Lewin2, I Watt3, D Thompson3

1. Centre for Reviews and Dissemination; 2. British Heart Foundation Care and Education Research Group, Department of Health Sciences, University of York; 3. Department of Health Sciences, University of York

Publications

Centre for Reviews and Dissemination. Predictors of delay in seeking medical help in patients with suspected heart attack, and interventions to reduce delay: A systematic review. CRD Report 26. York: University of York. 2004

Kainth A, Hewitt A , Sowden A, Duffy S, Pattenden J, Lewin R, Watt I, Thompson D. A systematic review of interventions to reduce delay in patients with suspected heart attack. Emerg Med J. 2004;21:506-8

Presentations

Kainth A, Hewitt A, Pattenden J, Sowden A, Duffy S, Watt I, Lewin RJP, Thompson D. A systematic review of interventions to reduce delay in patients with suspected heart attack. European Health Psychology Society Conference. Lisbon 2002

Funding

Commissioned by NHS Northern and Yorkshire Regional Office