Authors' objectives:

This study aimed to carry out two linked systematic reviews; one to identify the factors associated with patient decision time (referred to as patient delay), and one to evaluate the effectiveness of interventions aiming to reduce patient or pre-hospital delay. In particular, two research questions were addressed:

1) What are the factors that influence the time to seeking medical help following the onset of signs and symptoms of an acute myocardial infarction (AMI)?

2) How effective are interventions that aim to reduce the time from the onset of signs and symptoms of an AMI to seeking medical help/arrival at hospital?

Authors' results and conclusions: Factors: Eleven studies, all observational in design, met the inclusion criteria. There was some evidence that the following factors might be associated with longer delay time: symptom onset beginning at home, less people present, being female, being of older age, experiencing less pain, and not attributing symptoms to an AMI or the heart. However, due to the poor quality of the studies and the small number of studies that investigated each type of predictor, it was difficult to draw any firm conclusions. Interventions: Eleven studies (two RCTs, one controlled trial and eight before-and-after studies) met the inclusion criteria. Five of these studies (the controlled trial and four before-and-after studies) reported the interventions to have statistically significant positive effects on delay time, whilst the other six (the two RCTs and four before-and-after studies) reported no statistically significant effect. In general, the quality of these studies was poor, with the majority of the studies being before-and-after in design, and only three of the studies employing a control group. With regard to secondary outcomes, the three studies that reported the percentage of persons using ambulance or medic transport showed that the intervention had no statistically significant effect on this outcome. Both of the studies that reported the number of calls made to 911 or switchboard for medical emergencies reported an increase in this outcome during the intervention. Of the five studies that examined the number of emergency department (ED) visits for chest pain, three reported an increase in this outcome as an effect of the intervention. Mortality was not statistically significantly affected by the intervention in the two studies that examined this outcome. Of the three studies examining receipt of reperfusion therapy, two reported an increase in this outcome after the intervention.

Authors' recommendations: 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 andED visits. 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.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://www.york.ac.uk/inst/crd/CRD_Reports/crdreport26.pdf

Year Published: 2004

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: England

Organisation Name: University of York

Contact Address: University of York, York, Y01 5DD, United Kingdom. Tel: +44 1904 321040, Fax: +44 1904 321041,

Contact Name: crd@york.ac.uk

Contact Email: crd@york.ac.uk

Copyright: Centre for Reviews and Dissemination