Factors associated with delay in seeking health care for hospitalized patients with acute coronary syndromes: the GREECS study.

OBJECTIVE To examine the particular features that characterized patients who arrived in the hospital relatively early compared to those who arrived relatively late after the onset of cardiac symptoms. METHODS A sample of 6 hospitals located in Greek urban and rural regions was selected. In these hospitals we recorded almost all non-fatal admissions with first event an acute coronary syndrome, from October 2003 to September 2004. 2172 patients were included in the study (76% men, 24% women). The time delay from symptom onset to hospitalization was recorded. Socio-demographic, clinical, dietary and other lifestyle characteristics were also recorded. RESULTS The overall median (25th, 75th percentiles) delay time was 3.5 (2, 8) h. Patients with a history of hypertension or diabetes mellitus, as well as those receiving diuretics and calcium antagonists, were more likely to seek medical care more than 6 h after the onset of symptoms. Patients who died in hospital had sought medical care later than those who survived (p = 0.008). Moreover, the administration of thrombolytic therapy was inversely related with the time interval between the onset of symptoms and presentation to hospital. Median (25th, 75th percentiles) delay time was 2 (1, 4) h for patients who received such therapy and 4 (2, 11) h for those who did not (p < 0.001). CONCLUSION Our findings indicate the need for developing community-wide educational approaches to reduce delay.