Many people who experience heart attacks still wait more than two hours from symptom onset to visit the hospital despite public health campaigns to encourage quicker patient response time.

Both the American College of Cardiology (ACC) and the American Heart Association (AHA) advise patients who experience acute coronary symptoms to call 911 no later than five minutes after onset if symptoms persist or worsen.

In a study published online today in the Archives of Internal Medicine, U.S. researchers examined trends and factors associated with hospital delay time in 104,622 patients with non-ST-segment elevation myocardial infarction (STEMI). Patients were enrolled from 568 hospitals participating in the CRUSADE National Quality Improvement Initiative to improve ACC and AHA guideline adherence. 

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More than half of patients (59%) waited longer than two hours before seeking medical attention, the researchers found. Furthermore, median delay times stayed the same between 2001 and 2006 at 2.6 hours (interquartile range, 1.3-6.0 hours; P value for trend=0.16).

“The minimal reductions in delay times we observed suggest that current practice is failing to effectively educate and activate our patients,” the researchers wrote.

Patients who were older, female, nonwhite and current smokers had longer delay times, while those who presented to the hospital between 12 AM and 8 AM reported shorter delay times (25% shorter) compared with their daytime counterparts.

Because the effect on delay times from each of these factors was small (<10%), interventions aimed at improving patient awareness should focus on everyone at risk for a heart attack and not just those who fit a certain profile, according to the researchers.

Although it remains unclear why patients sought care more quickly at night, the researchers proposed several explanations including heightened fear at night when patients may be alone at home; higher symptom tolerance during the daytime during activity or work; and a perceived shorter waiting time at a less crowded emergency department during nighttime hours.

“Novel strategies to improve patient responsiveness to seek care are critical and important for both patients with STEMI or non-STEMI,” the researchers wrote.