Delays in Seeking Medical Care in Hospitalized Patients with Decompensated Heart Failure

Goldberg, Robert J.; Goldberg, Jordan H.; Pruell, Sean; Yarzebski, Jorge; Lessard, Darleen; Spencer, Frederick A.; Gore, Joel M.

doi:10.1016/j.amjmed.2007.10.032

« Previous Next »The American Journal of Medicine
Volume 121, Issue 3 , Pages 212-218, March 2008

Delays in Seeking Medical Care in Hospitalized Patients with Decompensated Heart Failure

Robert J. Goldberg, PhD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
- Requests for reprints should be addressed to Robert J. Goldberg, PhD, Department of Cardiovascular Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01655.
Jordan H. Goldberg
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
Sean Pruell
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
Jorge Yarzebski, MD, MPH
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
Darleen Lessard, MS
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
Frederick A. Spencer, MD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester
- Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
Joel M. Gore, MD
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester

Abstract

Purpose

The magnitude of, and factors associated with, prolonged delay in seeking medical care in patients with acute myocardial infarction has been well described. It is unknown, however, what the extent of, and factors associated with, prehospital delay are in patients hospitalized with acute heart failure. The purpose of this study was to examine patterns of prehospital delay, and factors associated with delay in seeking medical care, in patients hospitalized with acute heart failure at all 11 medical centers in the Worcester, Massachusetts metropolitan area.

Methods

The medical records of 2587 greater Worcester residents with decompensated heart failure who were hospitalized in 2000 were reviewed for the collection of information about prehospital delay and demographic and clinical factors associated with extent of delay.

Results

Information about acute symptom onset and duration of delay in seeking medical care was available in only 44% of the hospital charts of patients with heart failure. The average delay time was 13.3 hours, while the median was 2.0 hours. Male sex, multiple presenting symptoms, absence of a history of heart failure, and seeking medical care between midnight and 6:00 am were associated with prolonged prehospital delay.

Conclusions

The results of this study in residents of a large New England metropolitan area suggest that patients hospitalized with acute heart failure exhibit considerable delays in seeking medical care. Several demographic and clinical characteristics were associated with prolonged delay. More research is needed to better understand the reasons why patients with this serious and increasingly prevalent clinical syndrome delay seeking medical care in a timely fashion.

Keywords: Care-seeking behavior, Heart failure, Prehospital delay