Abstract
Background
Patient decision delay is the main reason why many patients fail to receive timely
medical intervention for symptoms of acute coronary syndrome (ACS).
Study Objectives
This study examines the validity of slow-onset and fast-onset ACS presentations and
their influence on ACS prehospital delay times. A fast-onset ACS presentation is characterized
by sudden, continuous, and severe chest pain, and slow-onset ACS pertains to all other
ACS presentations.
Methods
Baseline data pertaining to medical profiles, prehospital delay times, and ACS symptoms
were recorded for all ACS patients who participated in a large multisite randomized
control trial (RCT) in Dublin, Ireland. Patients were interviewed 2–4 days after their
ACS event, and data were gathered using the ACS Response to Symptom Index.
Results
Only baseline data from the RCT, N = 893 patients, were analyzed. A total of 65% (n = 577)
of patients experienced slow-onset ACS presentation, whereas 35% (n = 316) experienced
fast-onset ACS. Patients who experienced slow-onset ACS were significantly more likely
to have longer prehospital delays than patients with fast-onset ACS (3.5 h vs. 2.0 h,
respectively, t = −5.63, df 890, p < 0.001). A multivariate analysis of delay revealed that, in the presence of other
known delay factors, the only independent predictors of delay were slow-onset and
fast-onset ACS (β = −.096, p < 0.002) and other factors associated with patient behavior.
Conclusion
Slow-onset ACS and fast-onset ACS presentations are associated with distinct behavioral
patterns that significantly influence prehospital time frames. As such, slow-onset
ACS and fast-onset ACS are legitimate ACS presentation phenomena that should be seriously
considered when examining the factors associated with prehospital delay.
Keywords
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Article info
Publication history
Published online: October 14, 2013
Accepted:
August 14,
2013
Received in revised form:
March 19,
2013
Received:
March 29,
2012
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
