Patients' interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction

Objective - To examine whether the association between expected symptoms of acute myocardial infarction and actual symptoms predicted delay in reaching hospital and help seeking behaviour. Design - During hospital convalescence, participants completed a structured interview designed to measure symptom experience and help seeking behaviour following the onset of symptoms of acute myocardial infarction. Patients - 88 patients admitted to hospital with their first myocardial infarction. Main outcome measures - Delay in reaching hospital from onset of worst symptoms, obtained from ambulance and hospital records. Results - The most common symptoms expected by patients with myocardial infarction were central chest pain (76%), radiating arm or shoulder pain (34%), and collapse (26%). The most common symptoms experienced were sweats or feeling feverish (78%), chest pain (64%), and arm, shoulder, or radiating pain (66%). A mismatch between symptoms experienced and those expected occurred in 58% of patients, and was associated with delay. Patients who experienced a mismatch between expectation and actual symptoms also were more likely to have a third party decide to call for help. Conclusions - The experience and interpretation of symptoms is an important source of delay and help seeking following onset of myocardial infarction symptoms.