An international perspective on the time to treatment for acute myocardial infarction

Kathleen Dracup, Debra K. Moser, Sharon McKinley, Carol Ball, Keiko Yamasaki, Cho Ja Kim, Lynn V. Doering, Mary A. Caldwell

Research output: Contribution to journalReview articlepeer-review

59 Scopus citations


Purpose: To compare delay and circumstances of decisions to seek care in patients with acute myocardial infarction (AMI) in the United States (US), England, Australia, South Korea, and Japan. Design: Comparative prospective design. Methods: Patients diagnosed with AMI (N=913) were interviewed within 72 hours of hospital admission for confirmed AMI using the Response to Symptoms Questionnaire. Delay times were calculated from review of emergency room records and patients' interviews. Analysis of variance was used to test differences in delay time among countries. Findings: Median delay ranged from 2.5 hours in England to 6.4 hours in Australia, with the three Pacific Rim countries reporting median delay times > 4 hours. The majority of patients experienced initial symptoms at home (range: 56% in Japan to 73% in the US) with the most common witness being a family member (32% in South Korea to 48% in England). Ambulance use was widely divergent with the highest use in England (85%) and the lowest use in the US (42%). Conclusions: In all countries, median delay was too long to obtain maximum benefit from AMI therapies, particularly thrombolysis. Education and counseling of patients and families to reduce prehospital delay in AMI episodes might be more effective if the various factors influencing patients' first responses to symptoms are considered, as well as differences in health care systems.

Original languageEnglish
Pages (from-to)317-323
Number of pages7
JournalJournal of Nursing Scholarship
Issue number4
StatePublished - 2003

Bibliographical note

Copyright 2018 Elsevier B.V., All rights reserved.


  • Delay time
  • England
  • Myocardial infarction
  • Pacific Rim
  • US

ASJC Scopus subject areas

  • General Nursing


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