International comparison of factors associated with delay in presentation for AMI treatment

Background: Prehospital delay in response to acute myocardial infarction (AMI) symptoms is well documented in the US and Europe, but little is known about it in Asian countries where cardiovascular disease is increasing. Aims: We conducted an observational study of delay times and factors associated with hospital presentation times in 595 patients with AMI from the US, England, Japan and South Korea. Methods: Patients were interviewed about responses to symptoms within 72 h of hospital admission and the medical records were reviewed. Results: The proportions of patients with delay times of 1 h or less were: US - 23%, Korea - 18%, England - 15% and Japan - 8%. In the US and England when others present at symptom onset called an ambulance patients presented two to three times sooner. Independent predictors of presentation within an hour of symptom onset were attribution of symptoms to the heart and not waiting for symptoms to go away. Conclusion: Similar education about the need to seek treatment early in response to AMI symptoms may be applicable in Western and Eastern industrialised populations.