Cardiology fellow University of Manitoba Winnipeg, Manitoba, Canada
Background: Acute coronary syndrome (ACS) is the leading cause of death in Canada, with approximately 70,000 new Canadians diagnosed annually. While delays from first medical contact (FMC) to percutaneous coronary intervention (PCI) have improved significantly, the time from symptom onset (SO) to FMC remains largely unchanged, likely due to complex and poorly understood patient behavioural and situational factors. Our study aims to characterize patients’ presenting symptoms and identify factors contributing to delays in seeking medical care. By recognizing common themes, we seek to develop targeted public awareness initiatives to highlight key symptoms and promote timely healthcare access.
METHODS AND RESULTS: In this single-centre prospective study, we surveyed consecutive admitted ACS patients between May to August 2024. Quantitative data were analyzed using descriptive statistics, while categorical data were assessed with counts and percentages. The Mann-Whitney Test was applied to continuous variables, and chi-square or Fisher’s Exact test were used for categorical variables.
Among the 117 participants, 75.2% were male, with a median age of 67±11 years. Of those, 50.4% had ST- elevation myocardial infarction, 41.1% had non-ST-elevation myocardial infarction, and 8.5% had unstable angina.
The median SO-FMC delay was 90 minutes (IQR 20-450 minutes). The primary reasons were misinterpretation of symptoms as non-cardiac (47%), and the belief that symptoms would improve without intervention (38%). The most common ACS symptoms were chest discomfort (88%), diaphoresis (64%), and shortness of breath (54%). Certain symptom characteristics, such as sudden onset (p=0.001), continuous symptoms (p=0.000006), and diaphoresis (p=0.000002), were associated with earlier presentation. Notably, 55% of patients chose to visit the emergency room rather than activate emergency medical services (EMS), though EMS activation was associated with earlier presentation (p=0.000007). Although 83% of patients were aware of heart attack symptoms, only 28% recognized the urgency conveyed by the phrase "time is muscle." Education by healthcare professionals on ACS symptoms and the importance of EMS was associated with earlier care-seeking (p=0.01).
Conclusion: In summary, we identified factors contributing to delayed ACS presentation, which may be used in targeted education to improve outcomes. These results highlight the need for further public health education and interventions to reduce SO-FMC time and improve ACS outcomes.
