The purpose of this study was to examine factors associated with pre-hospital delay time in patients hospitalized for evaluation of heart attack symptoms. Data for this study were drawn from the Rapid Early Action for Coronary Treatment (REACT) study, a multicenter, randomized, community trial designed to test a community intervention to reduce the duration of pre-hospital delay in persons having heart attack symptoms. Communities were located in Alabama, Louisiana, Massachusetts, Minnesota, North Dakota, Oregon, South Dakota, Texas, Washington, and Wisconsin; there were 44 hospitals. The data was collected from December 1995 to March 1996.

The distribution of delay times for 2,726 patients hospitalized for suspected acute cardiac ischemia and discharged with a CHD-related diagnosis was right skewed with a median of two hours and a mean of five hours. With regard to race, the pre-hospital delay was longer among Hispanics and non-Hispanic blacks than for non-Hispanic whites. Multivariate analyses showed that the delay was significantly longer among non-Hispanic blacks than among non-Hispanic whites (by 43 minutes). It was also longer among older patients (by 14 minutes for each 10-year age increment), Medicaid recipients versus the privately insured (by 41 minutes), the privately insured versus Medicare recipients (by 27 minutes), and patients not arriving by ambulance (by 47 minutes).

It is noteworthy that there were patterns to the missing data that should be considered when interpreting these data. Specific to race analyses, data were missing substantially more for Hispanics and non-Hispanic blacks than for non-Hispanic whites.

The authors do not discuss reasons for the racial patterns, although they cite their previous study of overall deficiencies and subgroup deficits in knowledge of health attack symptoms in the general population of these communities (Goff DC, et al. Knowledge of health attack symptoms in a population survey in the US: REACT. Ach Intern Med 1998; 158:2329-2338). They note that “these knowledge deficits mirror the differences in pre-hospital delay time observed in this study. Deficiencies in knowledge as well as {maladaptive coping strategies, misattribution of the symptoms to a potentially less serious cause, embarrassment about being wrong, or other barriers} probably contribute to the delays observed in this and other studies.”