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Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions
Preventive and Behavioral Medicine Publications and Presentations
  • John R. Finnegan, University of Minnesota
  • Hendrika Meischke, King County Department of Emergency Services, Seattle, Washington
  • Jane G. Zapka, University of Massachusetts Medical School
  • Laura Leviton, Robert Wood Johnson Foundation
  • Angela Meshack, University of Texas
  • Ruby Benjamin-Garner, University of Texas
  • Barbara Estabrook, University of Massachusetts Medical School
  • Nancy Johnson Hall, University of Minnesota
  • Sheri Schaeffer, University of Massachusetts Medical School
  • Cassandra Smith, University of Massachusetts Medical School
  • Elissa R. Weitzman, Harvard University
  • James M. Raczynski, University of Alabama
  • Elaine Stone, National Heart, Lung and Blood Institute
UMMS Affiliation
Department of Medicine, Division of Preventive and Behavioral Medicine
Publication Date
Document Type

BACKGROUND: Patient delay in seeking health care for heart attack symptoms is a continuuing problem in the United States.

METHODS: Investigators conducted focus groups (N = 34; 207 participants) in major U.S. regions (NE, NW, SE, SW, MW) as formative evaluation to develop a multi-center randomized community trial (the REACT Project). Target groups included adults with previous heart attacks, those at higher risk for heart attack, and bystanders to heart attacks. There were also subgroups reflecting gender and ethnicity (African-American, Hispanic-American, White).

FINDINGS: Patients, bystanders, and those at higher risk expected heart attack symptoms to present as often portrayed in the movies, that is, as sharp, crushing chest pain rather than the more common onset of initially ambiguous but gradually increasing discomfort. Patients and those at higher risk also unrealistically judge their personal risk as low, understand little about the benefits of rapid action, are generally unaware of the benefits of using EMS/9-1-1 over alternative transport, and appear to need the "permission" of health care providers or family to act. Moreover, participants reported rarely discussing heart attack symptoms and appropriate responses in advance with health care providers, spouses, or family members. Women often described heart attack as a "male problem," an important aspect of their underestimation of personal risk. African-American participants were more likely to describe negative feelings about EMS/9-1-1, particularly whether they would be transported to their hospital of choice.

CONCLUSIONS: Interventions to reduce patient delay need to address expectations about heart attack symptoms, educate about benefits and appropriate actions, and provide legitimacy for taking specific health care-seeking actions. In addition, strategy development must emphasize the role of health care providers in legitimizing the need and importance of taking rapid action in the first place.

DOI of Published Version
Finnegan JR Jr, Meischke H, Zapka JG, Leviton L, Meshack A, Benjamin-Garner R, Estabrook B, Hall NJ, Schaeffer S, Smith C, Weitzman ER, Raczynski J, Stone E. Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions. Prev Med. 2000 Sep;31(3):205-13. PubMed PMID: 10964634. doi:10.1006/pmed.2000.0702
Related Resources
Link to article in PubMed
PubMed ID
Citation Information
John R. Finnegan, Hendrika Meischke, Jane G. Zapka, Laura Leviton, et al.. "Patient delay in seeking care for heart attack symptoms: findings from focus groups conducted in five U.S. regions" Vol. 31 Iss. 3 (2000) ISSN: 0091-7435
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