Heart failure treatment delays vary widely
MedWire News: Delays in the time to treatment - from symptom onset to hospital admission - vary widely for patients with heart failure (HF), say the authors of a literature review published in the European Journal of Heart Failure.
They believe clinicians need to be more vigilant in identifying high-risk individuals, and need to give patients appropriate education on how to recognize early warning signs.
Sherry Grace (York University, Toronto, Ontario, Canada) and co-authors carried out a literature search to assess the variation in length of delay in seeking medical care for HF symptoms, and to try to identify factors contributing to such delay.
Nine studies, with a combined cohort of 4169 participants aged an average of 70.9 years and who were admitted to hospital with symptoms of HF, were included in the review.
The reviewers found that when admitted to hospital HF patients report a wide variation of time delays from symptom onset to treatment, ranging from 2 hours to 7 days.
Results varied between studies, but factors suggested to increase delay included dyspnea, edema, and orthopnea, whereas chest pain decreased the amount of time to hospital admission.
No specific symptom pattern was consistently linked with an increase or decrease in time to hospital admission, but there was some evidence that a more gradual onset of symptoms could increase and higher physical symptom distress reduce time to admission.
One study looked at the timing of symptoms, and found that nocturnal onset was associated with an increased delay in seeking medical care, but day-time onset reduced time to hospital admission.
Grace et al recognize that the findings of the review should be treated with caution due to its narrative design.
However, they suggest: "Access to outpatient programs such as HF clinics or cardiac rehabilitation may have a positive impact in not only reducing the need for urgent care, but also increasing the awareness of symptoms in high-risk patients and ultimately their receipt of timely urgent care."
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By Helen Albert