Open Access

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

  • Johan Herlitz1, 2Email author,
  • Birgitta WireklintSundström2,
  • Angela Bång2,
  • Annika Berglund3,
  • Leif Svensson3 and
  • Christian Blomstrand4
Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine201018:48

https://doi.org/10.1186/1757-7241-18-48

Received: 19 May 2010

Accepted: 6 September 2010

Published: 6 September 2010

Abstract

Background

The two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably.

In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count.

This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase.

Method

A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.

Results

In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women).

With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably.

In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke.

Conclusion

Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.

Background

Closer collaboration between disciplines handling various life-threatening complications of atherosclerosis has the potential to improve our understanding of ways of improving treatment. The literature about the early treatment of stroke has mainly appeared during the last decade, whereas similar literature about the heart often appeared 10 years earlier.

One explanation for this difference might be the multidisciplinary nature of stroke management that may include not only emergency physicians but also geriatrics, neurologists, and radiologists most of whom previously had no experience of emergency work. This must have been one important bar to progress.

It is now almost 40 years since the opportunity was first reported, in dogs, to influence the extent of myocardial damage by early intervention with various medications after a coronary artery occlusion [1]. A few years later, further animal experiments indicated that the duration of a coronary occlusion was directly related to the extent of myocardial damage [2]. These research findings form the background to the dramatic evolution in the early treatment of AMI, where "time is muscle" has become a prestige phrase and the limitation of infarct size is the principal aim.

In 1986, the first large-scale study showing a reduction in mortality in men and women with a threatened myocardial infarction, if an intravenous lytic agent was given at an early stage, was published [3]. If this treatment was given within the first hour after the onset of symptoms, the mortality was reduced by 50% [3]. This resulted in the formulation of "the golden hour", which meant that, if patients were treated with thrombolysis within the first hour after the onset of symptoms, 80 lives/1,000 treated could be saved instead of the overall 19/1,000 treated [4]. However, it was also shown that patients with ST-segment elevation myocardial infarction (STEMI) was a subgroup in which very early revascularisation worked [4].

Early trials in stroke in the pre-computed tomography (CT) era in the 1960 s and 1970 s were discouraging due to haemorrhages and increased mortality. In the post-CT era in the 1980 s, increasing optimism was still hampered by the early negative results.

In 1995, it was first reported from a randomised study that treatment with an intravenous lytic agent in acute ischemic stroke resulted in an improved prognosis [5]. These findings of a similar positive effect by a lytic agent in the setting of an acute infarction in two different organs (the heart and the brain) call for an evaluation of the differences and similarities between AMI and acute ischemic stroke. A comparison of this kind will include various aspects of the early phase, including patient factors, community factors and health care system factors. In one previous single county report EMS response times did not differ between AMI and stroke patients [6].

Differences in pathophysiology explaining differences in possibility for early intervention

In stroke, the mechanism behind symptom onset can be either an infarction through different mechanisms such as lacunar stroke, cerebral embolus, arteriosclerotic large vessel disease or a haemorrhage [7], whereas, in AMI, a fresh occluding or non-occluding thrombus is usually the cause of the symptoms, although other mechanisms such as hypotension or spasm are a possibility [8]. It is estimated that about 10% of all strokes are caused by a haemorrhage. On the other hand, many patients with a fresh occluding thrombus in a coronary artery die suddenly and are therefore not available for treatment. Sudden death due to stroke is more commonly the result of a haemorrhagic stroke, particularly subarachnoid haemorrhage.

In a comparison between stroke and AMI, it seems appropriate, if possible, to restrict the comparison to cases in which an ischemic event is the cause of organ damage. In AMI we aimed, when possible, to focus on STEMI.

Methods

In February and June 2010, literature searches were performed in the PubMed, EMBASE (Ovid SP) and Cochrane Library databases. Variation of the following terms were used, adopted for each database:

Databases using the following terms:

(Acute myocardial infarction OR AMI OR acute coronary syndrome OR ACS) AND hospital arrival OR arrival times OR delay OR delays AND (Ambulance OR ambulances OR emergency service). In the search for stroke the word stroke replaced acute myocardial infarction OR AMI OR acute coronary syndrome OR ACS. A decision was also made to limit all searches to articles published in English only.

An example of number of hits is shown below for Embase and 'acute myocardial infarction'.

Search history (159 hits)

EMBASE

  1. 1.

    acute myocardial infarction.mp. or exp acute heart infarction/(44307)

     
  2. 2.

    ami.mp. (9661)

     
  3. 3.

    acute coronary syndrome. mp. or exp acute coronary syndrome/(10794)

     
  4. 4.

    acs.mp. (5890)

     
  5. 5.

    1 or 2 or 3 or 4 (57652)

     
  6. 6.

    hospital arrival.mp. (301)

     
  7. 7.

    arrival times.mp. (257)

     
  8. 8.

    delay.mp. (79237)

     
  9. 9.

    delays.mp. (19917)

     
  10. 10.

    6 or 7 or 8 or 9 (94116)

     
  11. 11.

    ambulance.mp. or exp ambulance/(4499)

     
  12. 12.

    ambulances.mp. (546)

     
  13. 13.

    emergency service.mp. or exp emergency health service/(16477)

     
  14. 14.

    11 or 12 or 13 (19757)

     
  15. 15.

    5 and 10 and 14 (191)

     
  16. 16.

    limit 15 to english language (159)

     

In all, 433 articles were found for AMI and 186 for stroke.

In all, there are 226 references in this article. However, some of them have been obtained from other sources (mainly from various experts in the field. Some were found in the reference lists from the articles found in the search. Furthermore, some of the references cannot be found from our search words but are still relevant for the completeness of this article.

Sixty-six of the articles found for AMI are referred to in the article. The corresponding figures for stroke is 58.

The Review

Delay

Various components of delay

In both AMI and stroke, the delay can be divided into various components, where the pre-hospital and in-hospital delays make up the two main components.

In terms of both AMI and stroke, the patient's decision time accounts for the largest part of the pre-hospital delay [9, 10]. The median patient decision time has been reported to be fairly similar in AMI (60 min) [9] and stroke (60 min-90 min) [1012]. However, research on patients' decision time is limited and most research has focused on the delay between the onset of symptoms and admission to hospital, i.e. the total pre-hospital delay. This is associated with some problems, as, with regard to AMI in particular, the EMS systems have become more active on the scene (giving the patient various medications) over the years, thereby prolonging the delay between the onset of symptoms and admission to hospital. The patient decision time, on the other hand, is sometimes difficult to determine. In all probability, the best determinant of the patient decision time is the time between the onset of symptoms and the time of calling for EMS.

With regard to the in-hospital delay, AMI and stroke involve different parameters.

In AMI, the critical time is the time between admission to hospital and the time of admission to the catheterisation laboratory.

In acute stroke, the critical time is divided into two parts:

1/The time between arriving at hospital and CT scan and 2/The time between CT scan and the start of fibrinolysis. Further, an important time point is the time between stroke onset and care in a comprehensive stroke unit.

In terms of both AMI [1315] and stroke [1619], it has been clearly shown that the activation of the EMS system can function as a facilitator for shortening the in-hospital delay (including time to CT as well as time to treatment with fibrinolysis and percutaneous coronary intervention (PCI)).

In AMI, the introduction of the pre-hospital ECG has led to improved triage in the field [2023], resulting in a more rapid preliminary diagnosis, the possibility to start early reperfusion therapy on scene, and finally in the possibility to prepare the hospital for a direct transport to catheterization laboratory and early PCI. A similar instrument has not yet been proven in stroke.

Changes in delay

Despite large-scale efforts to reduce the delay between the onset of symptoms and the patient's decision time and admission to hospital respectively, the results have not been particularly impressive. In Sweden, the pre-hospital delay in AMI has not changed much during the last 10 years [24], but this should be related to the opportunity to increase the on-scene time for the EMS system. Nor has there been any marked decrease in the in-hospital delay [24].

In 4 USA communities there was no change in prehospital delay time between 1987 and 2000 [25]

However, among patients with STEMI the fast track concept appear to have reduced delay times (see separate chapter). Among stroke patients, there have been only small changes in delay during the last two decades [2629], but some changes were reported in Afro-Americans [29]. In 1993/1994, 17% of Afro-Americans arrived at hospital within three hours as compared with 26% in 1999. However, during the last few years, an increased focus on early diagnosis and rapid delivery has hopefully changed the situation [30, 31].

Variability in delay

There is large variability in the delay, caused among many things by geographical and cultural factors. In AMI, the delay from the onset of symptoms to admission to hospital has varied between regions [15, 3246]; (Table 1). Both STEMI and non-STEMI were included. However, STEMI is associated with a shorter prehospital delay [47, 48]. Also in stroke, the delay between onset of symptoms and hospital admission has been reported to vary markedly between different geographical regions [10, 12, 4979]; (Table 2). These studies were performed between 1993 and 2009. In the majority of studies, strokes of all types were involved and both women and men were included.
Table 1

Delay from symptom onset to arrival in hospital in AMI (including studies published the year 2000 and later)

Ref

Diagnosis

n

Country

Delay

(hour; median)

Year

38

AMI

526

Italy

3.5

2001

39

AMI

   

2003

  

192

USA

3.5

 
  

127

South Korea

4.5

 
  

136

Japan

4.5

 
  

141

England

2.5

 
  

317

Australia

6.5

 

41

AMI

194

USA

3.0

2003

40

ACS

250

Denmark

2.0

2004

42

ACS

100

New Zealand

4.0

2006

43

AMI

239

USA

2.5

2006

44

AMI

178

Turkey

2.0

2006

45

ACS

204

Lebanon

4.5

2006

46

ACS

1939

Sweden

2.5

2007

Range: 2.0 h-6.5 h Mean = 3.5 h

AMI = Acute myocardial infarction

ACS = Acute coronary syndrome

Table 2

Delay from symptom onset to arrival in hospital in stroke including studies (published the year 2000 and later)

Ref

Diagnosis

N

Country

Delay

(hour; median)

Year

58

Stroke

1207

USA

2.5

2000

59

Stroke

739

United Kingdom

6.0

2002

60

Stroke

16.922

Japan

6.0

2004

61

Stroke

558

Germany

2.5

2004

62

Stroke

100

Greece

3.0

2004

10

Stroke

196

Taiwan

5.5

2004

12

Stroke

229

Turkey

1.5

2005

64

Stroke

423

Spain

4.0

2005

50

Stroke

130

Japan

7.5

2006

66

Stroke or TIA

615

Switzerland

3.0

2006

68

Stroke

209

Israel

4.0

2006

69

Stroke

150

Australia

4.5

2006

70

Stroke

7901

USA

2.0

2007

72

Ischemic stroke

256

Korea

13.0

2007

73

Ischemic stroke

100

Singapore

16.0

2007

74

Ischemic stroke

129

Taiwan

1.0

2007

78

Stroke

400

USA

3.5

2008

77

Stroke

165

Pakistan

6.0

2008

76

Stroke

375

Italy

5.5

2008

79

Stroke

331

Switzerland

3.5

2009

Range: 1.0 h - 16.0 h. Mean = 5 h

TIA = Transitory Ischemic Attack

In stroke, it has also been shown that various aspects of delay were prolonged during the night [49, 52, 64, 67]. Specific hours during the night for increased risk were not defined. Similar findings were sporadically reported in AMI [80]. In stroke, a shorter delay has been reported at the weekend [81, 82]. In one study, 27% of patients arrived at hospital within one hour after symptom onset on Sundays compared with only 11% on other days of the week [82].

Delay and gender

In AMI, the results have consistently (in Sweden, the USA, the Netherlands and France) indicated that women have a prolonged pre-hospital delay, as compared with men, which is caused by a prolonged decision time [8387], but doctors' delay might also contribute [88]. The delay between onset of pain and arrival at hospital in these studies was around 30 minutes longer in women than in men.

Although a few reports have indicated similar findings in stroke [16, 68, 69, 16, 89], the overall results have not been as consistent and the opposite findings [90] or no difference [48, 71, 91] have also been reported.

There is still insufficient knowledge about the way women make decisions in the early phase of AMI and stroke [92, 93]. Even the in-hospital delay in AMI has been reported to be prolonged in women [87, 9496] and similar results were found in some stroke surveys [16, 58]] [97, 98] but not in others [30, 56, 59, 99].

Delay and previous cardiovascular disease

In overall terms, it does not appear that a history of previous infarction [100] or stroke has a major impact on delay in either AMI or stroke.

With regard to AMI, the reports on the influence of previous infarction on delay have been inconsistent; some suggest that a previous history of infarction reduces delay [85, 101], while this was not confirmed by others [102]. Even the opposite has been reported [80]. A history of hypertension [36], as well as diabetes [3335, 37], has been shown to be associated with a prolonged pre-hospital delay. Furthermore, the presence of pre-infarction angina has been associated with a longer pre-hospital delay [103].

With regard to stroke, it has been reported that a previous stroke is associated with a shorter delay [104], but the opposite has also been found [66]. It has been suggested that a previous coronary event shortens the delay in acute stroke [53], whereas a history of diabetes appears to be associated with a prolonged delay [67, 81].

Ethnicity and delay

An increased pre-hospital delay in AMI was found among the Asian and Latino population in the USA [105]. In the USA, door-to-ECG time at the emergency department was longer in non-white populations [106]. In the United Kingdom, South Asians used EMS less frequently in acute chest pain [107].

Afro-Americans had a longer delay in stroke [108]. However, among stroke patients the delay from 911 call to arrival in Emergency Department (ED) was not substantially influenced by living in poorer areas or ethnicity [109].

Patient factors

Symptom onset

There are occasional difficulties defining symptom onset in AMI as well as stroke. In AMI, there is sometimes a stuttering start of the pain, in both women and men, where there are difficulties delineating the true onset of infarction [103]. In stroke, some patients wake up with hemiparesis or dysarthria [70]. In both conditions, it is difficult to estimate how often there are uncertainties in the estimation of onset of infarction. However, a number of stroke surveys have estimated this figure, ranging from 19%-35% [61, 65, 110, 111]. These surveys were performed in the latter part of the 1990 s and the beginning of the 21st century, including both men and women and both ischemic and haemorrhagic stroke. The largest of these cohorts comprised 2,165 patients. In stroke, a transient ischemic attack (TIA) and in AMI, unstable angina can precede the major episode, making it difficult to establish the exact onset time.

Type of symptom

In AMI, a variety of symptoms have been described. The classical type, with the acute onset of severe pain associated with a cold sweat, has been reported to occur in about 20% of AMI cases in both women and men [112], however more frequently in STEMI. Other types include the more gradual onset of pain or pain that comes and goes [113]. However, a large number of patients have symptoms other than chest pain [114].

In stroke, there are a number of types of symptom onset, with sudden onset such as hemiparesis, hemihypesthesia, loss of vision in one or both eyes, speech problems, loss of consciousness, sudden headache, dizziness and balance problems [81]. Also in stroke, there is sometimes a more gradual increase in symptom severity and there are sometimes atypical symptoms as well [115].

Symptoms and delay

A sudden onset of symptoms in AMI has been reported to be associated with a shortened delay to hospital admission [48]. Conscious disturbances have been shown to shorten delay in stroke [116]. Similarly, more severe strokes have been associated with a shorter delay [81][108][117]. The increasing delay in women in AMI but also in some studies of stroke has been explained by more atypical symptoms in women [115].

Loss of consciousness and difficulty speaking shortened door-to-doctor time and door-to-image time in stroke [98].

Recognition

In AMI, with few exceptions, about 75% suspect a heart attack [46, 118, 119], more frequently in men than women [46]. The relationship between expected and perceived symptoms appears to be important for the decision process in AMI [120, 121]. Symptom recognition is an important factor in reducing delay in AMI [40, 122].

In stroke, about 25% - 50% of patients suspect stroke [11, 67, 78, 123126]. Awareness of stroke has been associated with a shorter delay [79, 127].

The use of the EMS

In AMI, the use of the EMS may vary between continents. In Europe and Australia, the figures often reach more than 50% [80, 128130], whereas in the United States the figures are often around 50% or lower [131133]. In 4 USA communities the use of EMS increased from 37% in 1987 to 44% in 2000 (p < 0.0001) [25]. In China and Singapore, clearly less than 50% of AMI patients used EMS [134, 135].

Patients with STEMI more frequently use an EMS [136]. More rapid definitive care is usually obtained by using the EMS [130, 133, 135, 137].

In stroke, the use of the EMS varies markedly between 12% and 69% [30, 62, 66, 16, 117, 59, 60, 125, 138142]. These surveys mostly include stroke in general, but some only include ischemic stroke.

Factors associated with the use of the EMS in AMI have been reported to be

1) Knowledge of the importance of quickly seeking medical care,

2) Abrupt onset of pain reaching maximum intensity within minutes,

3) Nausea or cold sweat,

4) Vertigo or near syncope,

5) ST-elevation ACS,

6) Increasing age,

7) Previous history of heart failure,

8) Long distance to hospital [136].

In stroke, these factors were older age and when someone other than the patient identified the problem [143].

The use of the EMS in stroke has been associated with a shorter delay to hospital admission and, furthermore, to a shorter in-hospital delay to treatment [16, 17, 59, 69, 76, 79, 90, 123, 144146].

Survival in relation to the use of EMS has not been clearly addressed, most probably because patients who use the EMS are older and have a different co-morbidity.

Community factors

Knowledge

In a 1995 survey in USA 89% of adult respondents reported the warning signs of a heart attack correctly [147].

The knowledge of stroke has been evaluated in a number of community surveys. A surprisingly high percentage (about 50%) do not recognise the most typical warning signs of stroke [148152].

In one survey in Spain, 60% were unable to describe any warning signs for stroke [153]. Similar observations were made among uninsured Latino immigrants in the USA [154].

Knowledge and delay

The knowledge of the importance of quickly seeking medical assistance shortens the pre-hospital delay and increases the use of the EMS in AMI [136, 155, 156]. Physicians have a shorter pre-hospital delay in AMI [156, 157]. In many patients, a heart attack differs considerably from their concept of a heart attack [121, 158, 159]. Mismatch has been reported to be as high as 58% [121].

Similar findings have been reported in stroke [30, 77, 160]. However, in one survey, knowledge of stroke was not associated with delay [161].

Intervention to improve knowledge

In the 1980 s and 1990 s, educational campaigns were started to increase the use of the EMS and reduce prehospital delays in AMI. In Europe, some reduced delays [155, 156] and, in the USA, some increased the use of the EMS [132]. However, overall these campaigns did not markedly change the situation [162, 163].

An educational campaign in Carolina increased the percentage of stroke patients who reached hospital within 24 hours [164]. Similar experiences were reported by others [165]. A population based stroke intervention trial in Berlin was effective in reducing prehospital delay in women but not in men [166].

In Texas, one educational intervention increased the percentage of stroke patients who received thrombolysis [167] and another potentially improved the intention to call 911 for stroke among school children [168].

Public education has increased the proportion of inhabitants who can identify stroke warning signs [169].

Witness and delay

In both AMI and stroke, the importance of relatives, friends or others with regard to delay has been highlighted [11, 116, 170]. This is particularly relevant in stroke, due to a more common patient incapacity.

Both patients who have suffered an AMI and their relatives appeared to act more appropriate to someone else's chest pain than to their own [171]. Patients with AMI often seek advice from family members and friends at symptom onset [9, 46, 170, 172176] and significant others appear to play a vital role in shortening the patient's decision time process in AMI [172], simply because of patient denial. Patients view of trustworthiness of others also seem to influence delay in AMI [177].

System factors

Recognition at dispatch centre

The opportunity for the early identification of AMI at the dispatch centre has been evaluated [178, 179]. Although the experiences were relatively positive, it has been suggested that computer algorithm support might increase the diagnostic accuracy still further [180].

In stroke about 30% were identified by dispatchers [142, 181].

Recognition by EMS

Early identification of AMI by the rescue team on the scene has been evaluated [182, 183]. The pre-hospital ECG has markedly improved the diagnostic accuracy, particularly with regard to STEMI [184].

Analysis of biochemical markers has not improved the diagnostic accuracy in a similar manner [185]. Therefor the preliminary diagnosis of AMI or ACS on the scene is currently based on clinical history, clinical examination and ECG.

In stroke, the rescue team has to rely on clinical history and clinical examination. Diagnostic scales to identify stroke patients have also been used [186]. With the support of the Face, Arm, Speech test, stroke diagnosis by paramedics has been reported to be 79% [187]. The diagnostic accuracy of stroke in the pre-hospital setting has not yet been evaluated as extensively as that of AMI, but one study found that thrombolytic checklists to identify eligible stroke patients are used more frequently (37%) than checklists to identify eligible AMI patients (28%) [186].

Pre-hospital treatment

In AMI, various therapeutic alternatives, including thrombolysis [188], nitroglycerine [189], aspirin [190] and beta-blockers [191], have been introduced in clinical routines.

In stroke, pre-hospital neuroprotective therapy has been started at research level [192].

Fast track

A number of studies have highlighted the value of fast-tracking patients with STEMI directly to the coronary care unit or catheterisation laboratory. This has been shown not only to shorten delay to treatment but also to improve outcome [193202]. The training of the staff in hospital and the implementation of guidelines or an audit programme can also reduce the in-hospital delay to treatment in AMI [203205].

It was recently shown that half of AMI patients admitted to the ED were given inappropriately low levels of triage [206]. The median door-to-ECG time was 12 min and the median door-to-thrombolysis time was 40 min [206]. One disturbing factor is the level of crowding at the ED [207].

A prolonged door-to-ECG time at the ED was associated with a poorer outcome [208]. The door-to-ECG time can be reduced by implementing a triage process [209].

Similar experiences were found in stroke [210212]. It was shown that a rapid response system in hospital could reduce the delay in stroke [213].

A pre-hospital notification increased the use of thrombolysis from 6% to 14% [214]. Similarly, an acute stroke team at the ED increased the use of thrombolysis [215].

A pre-hospital acute stroke triage protocol has also been shown to reduce the pre-hospital and in-hospital delay [216]. A Computerised Physician Order Entry-Based Stroke team approach programme significantly reduced the time from ED arrival to evaluation and treatment [217]. However, another approach in stroke is to introduce CT scanning at the ED [31]. This increased the eligibility for thrombolysis in stroke dramatically [31]. A fast track based on a competent pre-hospital clinical evaluation can also directly transfer patients to the stroke unit via the CT scanner.

A multilevel educational programme improved rapid hospitalisation and paramedic diagnostic accuracy in acute stroke, which also increased the number of patients within the three-hour tissue plasminogen activator window [30].

Final comments

Acute myocardial infarction and acute ischemic stroke are two conditions which are suitable for early revascularisation, which improves outcome. The delay from symptom onset to the delivery of treatment is therefore of the utmost importance in both conditions. In stroke, there is a drawback, as a possible haemorrhage must be excluded before thrombolysis can be delivered. In AMI, only patients with STEMI (about one third of all patients with AMI) have been shown to benefit from very early revascularisation, today usually PCI.

Telemedicine can help collaboration between smaller community hospitals and the large central hospital both in AMI [20, 218220] and in stroke [221225]. Telephone guidance of systemic thrombolysis in acute ischemic stroke is another approach [226].

The goal of more rapid delivery of treatment could perhaps be achieved by a reduction in patient decision time, an improvement in early identification and an improvement in logistics, including fast tracking (transporting the patient directly to the catheterisation laboratory in AMI and to the CT scan and stroke unit in stroke). Bridging therapies with intra-arterial thrombolysis or thrombectomy calls for the perfection of logistics, pre-hospital care and collaboration between hospitals.

Efforts to improve the early chain of care in AMI have been ongoing for the last two decades. Similar efforts in acute ischemic stroke have been in progress for the last decade.

In all probability, representatives from these two disciplines (cardiology and neurology) can learn from one another, with the common goal of limiting organ damage and thereby improving outcome in terms of both mortality and morbidity.

Authors contributions

JH is responsible for the design of the manuscript, the literature search and the writing of the manuscript. BW has contributed with constructive comments and references. ABe has contributed with valuable background information which was of importance for the design and content of the manuscript. ABå has contributed with valuable background information which was of importance for the design and content of the manuscript

LS has contributed with valuable background information which was of importance for the design and content of the manuscript. CB has contributed with constructive comments and references

All authors have read and improved the final manuscript

Declarations

Acknowledgements

This study was supported by grants from the Laerdal Foundation for Acute Medicine in Norway.

Many thanks to the librarians of the Medicine Library at the Sahlgrenska University Hospital Ann Liljegren and Therese Svanberg for their skilful support.

Authors’ Affiliations

(1)
Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital
(2)
School of Health Sciences, University of Borås, the Pre-hospital Research Centre in Western Sweden
(3)
Stockholm Pre-hospital Centre, South Hospital
(4)
Institute of Neuroscience and Physiology, Department of Clinical Neuroscience and Rehabilitation, Sahlgrenska Academy at Gothenburg University

References

  1. Maroko PR, Kjekshus JK, Sobel BE, Watanabe T, Covell JW, Ross J, Braunwald E: Factors influencing infarct size following experimental coronary artery occlusions. Circulation. 1971, 43: 67-82.PubMedView ArticleGoogle Scholar
  2. Reimer KA, Lowe JE, Rasmussen MM, Jennings RB: The "wave-front" phenomenon if ischemic cell death: Myocardial infarct size venus duration of coronary occlusion in dogs. Circulation. 1977, 56: 786-794.PubMedView ArticleGoogle Scholar
  3. Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardio (GISSI): Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction. Lancet. 1986, 1: 397-401.Google Scholar
  4. Califf RM: Ten years of benefit from a one-hour intervention. Circulation. 1998, 98: 2649-2651.PubMedView ArticleGoogle Scholar
  5. National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group: tissue plasminogen activator for acute ischemic stroke. N Engl J Med. 1995, 333: 1581-1587. 10.1056/NEJM199512143332401.View ArticleGoogle Scholar
  6. Evenson KR, Schroeder EB, Legare TB, Brice JH, Rosamond WD, Morris DL: A comparison of emergency medical services times for stroke and myocardial infarction. Prehosp Emerg Care. 2001, 5: 335-339. 10.1080/10903120190939463.PubMedView ArticleGoogle Scholar
  7. Massaro AR, Sacco RL, Scaff M, Mohr JP: Clinical discriminators between acute brain hemorrhage and infarction. Arq Neuropsiquiatr. 2002, 60 (2A): 185-191.PubMedView ArticleGoogle Scholar
  8. Burke AP, Virmani R: Pathophysiology of acute myocardial infarction. Med Clin North Am. 2007, 91: 553-572. 10.1016/j.mcna.2007.03.005.PubMedView ArticleGoogle Scholar
  9. Johansson I, Strömberg A, Swahn E: Factors related to delay times in patients with suspected acute myocardial infarction. Heart Lung. 2004, 33: 291-300. 10.1016/j.hrtlng.2004.04.002.PubMedView ArticleGoogle Scholar
  10. Chang KC, Tseng MC, Tan TY: Prehospital delay after acute stroke in Kaohsiung, Taiwan. Stroke. 2004, 35: 700-704. 10.1161/01.STR.0000117236.90827.17.PubMedView ArticleGoogle Scholar
  11. Mosley I, Nicol M, Donnan G, Patrick I, Dewey H: Stroke symptoms and the decision to call for an ambulance. Stroke. 2007, 38: 361-366. 10.1161/01.STR.0000254528.17405.cc.PubMedView ArticleGoogle Scholar
  12. Keskin Ö, Kalemoglu M, Ullusoy RE: A clinic investigation into prehospital and emergency department delays in acute stroke care. Med Princ Pract. 2005, 14: 408-412. 10.1159/000088114.PubMedView ArticleGoogle Scholar
  13. Kereiakes DJ, Weaver WD, Anderson JL, Feldman T, Gibler B, Aufderheide T, Williams DO, Martin LH, Anderson LC, Martin JS, McKendall G, Sherrid M, Greenberg H, Teichman SL: Time delays in the diagnosis and treatment of acute myocardial infarction: A tale of eight cities. Report from the Prehospital Study Group and the Cincinnati Heart Project. Am Heart J. 1990, 120: 773-780. 10.1016/0002-8703(90)90192-Z.PubMedView ArticleGoogle Scholar
  14. Morrison LJ, Brooks S, Sawadsky B, McDonald A, Verbeek PR: Prehospital 12-lead electrocardiography impact on acute myocardial infarction treatment times and mortality: A systematic review. Acad Emerg Med. 2006, 13: 84-89. 10.1111/j.1553-2712.2006.tb00989.x.PubMedView ArticleGoogle Scholar
  15. Kereiakes DJ, Gibler B, Martin LH, Pieper KS, Anderson LC, the Cincinnati Heart Project Study Group: Relative importance of emergency medical system transport and the prehospital electrocardiogram on reducing hospital time delay to therapy for acute myocardial infarction: A preliminary report from the Cincinnati Heart Project. Am Heart J. 1992, 123: 835-10.1016/0002-8703(92)90684-N.PubMedView ArticleGoogle Scholar
  16. Menon SC, Pandey DK, Morgenstern LB: Critical factors determining access to acute stroke care. Neurology. 1998, 51: 427-432.PubMedView ArticleGoogle Scholar
  17. Morris DL, Rosamond WD, Hinn AR, Gorton RA: Time delays in accessing stroke care in the emergency department. Acad Emerg. Med. 1999, 6: 218-223. 10.1111/j.1553-2712.1999.tb00159.x.PubMedView ArticleGoogle Scholar
  18. Mosley I, Nicol M, Donnan G, Patrick I, Kerr F, Dewey H: The impact of ambulance practice on acute stroke care. Stroke. 2007, 38: 2765-2770. 10.1161/STROKEAHA.107.483446.PubMedView ArticleGoogle Scholar
  19. Sablot D, Magnaudeix M, Akouz A, Rey J, De la Vega C, Blenet JC, Ortega L, Cassarini JF, Runavot G, Cerutti D, Filipov R, Garcia Y, Mora M, De la Coussaye JE: Impact of mobile intensive care units on treating stroke within the 3-hour time window in a semi-rural area. Presse Md. 2008, 37: 401-405. 10.1016/j.lpm.2007.07.018.View ArticleGoogle Scholar
  20. Terkelsen CJ, Nørgaard BL, Lassen JF, Gerdes JC, Ankersen JP, Rømer F, Nielsen TT, Andersen HR: Telemedicine used for remote prehospital diagnosing in patients suspected of acute myocardial infarction. J Intern Med. 2002Google Scholar
  21. Terkelsen CJ, Nørgaard BL, Lassen JF, Andersen HR: Prehospital evaluation in ST-elevation myocardial infarction patients treated with primary percutaneous coronary intervention. J of Electrocardiology. 2005, 38: 187-192. 10.1016/j.jelectrocard.2005.06.034.View ArticleGoogle Scholar
  22. Dalby M, Bouzamondo A, Lechat P, Montalescot G: Transfer for primary angioplasty versus immediate thrombolysis in acute myocardial infarction: a meta-analysis. Circulation. 2003, 349: 733-Google Scholar
  23. Curtis JP, Portnay EL, Wang Y, McNamara RL, Herrin J, Bradley EH, Magid DJ, Blaney ME, Canto JG, Krumholz HM: The pre-hospital electrocardiogram and time to reperfusion in patients with acute myocardial infarction 2000-2002. J Am Coll Cardiol. 2006, 47: 1544-1552. 10.1016/j.jacc.2005.10.077.PubMedView ArticleGoogle Scholar
  24. Riks-HIA. [http://www.ucr.uu.se/rikshia/]
  25. McGinn AP, Rosamond WD, Goff DC, Taylor HA, Miles JS, Chambless L: Trends in prehospital delay time and use of emergency medical services for acute myocardial infarction: Expeience in 4 US communities from 1987 - 2000. Am Heart J. 2005, 150: 392-400. 10.1016/j.ahj.2005.03.064.PubMedView ArticleGoogle Scholar
  26. Lacy CR, Bueno M, Kostis JB: Delayed hospital arrival for acute stroke. Annals Intern Med. 1999, 130: 328-View ArticleGoogle Scholar
  27. Ming Chow K, Che-Fai Hui A, Chun Szeto C, Sing Wong K, Kay R: Hospital arrival after acute stroke: Any better after 10 years. Cerebrovasc Dis. 2004, 17: 346-10.1159/000077953.View ArticleGoogle Scholar
  28. Pfefferkort T, Liebetrau M, Müller A, Bender A, Hamann GF: Increasing use of intravenous rt-PA does not affect in acute stroke. J Neurol. 2005, 252: 1500-1503. 10.1007/s00415-005-0899-4.View ArticleGoogle Scholar
  29. Kleindorfer DO, Broderick JP, Khoury J, Flaherty ML, Woo D, Alwell K, Moomaw CJ, Pancioli A, Jauch E, Miller R, Kissela BM: Emergency department arrival times after acute ischemic stroke during the 1990s. Neurocrit Care. 2007, 7: 31-35. 10.1007/s12028-007-0029-5.PubMedView ArticleGoogle Scholar
  30. Wojner-Alexandrov AW, Alexandrov AV, Rodriquez D, Persse D, Grotta JC: Houston paramedic and emergency stroke treatment and outcomes study (HoPSTO). Stroke. 2005, 36: 1512-1518. 10.1161/01.STR.0000170700.45340.39.PubMedView ArticleGoogle Scholar
  31. Lindsberg PJ, Häppölä O, Kallela M, Valanne L, Kuisma M, Kaste M: Door to thrombolysis: ER reorganization and reduced delays to acute stroke treatment. Neurology. 2006, 67: 334-336. 10.1212/01.wnl.0000224759.44743.7d.PubMedView ArticleGoogle Scholar
  32. Heriot AG, Brecker SJ, Coltart DJ: Delay in presentation after myocardial infarction. J Royal Soc Med. 1993, 86: 642-644.Google Scholar
  33. Yarsebski J, Goldberg RJ, Gore JM, Alpert JS: Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: The Worcester Heart Attack Study. Am Heart J. 1994, 128: 255-263. 10.1016/0002-8703(94)90477-4.View ArticleGoogle Scholar
  34. GISSI - Avoidable Delay Study Group: Epidemiology of avoidable delay in the care of patients with acute myocardial infarction in Italy. Arch Intern Med. 1995, 155: 1481-1488. 10.1001/archinte.155.14.1481.View ArticleGoogle Scholar
  35. Ottesen MM, Jørgensen LKS, Torp-Pedersen C: Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction. Eur Heart J. 1996, 17: 429-437.PubMedView ArticleGoogle Scholar
  36. Gurwitz JH, McLaughlin TJ, Willison DJ, Guadagnoli E, Hauptman PJ, Gao X, Soumerai SB: Delayed hospital presentation in patients who have had acute myocardial infarction. Ann Intern Med. 1997, 126: 593-599.PubMedView ArticleGoogle Scholar
  37. Sheifer SE, Rathore SS, Gersh BJ, Weinfurt KP, Oetgen WJ, Breall JA, Schulman K: Time to presentation with acute myocardial infarction in the elderly. Circulation. 2000, 102: 1651-1656.PubMedView ArticleGoogle Scholar
  38. Berton G, Cordiano R, Palmieri R, Guarnieri G, Stefani M, Palatini P: Clinical features associated with pre-hospital time delay in acute myocardial infarction. Ital Heart J. 2001, 2: 766-771.PubMedGoogle Scholar
  39. Dracup K, Moser DK, McKinley S, Ball C, Yamasaki K, Kim C-J, Doering LV, Caldwell MA: An international perspective on the time to treatment for acute myocardial infarction. J Nursing Scholarship. 2003, 35: 317-323. 10.1111/j.1547-5069.2003.00317.x.View ArticleGoogle Scholar
  40. Ottesen MM, Dixen U, Torp-Pedersen C, Kǿber L: Prehospital delay in acute coronary syndrome - an analysis of the components of delay. Inter J Cardiol. 2004, 96: 97-103. 10.1016/j.ijcard.2003.04.059.View ArticleGoogle Scholar
  41. Moser DK, McKinley S, Dracup K, Chung ML: Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms. Pat Education Counceling. 2005, 56: 45-54. 10.1016/j.pec.2003.11.011.View ArticleGoogle Scholar
  42. Tanner H, Larsen P, Lever N, Galletly D: Early recognition and early access for acute coronary syndromes in New Zealand: key links in the chain of survival. New Zealand Med J. 2006, 119 (1232): U1927-PubMedGoogle Scholar
  43. Hwang SY, Ryan C, Zerwic JJ: The influence of age on acute myocardial infarction symptoms and patient delay in seeking treatment. Prog Cardiovasc Nurs. 2006, 21 (1): 20-27. 10.1111/j.0197-3118.2006.04713.x.PubMedView ArticleGoogle Scholar
  44. Ayrik C, ERgene U, Kinay O, Nazli C, Unal B, Ergene O: Factors influencing emergency department arrival time and in-hospital management of patients with acute myocardial infarction. Advances in Terapy. 2006, 23: 244-255. 10.1007/BF02850130.Google Scholar
  45. Noureddine S, Adra M, Arevian M, Dumit MA, Puzantian H, Shehab D, Abchee A: Delay in seeking health care for acute coronary syndromes in a Lebanese sample. J Transcult. Nurs. 2006, 17: 341-348. 10.1177/1043659606291544.PubMedView ArticleGoogle Scholar
  46. Thuresson M, Berglin Jarlöv M, Lindahl B, Svensson L, Zedigh C, Herlitz J: Thoughts, actions and factors associated with prehospital delay in patients with acute coronary syndrome. Heart Lung. 2007, 36: 398-409. 10.1016/j.hrtlng.2007.02.001.PubMedView ArticleGoogle Scholar
  47. Perkins-Porras L, Whitehead DL, Strike PC, Steptoe A: Pre-hospital delay in patients with acute coronary syndrome: Factors associated with patient decision time and home-to-hospital delay. Eur J Cardiovasc Nurs. 2009, 8: 26-33. 10.1016/j.ejcnurse.2008.05.001.PubMed CentralPubMedView ArticleGoogle Scholar
  48. Herlitz J, Thuresson M, Svensson L, Lindqvist J, Lindahl B, Zedigh C, Jarlöv M: Factors of importance for patients' decision time in acute coronary syndrome. Int J Cardiol. 2010, 141: 236-242. 10.1016/j.ijcard.2008.11.176.PubMedView ArticleGoogle Scholar
  49. Barsan WG, Brott TG, Broderick JP, Haley EC, Levy DE, Marler JR: Time of hospital presentation in patients with acute stroke. Arch Intern Med. 1993, 153: 2558-2561. 10.1001/archinte.153.22.2558.PubMedView ArticleGoogle Scholar
  50. Iguchi Y, Wada K, Shibazaki K, Inoue T, Ueno Y, Yamashita S, Kimura K: First impression at stroke onset plays an important role in early hospital arrival. Intern Med. 2006, 45: 447-451. 10.2169/internalmedicine.45.1554.PubMedView ArticleGoogle Scholar
  51. Pistollato G, Ermani M, for the Italian SINV (Società Interdisciplinare Neurovascolare) Study Group: Time of hospital presentation after stroke. A multicenter study in north-east Italy. Ital, J Neurol Sci. 1996, 17: 401-407. 10.1007/BF01997714.View ArticleGoogle Scholar
  52. Streifler JY, Davidovitch S, Sendovski U: Factors associated with the time of presentation of acute stroke patients in an Israeli Community Hospital. Neuroepidemiology. 1998, 17: 161-166. 10.1159/000026168.PubMedView ArticleGoogle Scholar
  53. Smith MA, Doliszny KM, Shahar E, McGovern PG, Arnett DK, Luepker RV: Delayed hospital arrival for acute stroke: the Minnesota stroke survey. Ann Intern Med. 1998, 129: 190-196.PubMedView ArticleGoogle Scholar
  54. Kothari R, Jauch E, Broderick J, Brott T, Sauerbeck L, Khoury J, Liu T: Acute stroke: delays to presentation and emergency department evaluation. Ann Emerg Med. 1999, 33: 3-8. 10.1016/S0196-0644(99)70431-2.PubMedView ArticleGoogle Scholar
  55. Casetta I, Granieri E, Gilli G, Lauria G, Tola MR, Paolino E: Temporal trend and factors associated with delayed hospital admission of stroke patients. Neuroepidemiology. 1999, 18: 255-264. 10.1159/000026220.PubMedView ArticleGoogle Scholar
  56. Wester P, Rådberg J, Lundgren B, Peltonen M: Factors associated with delayed admission to hospital and in-hospital delays in acute stroke and TIA. A prospective multicenter study. Stroke. 1999, 30: 40-48.PubMedView ArticleGoogle Scholar
  57. Lannehoa Y, Bouget J, Pinel JF, Garnier N, Leblanc JP, Branger B: Analysis of time management in stroke patients in three French emergency departments: from stroke onset to computed tomography scan. Eur J Emerg Med. 1999, 6: 95103-View ArticleGoogle Scholar
  58. Morris DL, Rosamond W, Madden K, Schultz C, Hamilton S: Prehospital and emergency department delays after acute stroke. The Genentech stroke presentation survey. Stroke. 2000, 31: 2585-2590.PubMedView ArticleGoogle Scholar
  59. Harraf F, Sharma AK, Brown MM, Lees KR, Vass RI, Kalra L: A multicentre observational study of presentation and early assessment of acute stroke. Brit Med J. 2002, 325: 17-21. 10.1136/bmj.325.7354.17.PubMed CentralPubMedView ArticleGoogle Scholar
  60. Kimura K, Kazui S, Minematsu K, Yamaguchi T: Analysis of 16.922 patients with acute ischemic stroke and transient ischemic attack in Japan. Cerebrovasc Dis. 2004, 18: 47-56. 10.1159/000078749.PubMedView ArticleGoogle Scholar
  61. Rossnagel K, Jungehülsing GJ, Nolte CH, Müller-Nordhorn J, Roll S, Wegscheider K, Villringer A, Willich SN: Out-of-hospital delays in patients with acute stroke. Annals of Emerg Med. 2004, 44: 476-483. 10.1016/j.annemergmed.2004.06.019.View ArticleGoogle Scholar
  62. Koutlas E, Rudolf J, Grivas G, Fitsioris X, Georgiadis G: Factors influencing the pre- and in-hospital management of acute stroke - data from a Greek tertiary care hospital. Eur Neurol. 2004, 51: 35-37. 10.1159/000075084.PubMedView ArticleGoogle Scholar
  63. Kimura K, Kazui S, Minematsu K, Yamaguchi T: Hospital-based prospective registration of acute ischemic stroke and transient ischemic attack in Japan. J. Stroke and Cerebrovasc. Dis. 2004, 13: 1-11. 10.1016/j.jstrokecerebrovasdis.2003.11.025.View ArticleGoogle Scholar
  64. López-Hernández N, Garcia-Escrivá A, Sánchez-Payá J, Llorens-Soriano P, Alvarez-Saúco M, Pampliega-Pérez A, Gracia-Fleta F, Carneado-Ruiz J, Moltó-Jordá JM: Delays before and after arrival at the hospital in the treatment of strokes. Rev Neurol. 2005, 40: 531-536.PubMedGoogle Scholar
  65. Qureshi AI, Kirmani JF, Sayed MA, Safdar A, Ahmed S, Ferguson R, Hershey LA, Qazi KJ: Time to hospital arrival, use of thrombolytics and in-hospital outcomes in ischemic stroke. Neurology. 2005, 64: 2115-2120. 10.1212/01.WNL.0000165951.03373.25.PubMedView ArticleGoogle Scholar
  66. Agyeman O, Nedeltchev K, Arnold M, Fischer U, Remonda L, Isenegger J, Schroth G, Mattle HP: Time to admission in acute ischemic stroke and transient ischemic attack. Stroke. 2006, 37: 963-966. 10.1161/01.STR.0000206546.76860.6b.PubMedView ArticleGoogle Scholar
  67. Iguchi Y, Wada K, Shibazaki K, Inoue T, Ueno Y, Yamashita S, Kimura K: First impression at stroke onset plays an important role in early hospital arrival. Internal Medicine. 2006, 45 (7): 447-451. 10.2169/internalmedicine.45.1554.PubMedView ArticleGoogle Scholar
  68. Mandelzweig L, Goldbourt U, Boyko V, Tanne D: Perceptual, social, and behavioral factors associated with delays in seeking medical care in patients with symptoms of acute stroke. Stroke. 2006, 37: 1248-1253. 10.1161/01.STR.0000217200.61167.39.PubMedView ArticleGoogle Scholar
  69. Barr J, McKinley S, O'Brien E, Herkes G: Patient recognition of and response to symptoms of TIA or stroke. Neuroepidemiology. 2006, 26: 168-175. 10.1159/000091659.PubMedView ArticleGoogle Scholar
  70. Prehospital and Hospital Delays After Stroke Onset United States, 2005-2006. MMWR. Morbidity and Mortality Weekly Report. 2007, 56 (19): 474-478.Google Scholar
  71. Nowacki P, Nowik M, Bajer-Czajkowska A, Porebska A, Zywica A, Nocon D, Drechsler H, Safranow K: Patients' and bystanders' awareness of stroke and pre-hospital delay after stroke onset: Perspectives for thrombolysis in West Pomerania Province, Poland. Eur Neurol. 2007, 58: 159-165. 10.1159/000104717.PubMedView ArticleGoogle Scholar
  72. Kwon YD, Yoon SS, Chang H: Impact of an early hospital arrival on treatment outcomes in acute ischemic stroke patients. J Prev Med Pub Health. 2007, 40: 130-136. 10.3961/jpmph.2007.40.2.130.View ArticleGoogle Scholar
  73. De Silva DA, Ong S-H, Elumbra D, Wong M-C, Chen CLJ, Chang HM: Timing of hospital presentation after acute cerebral infarction and patients' acceptance of intravenous thrombolysis. Ann Acad Med Singapore. 2007, 36: 244-246.PubMedGoogle Scholar
  74. Chen CH, Huang P, Yang Y-H, Liu CK, Lin TJ, Lin RT: Pre-hospital and in-hospital delays after onset of acute ischemic stroke - A hospital-based study in Southern Taiwan. Kaohsiung J Med Sci. 2007, 23: 552-559. 10.1016/S1607-551X(08)70002-0.PubMedView ArticleGoogle Scholar
  75. Juhl Majersik J, Smith MA, Zahuranec DB, Sánchez BN, Morgenstern LB: Population-based analysis of the impact of expanding the time window for acute stroke treatment. Stroke. 2007, 38: 3213-3217. 10.1161/STROKEAHA.107.491852.View ArticleGoogle Scholar
  76. Maestroni A, Mandelli C, Manganaro D, Zecca B, Rossi P, Monzani V, Torgano G: Factors influencing delay in presentation for acute stroke in an emergency department in Milan, Italy. Emerg Med J. 2008, 25: 340-345. 10.1136/emj.2007.048389.PubMedView ArticleGoogle Scholar
  77. Siddiqui M, Siddiqui SR, Zafar A, Khan FS: Factors delaying hospital arrival of patients with acute stroke. J Pak Med Assoc. 2008, 58: 178-182.PubMedGoogle Scholar
  78. Stead LG, Vaidyanathan L, Bellolio MF: Knowledge of signs, treatment and need for urgent management in patients presenting with an acute ischaemic stroke or transient ischaemic attack: a prospective study. Emerg Med J. 2008, 25: 735-739. 10.1136/emj.2008.058206.PubMedView ArticleGoogle Scholar
  79. Sekoranja L, Griesser A-C, Wagner G, Njamnshi AK, Temperli P, Herrmann FR, Grandjean R, Niquille M, Vermeulen B, Rutschmann OT, Sarasin F, Sztajzel R: Factors influencing emergency delays in acute stroke management. Swiss Med WKLY. 2009, 139: 393-399.PubMedGoogle Scholar
  80. Ingarfield SL, Jacobs IG, Jelinek GA, Vountain D: Patient delay and use of ambulace by patients with chest pain. Emerg Med Austr. 2005, 17: 218-223. 10.1111/j.1742-6723.2005.00726.x.View ArticleGoogle Scholar
  81. Palomeras E, Fossas P, Quintana M, Monteis R, Sebastian M, Fábregas C, Ciurana A, Ribó M, Cano A, Sanz P, Floriach M, Àlvarez-Sabin J: Emergency perception and other variables associated with extra-hospital delay in stroke patients in the Maresme region (Spain). Eur J Neurol. 2008, 15: 329-335. 10.1111/j.1468-1331.2008.02082.x.PubMedView ArticleGoogle Scholar
  82. Jungehulsing GJ, Rossnagel K, Nolte CH, Muller-Nordhorn J, Roll S, Klein M, Wegscheider K, Einhaupl KM, Willich SN, Villringer A: Emergency department delays in acute stroke - analysis of time between ED arrival and imaging. Eur J Neurol. 2006, 13: 225-232. 10.1111/j.1468-1331.2006.01170.x.PubMedView ArticleGoogle Scholar
  83. Johansson I, Strömberg A, Swahn E: Ambulance use in patients with acute myocardial infarction. Eur J of Cardiovasc Nurs. 2004, 19: 5-12.View ArticleGoogle Scholar
  84. Meischke H, Eisenberg M, Larsen M: Prehospital delay interval for patients who use emergency medical service: the effect of heart-related medical conditions and demographic variables. Ann Emerg Med. 1993, 22: 1597-1601. 10.1016/S0196-0644(05)81267-3.PubMedView ArticleGoogle Scholar
  85. Leizorovics A, Haugh M, Mercier C, Boissel J: Prehospital and hospital time delays in thrombolytic treatment in patients with suspected acute myocardial infarction. Analysis of data from the EMIP study. Eur Heart J. 1997, 18: 248-253.View ArticleGoogle Scholar
  86. Ziljstra F, Patel A, Jones M, Grines C, Ellis S, Garcia E, Grinfeld L, gibbons RJ, Ribeiro EE, Ribichini F, Granger C, Akhras F, Weaver WD, Simes RJ: Clinical characteristics and outcome of patients with early (< 2 h), and intermediate (2-4 h) and late ( > 4) presentation treated by primary coronary angioplasty or thrombolytic therapy for acute myocardial infarction. Eur Heart J. 2002, 23: 550-557. 10.1053/euhj.2001.2901.View ArticleGoogle Scholar
  87. Lambrew CT, Bowlby LJ, Rogers WJ, Chandra NC, Weaver WD: Factors influencing the time to thrombolysis in acute myocardial infarction. Arch Intern Med. 1997, 157: 2577-2582. 10.1001/archinte.157.22.2577.PubMedView ArticleGoogle Scholar
  88. Bouma J, Broer J, Bleeker J, van Sonderen E, Meyboom-de Jong B, DeJongste MJL: Longer pre-hospital delay in acute myocardial infarction in women because of longer doctor decision time. J Epidemiol Community Health. 1999, 53: 459-464. 10.1136/jech.53.8.459.PubMed CentralPubMedView ArticleGoogle Scholar
  89. Eung RT: Hong Kong patients' knowledge of stroke does not influence time-to-hospital presentation. J Clin Neurosci. 2001, 8: 311-314. 10.1054/jocn.2000.0805.View ArticleGoogle Scholar
  90. Derex L, Adeleine P, Nighoghossian N, Honnorat J, Trouillas P: Factors influencing early admission in a French stroke unit. Stroke. 2002, 33: 153-159. 10.1161/hs0102.100533.PubMedView ArticleGoogle Scholar
  91. Lacy CR, Suh DC, Bueno M, Kostis JB: Delay in presentation and evaluation for acute stroke: Stroke Time Registry for Outcomes Knowledge and Epidemiology (S.T.R.O.K.E.). Stroke. 2001, 32: 63-69.PubMedView ArticleGoogle Scholar
  92. Turris SA, Finamore S: Reducing delay for women seeking treatment in the Emergency Department for symptoms of potential cardiac illness. J Emerg Nursing. 2008, 34: 509-515. 10.1016/j.jen.2007.09.016.View ArticleGoogle Scholar
  93. Lisabeth LD, Brown DL, Morgenstern LB: Barriers to intravenous tissue plasminogen activator for acute stroke therapy in women. Gend Med. 2006, 3: 270-278. 10.1016/S1550-8579(06)80215-9.PubMedView ArticleGoogle Scholar
  94. Perers E, Caidahl K, Herlitz J, Karlson BW, Karlsson T, Hartford M: Treatment and short-term outcome in women and men with acute coronary syndromes. Int J Cardiol. 2005, 103: 120-127. 10.1016/j.ijcard.2004.07.015.PubMedView ArticleGoogle Scholar
  95. Jackson RE, Anderson W, Peacock WF, Vaught L, Carley RS, Wilson AG: Effect of a patient's sex on the timing of thrombolytic therapy. Ann Emerg Med. 1996, 27: 8-15. 10.1016/S0196-0644(96)70289-5.PubMedView ArticleGoogle Scholar
  96. Grech C, Pannell D, Smith-Sparrow T: The delay in transfer between the emergency department and the critical care unit for patients with an acute cardiac event - in hospital factors. Aust Crit Care. 2001, 14: 139-145. 10.1016/S1036-7314(05)80055-4.PubMedView ArticleGoogle Scholar
  97. Engelstein E, Margulies J, Jeret JS: Lack of t-PA use for acute ischemic stroke in a community hospital: High incidence of exclusion criteria. Am J Emerg Med. 2000, 18: 257-260. 10.1016/S0735-6757(00)90116-5.PubMedView ArticleGoogle Scholar
  98. Gargano JW, Wehner S, Reeves MJ: Do presenting symptoms explain sex differences in emergency department delays among patients with acute stroke?. Stroke. 2009, 40: 1114-1120. 10.1161/STROKEAHA.108.543116.PubMedView ArticleGoogle Scholar
  99. Kapral MK, Fang J, Hill MD, Silver F, Richrds J, Jaigobin C, Cheung AM, for the investigators of the Registry of the Canadian Stroke Network: Sex differences in stroke care and outcomes: Results from the Registry of the Canadian Stroke Network. Stroke. 2005, 36: 809-814. 10.1161/01.STR.0000157662.09551.e5.PubMedView ArticleGoogle Scholar
  100. Noureddine S: Patterns of responses to cardiac events over time. J Cardiovasc Nurs. 2009, 24: 390-397.PubMedView ArticleGoogle Scholar
  101. Newby LK, Rutsch WR, Califf RM, Simoons ML, Aylward PE, Armstrong PW, Woodlief LH, Lee KL, Topol EJ, Van de Werf F: Time from symptom onset to treatment and outcomes after thrombolytic therapy. GUSTO-1 Investigators. J Am Coll Cardiol. 1996, 27: 1646-1655. 10.1016/S0735-1097(96)82148-6.PubMedView ArticleGoogle Scholar
  102. Moser D, McKinley S, Dracup K, Chung M: Gender differences in reasons for patients' delay in seeking treatment for acute myocardial infarction symptoms. Patient Education and Counselling. 2005, 56: 45-54. 10.1016/j.pec.2003.11.011.View ArticleGoogle Scholar
  103. Yan H, Song L, Yang J, Sun Y, Hu D: The association between pre-infarction angina and care-seeking behaviors and its effects on early reperfusion rates for acute myocardial infarction. Inter J Cardiol. 2009, 135: 86-92. 10.1016/j.ijcard.2008.09.002.View ArticleGoogle Scholar
  104. Bohannon RW, Silverman IE, Ahlquist M: Time to emergency department arrival and its determinants in patients with acute ischemic stroke. Conn Med. 2003, 67: 145-148.PubMedGoogle Scholar
  105. Henderson SO, Magana RN, Korn CS, Genna T, Bretsky PM: Delayed presentation for care during acute myocardial infarction in a Hispanic population of Los Angeles County. Ethn Dis. 2002, 12: 3-7.Google Scholar
  106. Takakuwa KM, Shofer FS, Hollander JE: The influence of race and gender on time to initial electrocardiogram for patients with chest pain. Acad Emerg Med. 2006, 13: 867-872. 10.1111/j.1553-2712.2006.tb01740.x.PubMedView ArticleGoogle Scholar
  107. Ben-Shlomo Y, Naqvi H, Baker I: Ethnic differences in healthcare-seeking behaviour and management for acute chest pain: secondary analysis of the MINAP dataset 2002-2003. Heart. 2008, 94: 354-359. 10.1136/hrt.2007.119412.PubMedView ArticleGoogle Scholar
  108. Lichtman JH, Watanabe E, Allen NB, Jones SB, Dostal J, Goldstein LB: Hospital arrival time and intravenous t-PA use in US Academic Medical Centers 2001-2004. Stroke. 2009, 40: 3845-3850. 10.1161/STROKEAHA.109.562660.PubMedView ArticleGoogle Scholar
  109. Kleindorfer DO, Lindsell CJ, Broderick JP, Flaherty ML, Woo D, Ewing I, Schmit P, Moomaw C, Alwell K, Pancioli A, Jauch E, Khoury J, Miller R, Schneider A, Kissela BM: Community Socioeconomic status and prehospital times in acute stroke and transient ischemic attack: Do poorer patients have longer delays from 911 call to the emergency department?. Stroke. 2006, 37: 1508-1513. 10.1161/01.STR.0000222933.94460.dd.PubMedView ArticleGoogle Scholar
  110. Barber PA, Zhang J, Demchuk AM, Hill MD, Buchan AM: Why are stroke patients excluded from TPA therapy? An analysis of patient eligibility. Neurology. 2001, 56: 1015-1020.PubMedView ArticleGoogle Scholar
  111. Deng YZ, Reeves MJ, Jacobs BS, Birbeck GL, Kothari RU, Hickenbottom L, Mullard AJ, Wehner S, Maddox K, Majid A: IV tissue plasminogen activator use in acute stroke. Experience from a statewide registry. Neurology. 2006, 66: 306-312. 10.1212/01.wnl.0000196478.77152.fc.PubMedView ArticleGoogle Scholar
  112. Thuresson M, Jarlöv MB, Lindahl B, Svensson L, Zedigh C, Herlitz J: Symptoms and type of symptom onset in acute coronary syndrome in relation to ST-elevation, gender, age and a history of diabetes. Am Heart J. 2005, 150: 234-242. 10.1016/j.ahj.2004.08.035.PubMedView ArticleGoogle Scholar
  113. Ishihara M, Inoui I, Kawagoe T, Shimatani Y, Kurisu S, Hata T, Mitsuba N, Kisaka T: Impact of prodromal angina pectoris and white blood cell count on outcome of patients with acute myocardial infarction. Int J Cardiol. 2005, 103: 150-155. 10.1016/j.ijcard.2004.08.046.PubMedView ArticleGoogle Scholar
  114. Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Lambrew CT, Ornato JP, Barron HV, Kiefe CI: Prevalence, clinical characteristics, and mortality among patients with myocardial infarction presenting without chest pain. JAMA. 2000, 283: 3223-3229. 10.1001/jama.283.24.3223.PubMedView ArticleGoogle Scholar
  115. Larkin M: Women's "non-traditional" stroke symptoms may delay emergency treatment. The Lancet. 2002, 360: 1398-10.1016/S0140-6736(02)11423-1.View ArticleGoogle Scholar
  116. Tanaka Y, Nakajima M, Hirano T, Uchino M: Factors influencing pre-hospital delay after ischemic stroke and transient ischemic attack. Intern Med. 2009, 48: 1739-1744. 10.2169/internalmedicine.48.2378.PubMedView ArticleGoogle Scholar
  117. Pandian JD, Kalra G, Jaison A, Deepak SS, Shamsher S, Padala S, Singh Y, Abraham G: Factors delaying admission to a hospital-based stroke unit in India. J Stroke Cerebrovasc Dis. 2006, 15: 81-87. 10.1016/j.jstrokecerebrovasdis.2006.01.001.PubMedView ArticleGoogle Scholar
  118. Hartford M, Karlson BW, Sjölin M, Holmberg S, Herlitz J: Symptoms, thoughts and environmental factors in suspected acute myocardial infarction. Heart & Lung. 1993, 22: 64-70.Google Scholar
  119. Leslie WS, Urie A, Hooper J, Morrison CE: Delay in calling for help during myocardial infarction: reasons for the delay and subsequent pattern of accessing care. Heart. 2000, 84: 137-141. 10.1136/heart.84.2.137.PubMed CentralPubMedView ArticleGoogle Scholar
  120. Johnson JA, King KB: Influence of expectations about symptoms on delay in seeking treatment during a myocardial infarction. Am J Crit Care. 1995, 4: 29-35.PubMedGoogle Scholar
  121. Horne R, James D, Petrie K: Patients' interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction. Heart. 2000, 83: 388-393. 10.1136/heart.83.4.388.PubMed CentralPubMedView ArticleGoogle Scholar
  122. Ryan CJ, Zerwic JJ: Perceptions of symptoms of myocardial infarction related to health care seeking behaviors in the elderly. J Cardiovasc Nurs. 2003, 18: 184-196. 10.1111/j.0889-7204.2003.02005.x.PubMedView ArticleGoogle Scholar
  123. Clark JM, Anderson Renier S: A community stroke study: Factors influencing stroke awareness and hospital arrival time. J Stroke and Cerebrovasc Dis. 2001, 10 (6): 274-278. 10.1053/jscd.2001.123774.View ArticleGoogle Scholar
  124. Nolte CH, Rossnagel K, Jungehuelsing J, Müller-Nordhorn J, Roll S, Reich A, Willich SN, Villringer A: Gender differences in knowledge of stroke in patients with atrial fibrillation. Preventive Medicine. 2005, 41: 226-231. 10.1016/j.ypmed.2004.11.003.PubMedView ArticleGoogle Scholar
  125. Salisbury HR, Banks BJ, Footitt DR, Winner SJ, Reynolds DJM: Delay in presentation of patients with acute stroke to hospital in Oxford. QJ Med. 1998, 91: 635-640.View ArticleGoogle Scholar
  126. Williams JE, Rosamond WD, Morris DL: Stroke symptom attribution and time to emergency department arrival: the delay in accessing stroke healthcare study. Acad Emerg Med. 2000, 7: 93-96. 10.1111/j.1553-2712.2000.tb01900.x.PubMedView ArticleGoogle Scholar
  127. Rasmussen BH, Germer U, Kammersgaard LP, Olsen TS: Factors of importance for early and late admission of patients with stroke and transient cerebral ischemia. Ugeskr Laeger. 2003, 165: 225-228.PubMedGoogle Scholar
  128. Berglin Blohm M, Hartford M, Karlson BW, Luepker RV, Herlitz J: An evaluation of the results of media and educational campaigns designed to shorten the time taken by patients with acute myocardial infarction to decide to go to hospital. Heart. 1996, 76: 430-434. 10.1136/hrt.76.5.430.View ArticleGoogle Scholar
  129. Herlitz J, Hjälte L, Karlson BW, Suserud BO, Karlsson T: Characteristics and outcome of patients with acute chest pain in relation to the use of ambulance in an urban and rural area. Am J Emerg Med. 2006, 24: 775-781. 10.1016/j.ajem.2006.03.016.PubMedView ArticleGoogle Scholar
  130. Hitchcock T, Rossouw F, McCoubrie D, Meek S: Observational study of prehospital delays in patients with chest pain. Emerg Med J. 2003, 20: 270-273. 10.1136/emj.20.3.270.PubMed CentralPubMedView ArticleGoogle Scholar
  131. Canto JG, Zalenski RJ, Ornato JP, Rogers WJ, Kiefe CI, Magid D, Shlipak MG, Frederick PD, Lambrew CG, Littrell KA, Barron HV: Use of emergency medical services in acute myocardial infarction and subsequent quality of care: observations from the National Registry of Myocardial Infarction 2. Circulation. 2002, 106: 3018-3023. 10.1161/01.CIR.0000041246.20352.03.PubMedView ArticleGoogle Scholar
  132. Luepker RV, Raczynski JM, Osganian S, Goldberg RJ, Finnegan JR, Hedges JR, Goff DC, Eisenberg MS, Zapka JG, Feldman HA, Labarthe DR, McGovern PG, Cornell CE, Proschan MA, Simons-Morton DG: Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The rapid early action for coronary treatment (REACT) Trial. JAMA. 2000, 284: 60-67. 10.1001/jama.284.1.60.PubMedView ArticleGoogle Scholar
  133. Alonzo AA: The effect of health care provider consultation on acute coronary syndrome care-seeking delay. Heart Lung. 2007, 36: 307-318. 10.1016/j.hrtlng.2007.05.002.PubMedView ArticleGoogle Scholar
  134. Hoo KK, Lee SW, Ooi SB, Lateef F, Lim SH, Anantharaman V: Acute coronary syndrome - factors causing delayed presentation at the Emergency Department. Ann Acad Med Singapore. 2002, 31: 387-392.Google Scholar
  135. Song L, Yan H, Hu D: Patients with acute myocardial infarction using ambulance or private transporting to reach definitive care: Which mode is quicker?. Intern Med J.Google Scholar
  136. Thuresson M, Berglin Jarlöv M, Lindahl B, Svensson L, Zedigh C, Herlitz J: Factors that influence the use of ambulance in acute coronary syndrome. Am Heart J. 2008, 156: 170-176. 10.1016/j.ahj.2008.01.020.PubMedView ArticleGoogle Scholar
  137. Fukuoka Y, Dracup K, Ohno M, Kobayashi F, Hirayama H: Predictors of in-hospital delay to reperfusion in patients with acute myocardial infarction in Japan. J Emerg Med. 2006, 31: 241-245. 10.1016/j.jemermed.2005.12.019.PubMedView ArticleGoogle Scholar
  138. Wein TH, Staub L, Felberg R, Hickenbottom SL, Chan W, Grotta JC, Demchuk AM, Groff J, Bartholomew LK, Morgenstern LB: Activation of emergency medical services for acute stroke in a nonurban population. Stroke. 2000, 31: 1925-1928.PubMedView ArticleGoogle Scholar
  139. Katzan IL, Graber TM, Furlan AJ, Sundararajan S, Sila CA, Houser G, Landis DM: Cuyahoga County Operation Stroke speed of emergency department evaluation and compliance with National Institutes of Neurological Disorders and Stroke time targets. Stroke. 2003, 34: 994-998. 10.1161/01.STR.0000060870.55480.61.PubMedView ArticleGoogle Scholar
  140. Memis S, Tugrul W, Evci ED, Ergin F: Multiple causes for de4lay in arrival at hospital in acute stroke patients in Aydin, Turkey. BMC Neurology. 2008, 8: 15-18. 10.1186/1471-2377-8-15.PubMed CentralPubMedView ArticleGoogle Scholar
  141. Morales-Ortiz A, Amorin M, Fages EM, Moreno-Escribano A, Villaverde-González R, Martinez-Navarro ML, Marin-Marin J, Marin-Munoz J, G'mez-Espuch J, Garcia-Medina AM, Escribano-Soriano JB: Use of extra-hospital emergency systems in the treatment of acute stroke in the region of Murcia. Possible reperfussions on the urgent care of stroke patients. Rev Neurol. 2006, 42: 68-72.PubMedGoogle Scholar
  142. Porteous GH, Corry MD, Smith WS: Emergency medical services dispatcher identification of stroke and transient ischemic attack. Prehosp Emerg Care. 1999, 3: 211-216. 10.1080/10903129908958939.PubMedView ArticleGoogle Scholar
  143. Schroeder EB, Rosamond WD, Morris DL, Evenson KR, Hinn AR: Determinants of use of emergency medical services in a population with stroke symptoms: The second delay in accessing stroke health care (DASH II) Study. Stroke. 2000, 31: 2591-2596.PubMedView ArticleGoogle Scholar
  144. Lacy CR, Suh D-C, Bueno M, Kostis JB: Delay in presentation and evaluation for acute stroke. Stroke time registry for outcomes knowledge and epidemiology. Stroke. 2001, 32: 63-69.PubMedView ArticleGoogle Scholar
  145. Yip PK, Jeng JS, Lu CJ: Hospital arrival after onset of different types of stroke in greater Taipei. Taiwan. J Formos Med Assoc. 2000, 99: 532-537.PubMedGoogle Scholar
  146. Zerwic J, Young Hwang S, Tucco L: Interpretation of symptoms and delay in seeking treatment by patients who have had a stroke: Exploratory study. Heart Lung. 2007, 36: 25-34. 10.1016/j.hrtlng.2005.12.007.PubMedView ArticleGoogle Scholar
  147. Goff DC, Sellers DE, McGovern PG, Meischke H, Goldberg RJ, Bittner V, Hedges JR, Scott Allender P, Nichaman MZ: Knowledge of heart attack symptoms in a population survey in the United States. Arch Intern Med. 1998, 158: 2329-2338. 10.1001/archinte.158.21.2329.PubMedView ArticleGoogle Scholar
  148. Sug Yoon S, Byles J: Perceptions of stroke in the general public and patients with stroke: A qualitative study. BMJ. 2002, 324: 1065-1068. 10.1136/bmj.324.7345.1065.View ArticleGoogle Scholar
  149. Kothari R, Sauerbeck L, Jauch E, Broderick J, Brott T, Khoury J, Liu T: Patients awareness of stroke signs, symptoms, and risk factors. Stroke. 1997, 28: 1871-1875.PubMedView ArticleGoogle Scholar
  150. Pancioli AM, Broderick J, Kothari R, Brott T, Tuchfarber A, Miller R, Khoury J, Jauch E: Public perception of stroke warning signs and knowledge of potential risk factors. JAMA. 1998, 279: 1288-1292. 10.1001/jama.279.16.1288.PubMedView ArticleGoogle Scholar
  151. Samsa GP, Cohen SJ, Goldstein LB, Bonito AJ, Duncan PW, Enarson C, Defriese GH, Horner RD, Matchar DB: Knowledge of risk among patients at increased risk for stroke. Stroke. 1997, 28: 916-921.PubMedView ArticleGoogle Scholar
  152. Jones SP, Jenkinson AJ, Leathley MJ, Watkins CL: Stroke knowledge and awareness: an integrative review of the evidence. Age and Ageing. 2010, 39: 11-22. 10.1093/ageing/afp196.PubMedView ArticleGoogle Scholar
  153. Segura T, Vega G, López S, Rubio F, Castillo J: Public perception of stroke in Spain. Cerebrovasc Dis. 2003, 16: 21-26. 10.1159/000070110.PubMedView ArticleGoogle Scholar
  154. Goldstein LB, Silberberg M, McMiller Y, Yaggy SD: Stroke-related knowledge among uninsured latino immigrants in Durham County, North Carolina. J Stroke Cerebrovasc Dis. 2009, 18: 229-231. 10.1016/j.jstrokecerebrovasdis.2008.10.009.PubMedView ArticleGoogle Scholar
  155. Herlitz J, Blohm M, Hartford M, Karlson BW, Luepker R, Holmberg S, Risenfors M, Wennerblom B: Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction. Eur Heart J. 1992, 13: 171-177.PubMedGoogle Scholar
  156. Gaspoz JM, Unger PF, Urban P, Chevrolet JC, Rutishauser W, Lovis C, Goldman L, Héliot C, Séchaud L, Mischle S, Waldvogel FA: Impact of a public campaign on pre-hospital delay in patients reporting chest pain. Heart. 1996, 76: 150-155. 10.1136/hrt.76.2.150.PubMed CentralPubMedView ArticleGoogle Scholar
  157. Ridker PM, Manson JE, Goldhaber SZ, Hennekens CH, Buring JE: Comparison of delay times to hospital presentation for physicians and non physicians with acute myocardial infarction. Am J Cardiol. 1992, 70: 10-13. 10.1016/0002-9149(92)91381-D.PubMedView ArticleGoogle Scholar
  158. Johnson Zerwic J: Symptoms of acute myocardial infarction: Exceptions of a community sample. Heart Lung. 1998, 27: 75-81. 10.1016/S0147-9563(98)90015-2.View ArticleGoogle Scholar
  159. Rustan A, Clayton J, Calnan M: Patient' action during their cardiac event: qualitative study exploring differences and modifiable factors. Brit Med J. 1998, 316: 1060-1065.View ArticleGoogle Scholar
  160. Tan TY, Chang KC, Liou CW: Factors delaying hospital arrival after acute stroke in southern Taiwan. Chang Gung Med J. 2002, 25: 458-463.PubMedGoogle Scholar
  161. Ritter MA, Brach S, Rogalewski A, Dittrich R, Dziewas R, Weltermann B, Heuschmann PU, Nabavi DG: Discrepancy between theoretical knowledge and real action in acute stroke: self-assessment as an important predictor of time to admission. Neurol Res. 2007, 29: 476-479. 10.1179/016164107X163202.PubMedView ArticleGoogle Scholar
  162. Hedges JR, Feldman HA, Bittner V, Goldberg RJ, Zapka J, Osganian SK, Murray DM, Simons-Morton DG, Linares A, Williams J, Luepker RV, Eisenberg MS: Impact of community intervention to reduce patient delay time on use of reperfusion theapy for acute myocardial infarction; rapid early action for coronary treatment (REACT) trial. Acad Emerg Med. 2000, 7: 862-872. 10.1111/j.1553-2712.2000.tb02063.x.PubMedView ArticleGoogle Scholar
  163. Dracup K, McKinley S, Riegel B, Moser DK, Meischke H, Doering LV, Davidson P, Paul SM, Baker H, Pelter M: A randomized clinical trial to reduce patient prehospital delay to treatment in acute coronary syndrome. Circ Cardiovasc Qual Outcomes. 2009, 2: 524-532. 10.1161/CIRCOUTCOMES.109.852608.PubMed CentralPubMedView ArticleGoogle Scholar
  164. Alberts MJ, Perry A, Dawson DV, Bertels C: Effects of public and professional education on reducing the delay in presentation and referral of stroke patients. Stroke. 1992, 23: 352-356.PubMedView ArticleGoogle Scholar
  165. Dornan WA, Stroink AR, Pegg EE, Kattner KA, Gupta KL, Hayden CJ, Dick HJ: Community stroke awareness program increases public knowledge of stroke. Stroke. 1998, 29: 288-Google Scholar
  166. Müller-Nordhorn J, Wegscheider K, Nolte CH, Jungehülsing GJ, Rossnagel K, Reich A, Roll S, Willringer A, Willich SN: Population-based intervention to reduce prehospital delays in patients with cerebrovascular events. Arch Intern Med. 2009, 169: 1484-1490. 10.1001/archinternmed.2009.232.PubMedView ArticleGoogle Scholar
  167. Morgenstern LB, Bartholomew LK, Grotta JC, Staub L, King M, Chan W: Sustained benefit of a community and professional intervention to increase acute stroke therapy. Arch Intern Med. 2003, 163: 2198-2202. 10.1001/archinte.163.18.2198.PubMedView ArticleGoogle Scholar
  168. Morgenstern LB, Gonzales NR, Maddox KE, Brown DL, Karim AP, Espinosa N, Moyé LA, Pary JK, Grotta JC, Lisabeth LD, Conley KM: A randomized controlled trial to teach middle school children to recognize stroke and call 911: The kids identifying and defeating stroke project. Stroke. 2007, 38: 2972-2978. 10.1161/STROKEAHA.107.490078.PubMedView ArticleGoogle Scholar
  169. Schneider AT, Pancioli AM, Khoury JC, Rademacher E, Tuchfarber A, Miller R, Woo D, Kissela B, Broderick JP: Trends in community knowledge of the warning signs and risk factors for stroke. JAMA. 2003, 289: 343-346. 10.1001/jama.289.3.343.PubMedView ArticleGoogle Scholar
  170. Rasmussen CH, Munck A, Kragstrup I, Haghfelt T: Patient delay from onset of chest pain suggesting acute coronary syndrome to hospital admission. Scand Cardiovasc J. 2003, 37: 183-186. 10.1080/14017430310014920.PubMedView ArticleGoogle Scholar
  171. Henriksson C, Larsson M, Arnetz J, Berglin-Jarlöv M, Herlitz J, Karlsson J-E, Svensson L, Thuresson M, Zedigh C, Wernroth L, Lindahl B: Knowledge and attitudes toward seeking medical care for AMI-symptoms. Intern J Cardiol. 2010,Google Scholar
  172. Henriksson C, Lindahl B, Larsson M: Patients' and relatives' thoughts and actions during and after symptom presentation for an acute myocardial infarction. Eur J Cardiovasc Nurs. 2007, 6: 280-286. 10.1016/j.ejcnurse.2007.02.001.PubMedView ArticleGoogle Scholar
  173. Lovlien M, Schei B, Hole T: Prehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction. Eur J Cardiovasc Nurs. 2007, 6: 308-313. 10.1016/j.ejcnurse.2007.03.002.PubMedView ArticleGoogle Scholar
  174. Hackett TP, Cassem NH: Factors contributing to delay in responding to the signs and symptoms of acute myocardial infarction. Am J Cardiol. 1969, 24: 651-658. 10.1016/0002-9149(69)90452-4.PubMedView ArticleGoogle Scholar
  175. Alonzo AA: The impact of the family and lay others on care-seeking during life-threatening episodes of suspected coronary artery disease. Soc Sci Med. 1986, 22: 1297-1311. 10.1016/0277-9536(86)90093-6.PubMedView ArticleGoogle Scholar
  176. Løvlien M, Schei B, Hole T: Myocardial infarction: psychosocial aspects, gender differences and impact pre-hospital delay. J Adv Nursing. 2008, 63: 148-154. 10.1111/j.1365-2648.2008.04654.x.View ArticleGoogle Scholar
  177. Sullivan MD, Ciechanowski PS, Russo JE, Soine LA, Jordan-Keith K, Ting HH, Caldwell JH: Understanding why patients delay seeking care for acute coronary syndromes. Circ Cardiovasc Qual Outcomes. 2009, 2: 148-154. 10.1161/CIRCOUTCOMES.108.825471.PubMedView ArticleGoogle Scholar
  178. Sramek M, Post W, Koster RW: Telephone triage of cardiac emergency calls by dispatchers. A prospective study. Br Heart J. 1994, 71: 440-445. 10.1136/hrt.71.5.440.PubMed CentralPubMedView ArticleGoogle Scholar
  179. Herlitz J, Bång A, Isaksson L, Karlsson T: Ambulance despatchers' estimation of intensity of pain and presence of associated symptoms in relation to outcome among patients who call for an ambulance because of acute chest pain. Eur Heart J. 1995, 16: 1789-1794.PubMedGoogle Scholar
  180. Gellerstedt M, Bång A, Herlitz J: Could a computer-based system including a prevalence function support emergency medical systems and improve the allocation of life support level?. Eur J Emerg Med. 2006, 13: 290-294. 10.1097/00063110-200610000-00009.PubMedView ArticleGoogle Scholar
  181. Rajajee V, Saver J: Prehospital care of the acute stroke patient. Tech Vasc Interventional Rad. 2005, 8: 74-80. 10.1053/j.tvir.2005.03.004.View ArticleGoogle Scholar
  182. Grijseels EWM, Deckers JW, Hoes AW, Hartman JAM, Der van Does E, Van Loenen E, Simoons ML: Pre-hospital triage of patients with suspected myocardial infarction. Evaluation of previously developed algorithms and new proposals. Eur Heart J. 1995, 16: 325-332.PubMedGoogle Scholar
  183. Canto JG, Rogers WJ, Bowlby LJ, French WJ, Pearce DJ, Weaver WD, for the National Registry of Myocardial Infarction 2 Investigators: The prehospital electrocardiogram in acute myocardial infarction: Is its full potential being realized?. J Am Coll Cardiol. 1997, 29: 498-505. 10.1016/S0735-1097(96)00532-3.PubMedView ArticleGoogle Scholar
  184. Svensson L, Isaksson L, Axelsson C, Nordlander R, Herlitz J: Predictors of myocardial damage prior to hospital admission among patients with acute chest pain or other symptoms raising a suspicion of acute coronary syndrome. Cor Art Dis. 2003, 14 (3): 225-231. 10.1097/00019501-200305000-00006.Google Scholar
  185. Herlitz J, Svensson L: The value of biochemical markers for risk stratification prior to hospital admission in acute chest pain. Acute Cardiac Care. 2008, 10: 197-204. 10.1080/17482940802409662.PubMedView ArticleGoogle Scholar
  186. Brice JH, Evenson KR, Lellis JC, Rosamond WD, Aytur SA, Christian JB, Morris DL: Emergency Medical Services Education, Community Outreach, and Protocols for Stroke and Chest Pain in North Carolina. Prehosp Emerg Care. 2008, 12: 366-371. 10.1080/10903120802100100.PubMedView ArticleGoogle Scholar
  187. Harbison J, Hossain O, Jenkinson D, Davis J, Louw SJ, Ford GA: Diagnostic accuracy of stroke referrals from primary care emergency room physicians and ambulance staff using the face arm speech test. Stroke. 2003, 34: 71-76. 10.1161/01.STR.0000044170.46643.5E.PubMedView ArticleGoogle Scholar
  188. Morrison LJ, Verbeek PR, McDonald AC, Sawadsky BV, Cook DJ: Mortality and prehospital thrombolysis for acute myocardial infarction. A metaanalysis. JAMA. 2000, 283: 2686-2692. 10.1001/jama.283.20.2686.PubMedView ArticleGoogle Scholar
  189. Engelberg S, Singer AJ, Moldashel J, Sciammarella J, Thode HC, Henry M: Effects of prehospital nitroglycerin on hemodynamics and chest pain intensity. Prehosp Emerg Care. 2000, 4: 290-293. 10.1080/10903120090940967.PubMedView ArticleGoogle Scholar
  190. Bång A, Herlitz J, Grip L, Caidahl K, Karlsson T, Kihlgren S, Hartford M: (Letter to the Editor) The relative influence of age, previous history and therapeutic strategies prior to hospital admission among ambulance transported patients with ST-elevation myocardial infarction. Inter J Cardiol. 2009, 136: 213-214. 10.1016/j.ijcard.2008.04.014.View ArticleGoogle Scholar
  191. Gardtman M, Waagstein L, Karlsson T, Herlitz J: Has an intensified treatment in the ambulance of patients with acute severe left heart failure improved the outcome?. Eur J Emerg Med. 2000, 7: 15-24.PubMedView ArticleGoogle Scholar
  192. Saver JL, Kidwell C, Eckstein M, Starkman S: Prehospital neuroprotective therapy for acute stroke: results of the field administration of stroke therapy - Magnesium (FAST-MAG) Pilot Trial. Stroke. 2004, 35: e106-e108. 10.1161/01.STR.0000124458.98123.52.PubMedView ArticleGoogle Scholar
  193. Burns JMA, Hogg KJ, Rae AP, Hillis WS, Dunn FG: Impact of a policy of direct admission to a coronary care unit on use of thrombolytic treatment. Br Heart J. 1989, 61: 322-325. 10.1136/hrt.61.4.322.PubMed CentralPubMedView ArticleGoogle Scholar
  194. Pell ACH, Miller HC, Robertson CE, Fox KAA: Effect of "fast track" admission for acute myocardial infarction on delay to thrombolysis. Br Med J. 1992, 304: 83-87. 10.1136/bmj.304.6819.83.View ArticleGoogle Scholar
  195. Millar-Craig MW, Joy AV, Adamowicz M: Reduction in treatment delay by paramedic ECG diagnosis of myocardial infarction with direct CCU admission. Heart. 1997, 78: 456-461.PubMed CentralPubMedView ArticleGoogle Scholar
  196. Prasad N, Wright A, Hogg KJ, Dunn FG: Direct admission to the coronary care unit by the ambulance service for patients with suspected myocardial infarction. Heart. 1997, 78: 462-464.PubMed CentralPubMedView ArticleGoogle Scholar
  197. van't Hof AWJ, Rasoul S, van de Wetering H, Ernst N, Suryapranata H, Hoorntje JCA, Dambrink JHE, Gosselink M, Zijlstra F, Ottervanger JP, de Boer M-J: Feasibility and benefit of prehospital diagnosis, triage and therapy by paramedics only in patients who are candidates for primary angioplasty for acute myocardial infarction. Am Heart J. 2006, 151: 1255e1-1255e5.View ArticleGoogle Scholar
  198. Amit G, Cafri C, Gilutz H, Ilia R, Zahger D: Benefit of direct ambulance to coronary care unit admission of acute myocardial infarction patients undergoing primary percutaneous intervention. Inter J Cardiol. 2007, 119: 355-358. 10.1016/j.ijcard.2006.08.009.View ArticleGoogle Scholar
  199. Gross BW, Dauterman KW, Moran MG, Kotler TS, Schnugg SJ, Rostykus PS, Ross AM, Weaver WD: An approach to shorten time to infarct artery patency in patients with ST-segment elevation myocardial infarction. Am J Cardiol. 2007, 99: 1360-1363. 10.1016/j.amjcard.2006.12.058.PubMedView ArticleGoogle Scholar
  200. Dalby M, Kharbanda R, Ghimire G, Spiro J, Moore P, Roughton M, Lane R, Al-Obaidi M, Teoh M, Hutchison E, Whitbread M, Fountain D, Grocott-Mason R, Mitchell A, Mason M, Ilsley C: Achieving routine sub 30 minute door-to-balloon times in a high volume 24/7 primary angioplasty center with autonomous ambulance diagnosis and immediate catheter laboratory access. Am Heart J. 2009, 158: 829-835. 10.1016/j.ahj.2009.08.012.PubMedView ArticleGoogle Scholar
  201. Steg PG, Cambou JP, Goldstein P, Durand E, Sauval P, Kadri Z, Blanchard D, Lablanche J-M, Guéret P, Cottin Y, Juliard J-M, Hanania G, Vaur L, Danchin N: Bypassing the emergency room reduces delays and mortality in ST elevation myocardial infarction: the USIC 2000 registry. Heart. 2006, 92: 1378-1383. 10.1136/hrt.2006.101972.PubMed CentralPubMedView ArticleGoogle Scholar
  202. Bång A, Grip L, Herlitz J, Kihlgren S, Karlsson T, Caidahl K, Hartford M: Lower mortality after prehospital recognition and treatment followed by fast tracking to coronary care compared with admittance via emergency department in patients with ST-elevation myocardial infarction. Inter J Cardiol. 2008, 129: 325-332. 10.1016/j.ijcard.2007.09.001.View ArticleGoogle Scholar
  203. Porter G, Doughty R, Gamble G, Sharpe N: Thrombolysis in acute myocardial infarction: reducing in hospital treatment delay. New Zealand Med J. 1995, 108: 443-Google Scholar
  204. Lipton JA, Broce M, Lucas D, Mimnagh K, Matthews A, Reyes B, Burdette J, Wagner GS, Warren SG: Comprehensive hospital care improvement strategies reduce time to treatment in ST-elevation acute myocardial infarction. Crit Pathw Cardiol. 2006, 5: 29-33.PubMedView ArticleGoogle Scholar
  205. Lai C-L, Fan C-M, Liao P-C, Tsai K-C, Yang C-Y, Chu S-H, Chien K-L: Impact of an audit program and other factors on door to balloon times in acute ST-elevation myocardial infarction patients destined for primary coronary intervention. Acad Emerg Med. 2009, 16: 333-342. 10.1111/j.1553-2712.2009.00372.x.PubMedView ArticleGoogle Scholar
  206. Atzema CL, Austin PC, Tu JV, Schull MJ: Emergency department triage of acute myocardial infarction patients and the effect on outcomes. Ann Emerg Med. 2009, 53: 736-745. 10.1016/j.annemergmed.2008.11.011.PubMedView ArticleGoogle Scholar
  207. Schull MJ, Vermeulen M, Slaughter G, Morrison L, Daly P: Emergency department crowding and thrombolysis delays in acute myocardial infarction. Ann Emerg Med. 2004, 44: 577-585. 10.1016/j.annemergmed.2004.05.004.PubMedView ArticleGoogle Scholar
  208. Diercks DB, Kirk JD, Lindsell CJ, Pollack CV, Hoekstra JW, Gibler WB, Hollander JE: Door-to-ECG time in patients with chest pain presenting to the ED. Am J Emerg Med. 2006, 24: 1-7. 10.1016/j.ajem.2005.05.016.PubMedView ArticleGoogle Scholar
  209. Phelan MP, Glauser J, Smith E, Martin C, Schrump S, Mahone P, Peacoock WF: Improving emergency department door-to-electrocardiogram time in ST-segment elevation myocardial infarction. Crit Pathw Cardiol. 2009, 8: 119-121.PubMedView ArticleGoogle Scholar
  210. Nedeltchev K, Arnold M, Brekenfeld C, Isenegger J, Remonda L, Schroth G, Mattle HP: Pre- and in-hospital delays from stroke onset to intra-arterial thrombolysis. Stroke. 2003, 34: 1230-1234. 10.1161/01.STR.0000069164.91268.99.PubMedView ArticleGoogle Scholar
  211. Belvis R, Cocho D, Marti-Fàbregas J, Pagonabarraga J, Aleu A, Garcia-Bargo MD, Pons J, Coma E, Garcia-Alfranca F, Jiménes-Fàbrega X, Marti-Vilalta JL: Benefits of a prehospital stroke code system. Feasibility and efficacy in the first year of clinical practice in Barcelona, Spain. Cerebrovasc Dis. 2005, 19: 96-101. 10.1159/000082786.PubMedView ArticleGoogle Scholar
  212. Hamidon BB, Dewey HM: Impact of acute stroke team emergency calls on in-hospital delays in acute stroke care. J Clin Neuroscience. 2007, 14: 831-834. 10.1016/j.jocn.2006.03.029.View ArticleGoogle Scholar
  213. Gomez CR, Malkoff MD, Sauer CM, Tulyapronchote R, Burch CM, Banet GA: Code stroke. An attempt to shorten inhospital therapeutic delays. Stroke. 1994, 25: 1920-1923.PubMedView ArticleGoogle Scholar
  214. Kim SK, Lee SY, Bae HJ, Lee YS, Kim SY, Kang MJ, Cha JK: Prehospital notification reduced the door-to-needle time for iv t-PA in acute ischaemic stroke. Eur J Neurology. 2009, 16: 1331-1335. 10.1111/j.1468-1331.2009.02762.x.View ArticleGoogle Scholar
  215. Nazir FS, Petre I, Dewey HM: Introduction of an acute stroke team: An effective approach to hasten assessment and management of stroke in the emergency department. J Clin Neuroscience. 2009, 16: 21-25. 10.1016/j.jocn.2008.02.004.View ArticleGoogle Scholar
  216. Quain DA, Parsons MW, Loudfoot AR, Spratt NJ, Evans MK, Russell ML, Royan AT, Moore AG, Miteff F, Hullick C, Attia J, McElduff P, Levi CR: Improving access to acute stroke therapies: a controlled trial of organised pre-hospital and emergency care. MJA. 2008, 189: 429-433.PubMedGoogle Scholar
  217. Nam HS, Han SW, Ahn SH, Lee JY, Choi H-Y, Park IC, Heo JH: Improved time intervals by implementation of computerized physician order entry-based stroke team approach. Cerebrovasc Dis. 2007, 23: 289-293. 10.1159/000098329.PubMedView ArticleGoogle Scholar
  218. Terkelsen CJ, Lassen JF, Nørgaard BL, Gerdes JC, Poulsen SH, Bendix K, Ankersen JP, Gøtzsche LB-H, Rømer FK, Nielsen TT, Andersen HR: Reduction of treatment delay in patients with ST-elevation myocardial infarction: impact of pre-.hospital diagnosis and direct referral to primary percutanous coronary intervention. Eur Heart J. 2005, 26: 770-777. 10.1093/eurheartj/ehi100.PubMedView ArticleGoogle Scholar
  219. Sejersten M, Sillesen M, Hansen PR, Nielsen SL, Nielsen H, Trautner S, Hamptom D, Wagner GS, Clemmensen P: Effect on treatment delay of prehospital teletransmission of 12-lead electrocardiogram to a cardiologist for immediate triage and direct referral of patients with ST-segment elevation acute myocardial infarction to primary percutaneous coronary intervention. Am J Cardiol. 2008, 101: 941-946.PubMedView ArticleGoogle Scholar
  220. Rokos IC, Larson DM, Henry TD, Koenig WJ, Eckstein M, French WJ, Granger CB, Roe MT: Rationale for establishing regional ST-elevation myocardial infarction receiving center (SRC) networks. Am Heart J. 2006, 152: 661-667. 10.1016/j.ahj.2006.06.001.PubMedView ArticleGoogle Scholar
  221. Pedragosa A, Alvarez-Sabin J, Molina CA, Sanclemente C, Martin MC, Alonso F, Ribo M: Impact of a telemedicine system on acute stroke care in a community hospital. J Telemed Telecare. 2009, 15: 260-263. 10.1258/jtt.2009.090102.PubMedView ArticleGoogle Scholar
  222. Mitka M: Groups Back Telemedicine for Stroke Care. JAMA. 2009, 302: 20-21. 10.1001/jama.2009.890.PubMedView ArticleGoogle Scholar
  223. Audebert HJ, Schultes K, Tietz V, Heuschmann PU, Bogdahn U, Haberl RL, Schenkel J: Long-term effects of specialized stroke care with telemedicine support in community hospitals on behalf of the Telemedical Project for Integrative Stroke Care. Stroke. 2009, 40: 902-908. 10.1161/STROKEAHA.108.529255.PubMedView ArticleGoogle Scholar
  224. Schwamm LH, Audebert HJ, Amarenco P, Chumbler NR, Frankel MR, George MG, Gorelick PB, Horton KB, Kaste M, Lackland DT, Levine SR, Meyer BC, Meyers PM, Patterson V, Stranne SK, White CJ: Recommendations for the implementation of telemedicine within stroke systems of care. A policy statement from the American Heart Association. Stroke. 2009, 40: 2635-2660. 10.1161/STROKEAHA.109.192361.PubMedView ArticleGoogle Scholar
  225. Pervez MA, Silva G, Masrur S, Betensky RA, Furie KL, Hidalgo R, Lima F, Rosenthal ES, Rost N, Viswanathan A, Schwamm LH: Remote supervision of IV-tPA for acute ischemis stroke by telemedicine or telephone before transfer to a regional stroke center is feasible and safe. Stroke. 2010, 41: e18-e24. 10.1161/STROKEAHA.109.560169.PubMed CentralPubMedView ArticleGoogle Scholar
  226. Vaishnav AG, Pettigrew LC, Ryan S: Telephonic guidance of systemic thrombolysis in acute ischemic stroke: Safety outcome in rural hospitals. Clin Neurol Neurosurg. 2008, 110: 451-454. 10.1016/j.clineuro.2008.01.010.PubMedView ArticleGoogle Scholar

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