• Abdul Moiz Hafiz, Srihari S Naidu, Joshua DeLeon, Basil Alkhatib, Miguel Lorenz, Barry Rosenthal, and Kevin Marzo.
• Division of Cardiology, Winthrop University Hospital, Mineola, NY 11501, USA.
• Am J Emerg Med. 2013 Jun 1;31(6):922-7.

ObjectivesTo determine effect of first medical contact type on symptom onset-to-door time (SODT).BackgroundShorter total ischemic time is associated with improved outcomes in ST-elevation myocardial infarction.MethodsFrom 2005 to 2009, we reviewed records of all consecutive patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction at our tertiary care teaching hospital (median follow-up 3.85 years). We compared SODT in patients whose first medical contact was a private physician (in person or via telephone) vs patients who presented to the emergency department (ED) directly (in person or via Emergency Medical Services).ResultsOf 366 patients, 84 (23%) contacted a physician (group A) while 282 (77.6%) did not (group B). Group A had higher median SODT (239.5 vs 130 minutes, P = .0043) and significantly higher mortality (log rank P = .0392, Cox Proportional Hazard Model risk factors: physician contact first [P < .013], age [P < .0001] and peripheral vascular disease [P < .035]). Two factors associated with prolonged SODT: (1) contacting a physician first P = .002 and (2) personal mode of transportation, P = .002. Patients presenting during "on-hours" (weekdays) were more likely to first contact a physician compared with those presenting during "off-hours" (weeknights and weekends) (66.67% in group A vs 45.04% in group B, P < .001).ConclusionsPatients whose first medical contact was a physician had greater pre-hospital delays and worse survival compared to those who sought emergent medical care directly. This pattern occurred more often during "on-hours." Educational efforts aimed at both patient and physician office practices are warranted.Copyright © 2013 Elsevier Inc. All rights reserved.

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