The efficacy of the timely administration of thrombolytic treatment in the clinical management of acute myocardial infarction (MI) is well established. Large scale clinical trials have conclusively shown that the earlier the administration of such treatment, the greater the morbidity and mortality advantage.1 The demonstration of this time dependent relation has prompted research into factors that contribute to the delay interval between symptom onset and hospital presentation. The failure of sociodemographic and clinical factors to be consistently related to pre-hospital delay2 has recently focused attention on how patients make sense of their symptoms and determine whether they need urgent medical help.

Building on a recent study which found that patient delay was associated with a discrepancy between symptom experience and prior symptom expectation of MI,3 we extended the scope of this research by also investigating whether delay was related to having a family member present or to behaviours such as self medication before calling for help. We evaluated a consecutive sample comprising 47 participants with a confirmed diagnosis of acute MI (38 men and nine women with a mean (SD) age of 62 (13.4) years). Thirty eight per cent of the sample had a family history of MI and 15% of participants had experienced a previous MI.

Patients were required to recall both the symptoms experienced as part of their …