This study assessed components and determinants of pre-hospital delay in patients with acute coronary syndromes (ACS) admitted to Middlemore Hospital Coronary Care Unit between January 2009 and July 2010. Pre-hospital delay was defined as the time from onset of worst symptom(s) to defibrillator availability: either ambulance arrival at the scene or time of hospital arrival (non-ambulance patients). For 805 patients the median delay from symptom onset to defibrillator availability was 174 minutes; the delay to defibrillator availability was >3 hours for 50% of the cohort. The median delay was an hour longer for patients from areas of greatest deprivation compared with those from less deprived areas (208 vs 149 min; p=0.015) and 7 hours longer for non-ambulance vs ambulance patients (553 vs 130 min; p<0.001). Māori, Pacific, Indian and those from areas of higher deprivation were less likely to travel to hospital by ambulance. Of ST-elevation myocardial infarction patients eligible for reperfusion, over two-thirds of the total delay between symptom onset and reperfusion occurred pre-hospital.
