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care seeking, delay, heart failure, self-care



  1. Sethares, Kristen A. PhD, RN, CNE
  2. Sosa, Mary-Elizabeth MS, RN
  3. Fisher, Paige BA
  4. Riegel, Barbara DNSc, RN, FAAN, FAHA


Background: Despite reports that persons with heart failure (HF) symptoms delay up to 7 days before seeking treatment, few studies have prospectively explored specific factors influencing treatment-seeking delay in this population.


Objective: The purpose of this study was to explore how factors related to the symptom experience, such as perception (number and intensity), evaluation (attribution and understanding), and response (behaviors of patients and others) influence delay in seeking treatment for symptoms of acute decompensated HF.


Methods: Patients hospitalized for acute HF were enrolled into an exploratory, descriptive study. Only those who had HF for 3 months or longer and a previous HF admission were eligible. Data on factors related to the symptom experience, response to symptoms, and delay time were collected by interview during hospitalization. Delay time measured in hours was analyzed using generalized linear modeling.


Results: The sample of 131 adults was predominately older (77 +/- 11.3 years) men (55.7%). The median delay time was 60 hours (2.5 days), with a range of 1 to 336 hours (14 days). Only 34 (25.9%) sought care in less than 12 hours. Three variables were statistically significant determinants of long delay time-waiting to see if the symptoms would abate, receiving a passive response to symptoms from others, and living in a rural environment. These variables explained 13.9% of the variance in delay time. Clinical characteristics were not significant predictors of delay.


Conclusions: The response of patients (wait-and-see) and others (eg, don't worry) contributed to delay, as did living in a rural environment. Evaluative characteristics of attribution and understanding were not significant determinants of delay, suggesting that patient education alone will not effectively decrease delay. Instead, interventions directed toward decision making in response to symptoms and inclusion of family members in such discussions may be more effective.