In quality-of-life research, the current challenge is to devise models to clarify the elements of health-related quality of life (HRQOL) and the causal relationships among them. This revision of Wilson and Cleary's model includes a taxonomy of the variables that often have been used to measure HRQoL. This revision should be useful in research and clinical practice.

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Abstract-Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research. Key Words: AHA Scientific Statements Ⅲ acute coronary syndrome Ⅲ stroke Ⅲ delivery of health care D espite major advances in identifying effective treatments for heart attack and stroke, there are substantial difficulties in applying these treatments to care. The weak link in the chain of events leading to prompt and effective treatment is patient delay in seeking care. More than 50% of the 1.2 million people who suffer an acute myocardial infarction (AMI) or coronary death each year in the United States die in an emergency department (ED) or before reaching a hospital within an hour of symptom onset. 1 About 700 000 individuals will have a stroke each year, 167 000 of those who have strokes will die, and more will suffer a major disability. 1 Of the stroke deaths that occur each year, almost half occur before the patient reaches the hospital. 2 Many of these deaths and significant disability could be prevented if patients received earlier treatment. 1,3 Although the benefits of early treatment of heart attack and stroke are clear, only a minority of eligible patients receive optimally timed treatment for their symptoms because of delay in seeking care. The development and use of appropriate interventions to decrease treatment-seeking delay by patients could produce important gains in reducing death and disability from heart attack and stroke. Unfortunately, efforts to date to develop effective interventions have met with disappointing results. 4 -6 Accordingly, the purpose of this statement is to summarize the evidence that demonstrates the benefits of early treatment, 1,2 describes the extent of the problem of patient delay, 3 identifies the factors related to patient delay in seeking timely treatment, and reveals the inadequacies of our current approaches to decreasing patient delay. 4 Finally, we offer suggestions for clinical practice and future research. Benefits of Early TreatmentThe burden of cardiovascular disease is growing worldwide. Ischemic heart disease is the No. 1 cause of death in the The findings and conclusions in this scientific statement are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention and the National Heart, Lung, and Blood Institute.The American Heart Association makes every effort to av...

Symptoms of AMI occur in clusters, and these clusters vary among persons. None of the clusters identified in this study included all of the symptoms that are included typically as symptoms of AMI (chest discomfort, diaphoresis, shortness of breath, nausea, and lightheadedness). These AMI symptom clusters must be communicated clearly to the public in a way that will assist them in assessing their symptoms more efficiently and will guide their treatment-seeking behavior. Symptom clusters for AMI must also be communicated to the professional community in a way that will facilitate assessment and rapid intervention for AMI.

The reasons for delay differed in part by sex and race.

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The findings demonstrated similarities in symptom clusters during ACS, MI, and HF, despite multiple methods and analyses. These results may help clinicians to prepare at-risk patients for proper treatment-seeking and symptom self-management behaviors.