Risk assessment is a con- tinuous process that should be repeated throughout hospital- ization and at time of discharge. 3. Onset of MI 3.1. Patient-Related Delays and Initial Treatment Patients with STEMI do not seek medical care for approxi- mately 1.5 to 2 hours after symptom onset, and little change in this interval has occurred over the past 10 years.50,51 Patient delay times are often longer in women, blacks, the elderly, and Medicaid-onlyrecipientsandareshorterforMedicarerecipients (compared with privately insured patients) and patients who are taken directly to the hospital by emergency medical services Patients may delay seeking care because their symptoms differ from their preexisting bias that a heart attack should present dramatically with severe, crushing chest Approximately one third of patients with MI experience symptoms other than chest pain.7 Other reasons for delay in seeking treatment include 1) inappropriate reasoning that symp- toms will be self-limited or are not serious55 57 ; 2) attribution of symptoms to other preexisting conditions; 3) fear of embarrass- ment should symptoms turn out to be a false alarm ; 4) reluc- stereotypes of who is at risk for a heart attack, an especially common trait among women59 ; 6) lack of knowledge of the importance of rapid action, the benefits of calling EMS or 9-1-1, and the availability of reperfusion therapies54 ; and 7) attempted self-treatment with prescription and/or nonprescrip- To avoid such delays, healthcare providers should assist patients when possible in making anticipatory plans for timely recognition and response to an acute event. Family members, close friends, or advocates also should be enlisted as reinforcement for rapid action when the patient experiences symptoms of possible STEMI.60,61 Discussions should include a review of instructions for taking aspirin62 and nitroglycerin in response to chest pain. 