Abstract
Survival in the acute phase of myocardial infarction and the subsequent prognosis are critically dependent on the time between onset of symptoms and medical intervention. Studies have shown that the time that patients take to decide to seek help accounts for most of the delay. We documented the length of time from onset of symptoms to arrival in hospital for 201 patients consecutively admitted to one of four hospitals in the Regional Municipality of Ottawa-Carleton between October 1986 and February 1987 for suspected acute myocardial infarction. Of the 160 survivors 42% waited more than 4 hours (a critical time for effective thrombolytic therapy) before coming to hospital, and nearly a third did not arrive within 6 hours. On the basis of interviews conducted with 42 patients, sociodemographic factors, education, past experience with an acute myocardial infarction, a previous diagnosis of angina and a coronary-prone behaviour pattern did not explain the delay. How patients perceived the seriousness of their symptoms and how they used other illness-related coping strategies explained 46% of the variance in the delay. Interventions aimed at reducing the delay between onset of symptoms and treatment must focus on patients' preadmission behaviour.
Full text
PDFSelected References
These references are in PubMed. This may not be the complete list of references from this article.
- Doehrman S. R. Psycho-social aspects of recovery from coronary heart disease: a review. Soc Sci Med. 1977 Feb;11(3):199–218. doi: 10.1016/0037-7856(77)90094-4. [DOI] [PubMed] [Google Scholar]
- Gentry W. D., Haney T. Emotional and behavioral reaction to acute myocardial infarction. Heart Lung. 1975 Sep-Oct;4(5):738–745. [PubMed] [Google Scholar]
- Goldstein S., Moss A. J., Greene W. Sudden death in acute myocardial infarction. Relationship to factors affecting delay in hospitalization. Arch Intern Med. 1972 May;129(5):720–724. [PubMed] [Google Scholar]
- Hackett T. P., Cassem N. H. Development of a quantitative rating scale to assess denial. J Psychosom Res. 1974 Apr;18(2):93–100. doi: 10.1016/0022-3999(74)90072-5. [DOI] [PubMed] [Google Scholar]
- Hackett T. P., Cassem N. H. Factors contributing to delay in responding to the signs and symptoms of acute myocardial infarction. Am J Cardiol. 1969 Nov;24(5):651–658. doi: 10.1016/0002-9149(69)90452-4. [DOI] [PubMed] [Google Scholar]
- Hackett T. P., Cassem N. H., Wishnie H. A. The coronary-care unit. An appraisal of its psychologic hazards. N Engl J Med. 1968 Dec 19;279(25):1365–1370. doi: 10.1056/NEJM196812192792504. [DOI] [PubMed] [Google Scholar]
- Jones R. A., Wiese H. J., Moore R. W., Haley J. V. On the perceived meaning of symptoms. Med Care. 1981 Jul;19(7):710–717. doi: 10.1097/00005650-198107000-00002. [DOI] [PubMed] [Google Scholar]
- Kennedy J. W., Atkins J. M., Goldstein S., Jaffe A. S., Lambrew C. T., McIntyre K. M., Mueller H. S., Paraskos J. A., Weaver W. D. Recent changes in management of acute myocardial infarction: implications for emergency care physicians. J Am Coll Cardiol. 1988 Feb;11(2):446–449. doi: 10.1016/0735-1097(88)90114-3. [DOI] [PubMed] [Google Scholar]
- Mathey D. G., Sheehan F. H., Schofer J., Dodge H. T. Time from onset of symptoms to thrombolytic therapy: a major determinant of myocardial salvage in patients with acute transmural infarction. J Am Coll Cardiol. 1985 Sep;6(3):518–525. doi: 10.1016/s0735-1097(85)80107-8. [DOI] [PubMed] [Google Scholar]
- Matthews K. A., Siegel J. M., Kuller L. H., Thompson M., Varat M. Determinants of decisions to seek medical treatment by patients with acute myocardial infarction symptoms. J Pers Soc Psychol. 1983 Jun;44(6):1144–1156. doi: 10.1037//0022-3514.44.6.1144. [DOI] [PubMed] [Google Scholar]
- Mitic W. R., Perkins J. The effect of a media campaign on heart attack delay and decision times. Can J Public Health. 1984 Nov-Dec;75(6):414–418. [PubMed] [Google Scholar]
- Moss A. J., Goldstein S. The pre-hospital phase of acute myocadial infarction. Circulation. 1970 May;41(5):737–742. doi: 10.1161/01.cir.41.5.737. [DOI] [PubMed] [Google Scholar]
- Safer M. A., Tharps Q. J., Jackson T. C., Leventhal H. Determinants of three stages of delay in seeking care at a medical clinic. Med Care. 1979 Jan;17(1):11–29. doi: 10.1097/00005650-197901000-00002. [DOI] [PubMed] [Google Scholar]
- Sheehan F. H. Determinants of improved left ventricular function after thrombolytic therapy in acute myocardial infarction. J Am Coll Cardiol. 1987 Apr;9(4):937–944. doi: 10.1016/s0735-1097(87)80252-8. [DOI] [PubMed] [Google Scholar]
- Simon A. B., Feinleib M., Thompson H. K., Jr Components of delay in the pre-hospital phase of acute myocardial infarction. Am J Cardiol. 1972 Oct;30(5):476–482. doi: 10.1016/0002-9149(72)90037-9. [DOI] [PubMed] [Google Scholar]
- White C. W., Albanese M. A. Changes in cardiovascular health knowledge occurring from childhood to adulthood. A cross-sectional study. Circulation. 1981 May;63(5):1110–1115. doi: 10.1161/01.cir.63.5.1110. [DOI] [PubMed] [Google Scholar]
- Wielgosz A. T., Earp J. Perceived vulnerability to serious heart disease and persistent pain in patients with minimal or no coronary disease. Psychosom Med. 1986 Jan-Feb;48(1-2):118–124. doi: 10.1097/00006842-198601000-00010. [DOI] [PubMed] [Google Scholar]