Circulation, Vol 84, 1969-1976, Copyright © 1991 by American Heart Association
LW Kenyon, MW Ketterer, M Gheorghiade and S Goldstein
BACKGROUND. Prior studies have had difficulty identifying factors that
significantly explain patients' delay in responding to symptoms of acute
myocardial infarction (AMI). METHODS AND RESULTS. We therefore examined
factors affecting the time between symptom onset and hospital arrival for
103 AMI patients admitted to a Detroit metropolitan hospital between
October 1989 and January 1990. Variables evaluated included demographic and
medical history factors, psychological characteristics of somatic and
emotional awareness, and type A behavior. The mean prehospital delay time
was 9.0 +/- 10.8 hours (median, 5.0 hours; range, 0.25-62.0 hours). Delay
time was not significantly associated with demographic or medical history
categories or with type A behavior. Of study variables that can be
identified prior to evolution of an AMI, somatic and emotional awareness
were the only factors significantly predictive of delay time. Patients who
were more capable of identifying inner experiences of emotions and/or
bodily sensations sought treatment significantly earlier than patients with
low emotional or somatic awareness (low emotional awareness median delay,
12.8 hours; high emotional awareness median delay, 3.8 hours; low somatic
awareness median delay, 7 hours; high somatic awareness median delay, 4
hours). CONCLUSIONS. Variations in sensitivity to bodily sensations and
emotions appear to play an important role in treatment seeking and thus
potentially in treatment outcome for AMI patients. Assessment of these
characteristics in patients with coronary risk factors could allow early
identification of persons at risk of excessive delay in responding to
symptoms of AMI.
ARTICLES
Psychological factors related to prehospital delay during acute myocardial infarction
Department of Psychiatry, Henry Ford Hospital, Detroit, MI 48202.
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