[Patient-specific determinants of delay in goal-oriented patient behavior in acute myocardial infarct. Results of the post-infarct late potential study].
369 (63%) of 586 consecutive patients with confirmed myocardial infarction were admitted to hospital within 6 h of symptom onset. Patients' arrival to hospital followed a characteristic circadian distribution with a marked morning increase between 0600 and 1200 hours, and a corresponding decrease in the late night hours. There were no differences in the occurrence of late potentials and in ECG data between early and late arrival group. The early group (less than 5.9 h) was, however, characterized by significantly higher cardiac enzyme levels than the late group (greater than 6.0 h); they also experienced more arrhythmic events in the acute phase (16.0% vs. 9.7%; p less than 0.032). Catecholamines were significantly more often necessary (26.4% vs. 10.3%; p less than 0.0001). Six-month prognosis after AMI was markedly worse. The time between symptom onset and hospital arrival was not affected by age and risk factors. In univariate analysis, pain history and recurrent infarction also had no influence on delay of admission to hospital. The time interval was, however, significantly shorter when the acute event occurred during the night (18.4% vs. 8.3%; p less than 0.0001). Absence of prodromi in the prehospital phase (18.5% vs. 12.0%; p less than 0.04) and a higher socio-economic level (68.3% vs. 61.0%; p less than 0.077) also shortened the admission time, whereas a hyperactive behavioral pattern prolonged the delay time (21.1% vs. 28.9%; p less than 0.05).
Ladwig
K H
KH
Institut und Poliklinik für Psychosomatische Medizin, Psychotherapie und Medizinische Psychologie, Technischen Universität München.
Lehmacher
W
W
Roth
R
R
Breithardt
G
G
Budde
T
T
Borggrefe
M
M
D000328:Adult; D000368:Aged; D001145:Arrhythmias, Cardiac / Q000503:physiopathology* / Q000523:psychology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D015438:Health Behavior; D006352:Heart Ventricles / Q000503:physiopathology; D006760:Hospitalization; D006801:Humans; D007206:Individuality; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000503:physiopathology* / Q000523:psychology*; D010342:Patient Acceptance of Health Care; D011446:Prospective Studies; D012803:Sick Role
Patientenbezogene Determinanten der Verzögerung in einem zielorientierten Patientenverhalten bei akutem Myokardinfarkt. Ergebnisse aus der Postinfarkt-Spätpotential-Studie (PILP).