title: Emotional attitudes toward symptoms and inadequate coping strategies are major determinants of patient delay in acute myocardial infarction.
abstract: BACKGROUND
  Early reperfusion treatment in acute myocardial infarction (AMI) preserves ventricular function and saves lives. After onset of AMI symptoms, patients often delay for hours until the decision to seek medical help.
  
  
  OBJECTIVE
  Of the MI-heart (Myocardial Infarction--HElp seeking And ReacTions) study was to identify factors determining patient decision delay.
  
  
  METHODS
  739 consecutive patients with confirmed AMI (median age 65.3 years, 30.2% females) were studied after transfer from the intensive care unit. A standardized interview covered AMI symptoms, attitudes toward symptoms, coping strategies, and clinical and sociodemographic variables.
  
  
  RESULTS
  Of patients, 93.3% knew an AMI could be deadly. 43.9% of the patients who suspected an AMI, and knew it could be deadly, decided late (> 1 hour) to seek medical help. In univariate analyses, attitudes toward symptoms and coping strategies had the highest impact on a late decision. Stepwise logistic regression identified the following independent contributors to a late decision to seek medical help (relative risk, 95% confidence interval): wanting to wait and see (3.53; 2.32-5.39), not taking symptoms seriously (2.47; 1.64-3.72), not wanting to bother anybody (2.14; 1.29-3.57), symptoms improving at first (2.33; 1.52-3.56), asking others for advice (0.46; 0.30-0.71), taking pain medication (2.01; 1.01-4.03), age > 65 years (1.69; 1.17-2.44), very strong intensity of angina (0.60; 0.42-0.87).
  
  
  CONCLUSIONS
  Emotional attitudes to AMI symptoms and inadequate coping strategies are the major determinants of patient decision delay. They should be considered as a key factor in patient and public education. Modification of these emotional factors might best be achieved by an individualized approach.
authors.affiliation: Medizinische Klinik Klinikum Itzehoe Akademisches Lehrkrankenhaus, Universitäten Kiel und Lübeck Robert-Koch-Str. 2 25524 Itzehoe, Germany. m.kentsch@kh-itzehoe.de
authors.forename: M
authors.initials: M
authors.lastname: Kentsch
authors.forename: U
authors.initials: U
authors.lastname: Rodemerk
authors.forename: G
authors.initials: G
authors.lastname: Müller-Esch
authors.forename: U
authors.initials: U
authors.lastname: Schnoor
authors.forename: T
authors.initials: T
authors.lastname: Münzel
authors.forename: T H
authors.initials: TH
authors.lastname: Ittel
authors.forename: R
authors.initials: R
authors.lastname: Mitusch
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001294:Attitude to Health; D016009:Chi-Square Distribution; D003657:Decision Making; D004644:Emotions; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000523:psychology* / Q000628:therapy*; D016017:Odds Ratio; D010342:Patient Acceptance of Health Care; D012044:Regression Analysis; D012306:Risk; D011795:Surveys and Questionnaires; D013997:Time Factors