title: Understanding why patients delay seeking care for acute coronary syndromes.
abstract: BACKGROUND
  Better insight into the psychosocial factors associated with prehospital delays in seeking care for acute coronary syndromes is needed to inform the design of future interventions. Delay in presenting for care after the onset of symptoms is common, limits the potential benefit of acute reperfusion, and has not been reduced by interventions tested thus far.
  
  
  RESULTS
  Seven hundred ninety-six patients with suspected ischemic heart disease scheduled for clinically indicated imaging stress tests completed questionnaires concerning psychological distress and attachment styles (worthiness to receive care, trustworthiness of others to provide care). The primary dependent variable for this study was response to a question from the rapid early action for coronary treatment trial concerning intention to "wait until very sure" before seeking care for a possible "heart attack." Responses to this question were strongly associated with actual emergency department-reported and self-reported care delay in the rapid early action for coronary treatment trial. In multivariable ordinal regression models, a more negative view of the trustworthiness of others, greater physical limitations from angina, and no previous revascularization were independently associated with increased intention to wait to seek care for a myocardial infarction. Intention to wait was not associated with inducible ischemia or self-perceived risk of myocardial infarction.
  
  
  CONCLUSIONS
  Intention to delay seeking care for acute coronary syndromes is associated with a patient's view of the trustworthiness of others, previous experience with revascularization, and functional limitations, even after adjustment for objective and perceived acute coronary syndromes risk. These findings provide insight into novel factors contributing to longer delay times and may inform future interventions to reduce delay time.
authors.affiliation: Department of Psychiatry and Behavioral Sciences, Division of Cardiology, University of Washington, Seattle, Wash, USA. sullimar@u.washington.edu
authors.forename: Mark D
authors.initials: MD
authors.lastname: Sullivan
authors.forename: Paul S
authors.initials: PS
authors.lastname: Ciechanowski
authors.forename: Joan E
authors.initials: JE
authors.lastname: Russo
authors.forename: Laurie A
authors.initials: LA
authors.lastname: Soine
authors.forename: Kier
authors.initials: K
authors.lastname: Jordan-Keith
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
authors.forename: James H
authors.initials: JH
authors.lastname: Caldwell
mesh_terms: D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000523:psychology* / Q000628:therapy*; D000342:Affective Symptoms / Q000523:psychology; D000368:Aged; D001007:Anxiety / Q000453:epidemiology / Q000523:psychology; D003863:Depression / Q000453:epidemiology / Q000523:psychology; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017202:Myocardial Ischemia / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D009769:Object Attachment; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D011584:Psychology; D012044:Regression Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D014187:Transportation of Patients; D035502:Trust / Q000523:psychology