This Article Free upon publication Full Text Full Text (PDF) All Versions of this Article: 2/3/148    most recent CIRCOUTCOMES.108.825471v1 Submit an eLetter Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Sullivan, M. D. Articles by Caldwell, J. H. Search for Related Content PubMed PubMed Citation Articles by Sullivan, M. D. Articles by Caldwell, J. H. Related Collections Acute coronary syndromes CPR and emergency cardiac care Nuclear cardiology and PET Health policy and outcome research Behavioral/psychosocial - treatment Related Article

Original Articles

Understanding Why Patients Delay Seeking Care for Acute Coronary Syndromes

Mark D. Sullivan, MD, PhD; Paul S. Ciechanowski, MD, MPH; Joan E. Russo, PhD; Laurie A. Soine, ARNP; Kier Jordan-Keith, ARNP; Henry H. Ting, MD, MBA and James H. Caldwell, MD

From the Department of Psychiatry and Behavioral Sciences (M.D.S., P.S.C., J.E.R.), Division of Cardiology (L.A.S., J.H.C.), Department of Medicine, and Department of Radiology (L.A.S.), University of Washington, Seattle; the Department of Cardiology (K.J.-K.), VA Puget Sound Health Care System, Seattle, Wash; and Knowledge and Encounter Research Unit (H.H.T.), Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn.

Correspondence to Mark Sullivan, MD, PhD, Department of Psychiatry and Behavioral Sciences, Box 356560, University of Washington School of Medicine, 1959 NE Pacific Street, Seattle, WA 98195-6560. E-mail sullimar{at}u.washington.edu

Received October 1, 2008; accepted January 6, 2009.

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.

Methods and 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.

Key Words: prehospital delay • attachment theory • depression • anxiety • trust

Related Article

The Challenge of Reducing Prehospital Delay in Patients With Acute Coronary Syndrome

Kathleen Dracup
Circ Cardiovasc Qual Outcomes 2009 2: 144-145. [Extract] [Full Text] [PDF]

This article has been cited by other articles:

				H. H. Ting and E. H. Bradley Patient Education to Reduce Prehospital Delay Time in Acute Coronary Syndrome: Necessary But Not Sufficient Circ Cardiovasc Qual Outcomes, November 1, 2009; 2(6): 522 - 523. [Full Text] [PDF]

				H. M. Krumholz Medicine in the Era of Outcomes Measurement Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 141 - 143. [Full Text] [PDF]

				K. Dracup The Challenge of Reducing Prehospital Delay in Patients With Acute Coronary Syndrome Circ Cardiovasc Qual Outcomes, May 1, 2009; 2(3): 144 - 145. [Full Text] [PDF]