Preference for Information and Coping Styles in Treatment-Seeking Delay for Symptoms of Acute Myocardial Infarction

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The Ohio State University

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Acute myocardial infarction (AMI) is experienced by nearly 1.5 million Americans each year (National Heart, Lung, and Blood Institute (NHLBI), 2004). This serious cardiac event commonly referred to as a “heart attack” has a long list of common risk factors and is prominent in both men and women. Its symptoms should be acted on immediately. Research has shown that rapid treatment of AMI greatly reduces morbidity and mortality, and therefore, enhances overall patient outcome. The use of reperfusion techniques such as thrombolytic therapy and emergency percutaneous transluminal coronary angioplasty (PTCA) can be used, with the best advantage, shortly after onset of AMI symptoms, preferably within two hours (Zerwic, 1999). Longer delay time to hospital presentation for AMI symptoms has shown to be associated with decreased use of such therapies (Moser, McKinley, Dracup, & Chung, 2003), therefore increasing morbidity and mortality. Unfortunately, many patients miss the window of opportunity for treatment due to pre-hospital treatment-seeking delay. Recent studies have reported median delay times ranging from 1.5 to 6.5 hours and mean delay times ranging from 4 to 24 hours (Dracup & Moser, 1991). Delay to hospital presentation for heart attack symptoms has been well documented in both men and women. A difference in time delay between genders has not been found (Moser et al., 2003). However, other variables shown to be related to longer delay include history of coronary artery disease, older age, history of diabetes, and chronic atrial fibrillation (Berton, Cordiano, Palmieri, Guarieri, Stefani, & Palatini, 2001). Common reasons identified for increased delay reported by AMI patients include lack of recognition of cardiac symptoms, lack of recognition of symptoms as serious, denial, and embarrassment (Finnegan, Meischke, Zepka, Leviton, Meshak, & Benjamin-Carter et al., 2000). The most logical intervention for health care professionals to reduce this problem is to provide pertinent information to patients regarding heart attack symptoms and treatment protocol, especially those with existing cardiac risk factors. Mass media educational campaigns both in the United States and over seas, however, have not led to improvements in delay. Several reasons may have contributed to their failure. First, such programs have been focused on knowledge. While knowledge of heart attack risk factors, signs, and symptoms is certainly important, knowledge alone has consistently failed to greatly impact time to presentation for treatment (Ho, Eisenberg, Litwin, Schaeffer, & Damon, 1989; Mitic & Perkins, 1984). Recent studies have identified cognitive and emotional responses, or coping styles, as having a greater effect (Burnett, Blumenthal, Mark, Leimberger, & Califf, 1995; Dracup & Moser, 1997; McKinley, Moser, & Dracup, 2000). Furthermore, mass campaigns and even smaller community-based educational programs have failed to individualize teaching interventions for the public. Individual patients need or prefer varying amounts and types of information and may use different ways of coping. Tailoring of interventions to match the coping styles and information preferences has been successful in achieving positive outcomes for patients before surgeries and other medical procedures (Caldwell, 1991, Ludwick-Rosenthal & Neufeld, 1993; Martelli, Auerbaugh, Alexander, & Mercuri, 1987). However, there is a lack of research on the relationship of preference of information and coping styles used in primary educational interventions for unexpected medical events, such as AMI.



information preference, treatment-seeking delay, acute myocardial infarction