Causal beliefs, cardiac denial and pre-hospital delays following the onset of acute coronary syndromes
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Reducing pre-hospital delay is crucial in reducing mortality from acute coronary syndrome (ACS). Patient’s causal beliefs and coping styles may affect symptom appraisal and help-seeking behavior. We examined whether patient’s beliefs about the causes of their ACS and denial of impact were associated with pre-hospital delay. Pre-hospital delay data were collected from 177 patients with ACS. Retrospective causal beliefs and cardiac denial of impact were assessed using questionnaires. Factor analysis of causal beliefs produced 3 factors; beliefs in stress and emotional state, behavioral and clinical risk factors, and in heredity as causal influences. Patients with strong beliefs that stress and emotional state caused their ACS were more likely to have long pre-hospital delays (>130 min). There were no significant associations between pre-hospital delay and the other two causal belief factors. Patients with greater denial scores were also more likely to have long delays than those with low scores. These effects were independent of age, gender, education, previous myocardial infarction, history of depression and negative affectivity. Cognitive and emotional factors including patient’s beliefs about causes and avoidant coping help to explain variations in pre-hospital delay.
KeywordsCausal beliefs Denial Acute coronary syndrome Pre-hospital delay
This study was supported by the British Heart Foundation, Economic and Social Research Council and Medical Research Council. We are grateful to Dr Susan Edwards for participation in data collection, and the staff and patients of University College Hospital, St. George’s Hospital, Southend and Kingston Hospitals.
- British Heart Foundation. (2007). British heart foundation statistics database 2007. www.heartstats.org. Accessed on 21 March 2008.
- Buckley, T., McKinley, S., Gallagher, R., Dracup, K., Moser, D. K., & Aitken, L. M. (2006). The effect of education and counselling on knowledge, attitudes and beliefs about responses to acute myocardial infarction symptoms. European Journal of Cardiovascular Nursing, 6, 105–111. doi: 10.1016/j.ejcnurse.2006.05.005.PubMedCrossRefGoogle Scholar
- Chambless, L., Keil, U., Dobson, A., Mahonen, M., Kuulasmaa, K., Rajakangas, A. M., et al. (1997). Population versus clinical view of case fatality from acute coronary heart disease: Results from the WHO MONICA Project 1985–1990. Multinational monitoring of trends and determinants in cardiovascular disease. Circulation, 96, 3849–3859.PubMedGoogle Scholar
- Fibrinolytic Therapy Trialists’ Collaborative Group. (1994). Indications for fibrinolytic therapy in suspected acute myocardial infarction: Collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1000 patients. Fibrinolytic Therapy Trialists’ (FTT) Collaborative Group. Lancet, 343, 311–322.Google Scholar
- GISSI. (1986). Effectiveness of intravenous thrombolytic treatment in acute myocardial infarction: Gruppo Italiano per lo Studio della Streptochinasi nell’Infarto Miocardico. Lancet, 1, 397–402.Google Scholar
- Goff, D. C, Jr, Feldman, H. A., McGovern, P. G., Goldberg, R. J., Simons-Morton, D. G., Cornell, C. E., et al. (1999). Prehospital delay in patients hospitalized with heart attack symptoms in the United States: The REACT trial. Rapid Early Action for Coronary Treatment (REACT) Study Group. American Heart Journal, 138, 1046–1057. doi: 10.1016/S0002-8703(99)70069-4.PubMedCrossRefGoogle Scholar
- Goldberg, R. J., Steg, P. G., Sadiq, I., Granger, C. B., Jackson, E. A., Budaj, A., et al. (2002). Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). The American Journal of Cardiology, 89, 791–796. doi: 10.1016/S0002-9149(02)02186-0.PubMedCrossRefGoogle Scholar
- Goldberg, R. J., Yarzebski, J., Lessard, D., & Gore, J. M. (2000). Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: The Worcester Heart Attack study. Archives of Internal Medicine, 160, 3217–3223. doi: 10.1001/archinte.160.21.3217.PubMedCrossRefGoogle Scholar
- ISIS-2. (1988). Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17, 187 cases of suspected acute myocardial infarction: ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet, 2, 349–360.Google Scholar
- ISIS-3. (1992). A randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41,299 cases of suspected acute myocardial infarction. ISIS-3 (Third International Study of Infarct Survival) Collaborative Group. Lancet, 339, 753–770.CrossRefGoogle Scholar
- Kentsch, M., Rodemerk, U., Muller-Esch, G., Schnoor, U., Munzel, T., Ittel, T. H., et al. (2002). Emotional attitudes toward symptoms and inadequate coping strategies are major determinants of patient delay in acute myocardial infarction. Zeitschrift fur Kardiologie, 91, 147–155.PubMedCrossRefGoogle Scholar
- Luepker, R. V., Raczynski, J. M., Osganian, S., Goldberg, R. J., Finnegan, J. R., Jr., Hedges, J. R., et al. (2000). Effect of a community intervention on patient delay and emergency medical service use in acute coronary heart disease: The Rapid Early Action for Coronary Treatment (REACT) Trial. Journal of the American Medical Association, 284, 60–67.PubMedCrossRefGoogle Scholar
- Martin, R., Johnsen, E. L., Bunde, J., Bellman, S. B., Rothrock, N. E., Weinrib, A., et al. (2005). Gender differences in patients’ attributions for myocardial infarction: Implications for adaptive health behaviors. International Journal of Behavioral Medicine, 12, 39–45.PubMedCrossRefGoogle Scholar
- Moser, D. K., Kimble, L. P., Alberts, M. J., Alonzo, A., Croft, J. B., Dracup, K., et al. (2006). Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: A scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation, 114, 168–182.PubMedCrossRefGoogle Scholar
- Perkins-Porras, L., Whitehead, D. L., & Steptoe, A. (2006). Patients’ beliefs about the causes of heart disease: Relationships with risk factors, sex and socio-economic status. European Journal of Cardiovascular Prevention and Rehabilitation, 13, 724–730.Google Scholar
- Perkins-Porras, L., Whitehead, D. L., Strike, P. C., & Steptoe, A. (2008). Pre-hospital delay following symptom onset in patients with acute coronary syndrome: Factors associated with patient decision time and home to hospital delay. European Journal of Cardiovascular Nursing. doi: 10.1016/j.ejcnurse.2008.05.001.
- Stenstrom, U., Nilsson, A. K., Stridh, C., Nijm, J., Nyrinder, I., Jonsson, A., et al. (2005). Denial in patients with a first-time myocardial infarction: Relations to pre-hospital delay and attendance to a cardiac rehabilitation programme. European Journal of Cardiovascular Prevention and Rehabilitation, 12, 568–571.PubMedCrossRefGoogle Scholar