FACTORS CONTRIBUTING TO DELAY IN RESPONDING TO SIGNS AND SYMPTOMS OF ACUTE MYOCARDIAL INFARCTION

The delay time between the onset of symptoms and arrival at a medical facility for examination was studied in 100 randomly selected patients who had been admitted to a coronary care unit with a diagnosis of suspected or proved acute myocardial infarction. 1. 1. The delay time did not differ significantly between private and ward patients. In general, the patient with coronary symptoms was apt to respond sooner than later. These patients who delayed 5 or 6 hours could easily have delayed 48 hours or longer. The half-time for reaching medical aid was 3.9 hours. 2. 2. There was no significant relation between delay and age, sex, history of previous myocardial infarctions, socioeconomic scores and presenting symptoms. 3. 3. The time of delay tended to diminish as the subjective severity of the symptoms mounted. However, there was no relation between the severity of the disease, as measured by the Peel score, and the time of delay. 4. 4. There was a significant relation between the source of the symptom and delay. Thus, patients who recognized their heart as causing the symptom sought help sooner than those who displaced the cause to other organ systems. Patients who interpreted the symptom solely in terms of excluding the heart as causal delayed the longest. 5. 5. The role of a second person in initiating the decision to seek help was significant. For the largest, number of patients, a family member made the decision. Spouses appeared to be less successful in reducing delay than friends or associates. The most influential person in reducing delay in our series was an unrelated friend or stranger who was not associated with the patient's work. 6. 6. Physicians caused or contributed to patient delay in 12 per cent of our cases. They rationalized the delay along the same lines as the patient. Other organ systems were blamed or the pain was minimized by calling it angina. Since referral to the hospital was a simple matter, no adequate reason can be given for the procrastination of these doctors. 7. 7. The defense of denial is commonly used by the patient with coronary disease to control anxiety. The finding that no significant relation could be established between denial and delay in our data is explained. Denial was found to be significantly related to symptom displacement and the influence of another person on delay. Those patients who denied minimally recognized the heart as the source of trouble and did not require outside help to seek the advice of a physician. Patients whose denial was major displaced the source of trouble from the heart to other organ systems and tended to put off consulting a physician until someone else urged them to do so. © 1969.