Abstract
The time from symptom onset to reperfusion is a critical determinant of myocardial salvage and clinical outcomes in patients with acute myocardial infarction (AMI). This time period could be delayed if people do not seek help promptly and/or if the health system is not efficient in responding quickly and attending to these individuals. The aim of this study was to identify psychological factors associated with pre-hospital delay (PHD) or patients’ decisional delay (PDD) in people with an ongoing AMI. A search in PubMed/Medline from 1990 to 2021 with the keywords “pre-hospital delay” OR “prehospital delay” OR “patient delay” OR “decisional delay” OR “care seeking behavior” AND “psychological factors” OR “alexithymia” AND “myocardial infarction” was performed. Thirty-six studies were included, involving 10.389 patients. Wrong appraisal, interpretation and causal beliefs about symptoms, denial of the severity of the symptoms and high levels of alexithymia were found related to longer PHD or PDD. Alexithymia may be an overarching construct that explains the disparate findings of the studies exploring the role of psychological factors in PHD or PDD. Further studies are needed in order to analyse the role of alexithymia in patients with risk factors for AMI to prevent delay.
Highlights
In healthcare, “time to treatment” is an increasingly important dimension in order to prevent complications and to promote a successful management of many illnesses, such as acute myocardial infarction (AMI)
AMI is a medical emergency for which its treatment is time-dependent, especially when it occurs with ST segment-elevation (STEMI)
The largest proportion (60–80%) of the total ischemic time occurs before hospitalization, and it is determined by patients’ referral in seeking medical help, along with the time needed in the emergency medical system to treat the patient from the first intervention by a medicalized ambulance to the hospital door arrival [2]
Summary
“time to treatment” is an increasingly important dimension in order to prevent complications and to promote a successful management of many illnesses, such as acute myocardial infarction (AMI). AMI is a medical emergency for which its treatment is time-dependent, especially when it occurs with ST segment-elevation (STEMI). In this case, when recanalization of the culprit coronary artery occurs within the first hours of symptoms’ onset, reperfusion is critical for myocardial salvage and survival [1]. The largest proportion (60–80%) of the total ischemic time (from AMI symptoms onset to the recanalization of the culprit coronary artery) occurs before hospitalization, and it is determined by patients’ referral in seeking medical help (patients’ decisional delay—PDD), along with the time needed in the emergency medical system to treat the patient from the first intervention by a medicalized ambulance to the hospital door arrival (pre-hospital delay—PHD) [2]
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