The Contribution of Symptom Incongruence to Prehospital Delay for Acute Myocardial Infarction Symptoms Among Jordanian Patients

Abstract

Qualitative investigators have suggested that symptom incongruence, or a mismatch between symptoms that patients expect and those they experience in acute myocardial infarction (AMI), increases the time to hospitalization by affecting emotional, cognitive, and behavioral factors. No quantitative studies have been conducted that verify these relationships. We aimed to (a) examine the relationships among symptom incongruence, prehospital delay, anxiety level at onset of symptoms, perceived seriousness and importance of symptoms, source to which symptoms were attributed, and patients' first response at symptom onset and (b) test the independent association of symptom incongruence to prehospital delay. Jordanian patients with AMI (n = 299) were interviewed using validated questionnaires, and medical records were reviewed to collect information on patients' prehospital delay time, symptom incongruence, and response to AMI symptoms. Patients had low mean (7.5 ± 3.6) symptom incongruence scores (range 0-21 out of 24) and relatively short median prehospital delay (1.3 hours). Symptom incongruence was positively correlated with and independently predicted prehospital delay. Greater anxiety and greater perceived seriousness and importance of symptoms were associated with less incongruence and shorter prehospital delay. Patients who attributed their symptoms to a cardiac etiology had significantly shorter prehospital delay and less symptom incongruence than their counterparts. Patients who contacted the emergency medical service directly after symptom onset had shorter prehospital delay than their counterparts who did not, but did not differ on the level of symptom incongruence. Symptom incongruence may increase prehospital delay by complicating patients' efforts to label and respond to AMI symptoms.