Beyond sociodemographics: Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction

OBJECTIVE: To determine the impact of sociodemographic, clinical, cognitive, emotional, and social factors on patient delay in seeking treatment for symptoms of acute myocardial infarction. DESIGN: Multicenter descriptive survey. SETTING: Forty-three hospitals in North America. SUBJECTS: Two hundred and seventy-seven patients with confirmed acute myocardial infarction enrolled in a thrombolytic clinical trial. OUTCOME MEASURES: Time from symptom onset to arrival at the hospital for treatment. RESULTS: Patients with longer delays were older, had lower incomes, had diabetes, experienced their symptoms at home, did not appraise their symptoms as serious or originating from the heart, had symptoms that were intermittent in nature, waited to see whether symptoms disappeared, worried about troubling others, feared what might happen if they sought treatment, and did not realize the importance of symptoms. CONCLUSION: Patient appraisal of seriousness of symptoms is related to delay, whereas severity, nature, and knowledge of symptoms are not related. Cognitive and emotional responses affect patients' decisions to seek treatment.