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.

Symptoms of acute myocardial infarction: A correlational study of the discrepancy between patients’ expectations and experiences

“…The limited diversity of both the expected and experienced symptoms among the examined patients resulted in low symptom incongruence. Yet, as we previously reported, this low incongruence was sufficient to make our patients less apprehensive about their AMI symptoms, more confused regarding their symptoms origin, and consequently more reluctant to seek for immediate medical help (Abed et al, 2015b). Enhancing patients' awareness of AMI symptoms is the only way to reduce symptom incongruence given that the expectation, and not the experience, of symptoms is the amenable factor to improvement.…”

“…The delay in seeking treatment for AMI becomes significantly longer when patients develop symptom incongruence or the discordance between the symptoms they expect and the symptoms they actually experience during AMI (Abed et al, 2015b). Between 42% and 74% of patients with AMI experienced symptom incongruence (Chareonthaitawee et al, 2000;Song et al, 2010).…”

Impact of generalized anxiety disorder (GAD) on prehospital delay of acute myocardial infarction patients. Findings from the multicenter MEDEA study

“…Patients suffered from GAD also presented a comorbidity pattern of impaired mental health, meaning the patients with GAD were also significantly more likely to suffer from acute anxiety, depression, vital exhaustion and perceived stress. It has been well documented that pronounced acute anxiety/fear owing to the sudden onset of the life-threatening AMI leads to a shorter delay time, hereby favoring a good prognosis [27][28][29].…”

Psychosocial markers of pre‐hospital decision delay and psychological distress in acute coronary syndrome patients

“…In particular, we focused on two types of concerns based on their importance suggested in previous literature (Moser et al , ): (1) concerns related to the serious consequences of delaying help‐seeking in case it is needed (i.e., in case one is actually experiencing a heart attack) and (2) social concerns related to the consequences of seeking medical attention in the case of a false alarm (i.e., in case one is not suffering a heart attack). For example, fear about what could happen (Bray et al , ), experiencing serious symptoms (Fang et al , ), or attributing symptoms to a serious condition (Abed, Khalil, & Moser, ) have been linked to a shorter delay. In particular, patients who attribute their symptoms to a cardiac cause as opposed to temporal anxiety, musculoskeletal pain, or other less serious symptoms, wait on average one hour less before seeking medical attention for their symptoms (Abed et al , ; McKee et al , ; McKinley et al , ).…”

“…For example, fear about what could happen (Bray et al , ), experiencing serious symptoms (Fang et al , ), or attributing symptoms to a serious condition (Abed, Khalil, & Moser, ) have been linked to a shorter delay. In particular, patients who attribute their symptoms to a cardiac cause as opposed to temporal anxiety, musculoskeletal pain, or other less serious symptoms, wait on average one hour less before seeking medical attention for their symptoms (Abed et al , ; McKee et al , ; McKinley et al , ). In contrast, social and other‐oriented concerns such as feeling embarrassed to seek help or worrying about wasting other people's time have been linked to longer delays (Khraim, Scherer, Dorn, & Carey, ; McKinley et al , ).…”