Why Do Elders Delay Responding to Heart Failure Symptoms?

Abstract

The physical symptom experience and the cognitive and emotional response to HF symptoms were inadequate for timely care seeking for most of this older aged sample.

Heart failure awareness survey in Germany: general knowledge on heart failure remains poor

“…Second, lower awareness among non‐medical, non‐diagnosed individuals may lead to late presentation and treatment of HF due to a misinterpretation of the symptoms or misunderstanding of their severity. Previous studies of HF have shown that lower anxiety scores and false interpretation of early symptoms are associated with a longer duration of dyspnea and delays in seeking care 14, 15. Similarly, a large cohort study found that low health literacy, defined as the ability to ‘obtain, understand and process basic health information’ especially in printed form, was independently associated with higher all‐cause mortality in HF 16, 17.…”

Factors Associated With Patient Delay in Seeking Care After Worsening Symptoms in Heart Failure Patients

“…On the other hand, symptoms like swollen ankles, loss of appetite or fatigue often have a gradual pattern of worsening and can be perceived as not important or non-threatening, thus resulting in a longer patient delay as was also suggested in other studies. 10,15 One of the limitations of the study is the use of arbitrary cut-off scores based on the 33 rd and 66 th percentiles to differentiate between patients with short and long patient delay. However, in the existing literature no standard criterion on short or long delay time has been formulated.…”

“…Although delay in HF patients has been studied previously [6][7][8][9][10] , these studies actually assessed pre-hospital delay ( Figure 1). However, little is known on patient delay as we defined earlier as the 4 time from worsening symptoms to actually contacting a health care provider, which reflects the patients' own action in seeking care.…”

“…5,11 In contrast, the most common symptoms of worsening HF (dyspnea and fatigue) 2,6,8,15 often have a gradual pattern of worsening. Therefore many HF patients do not seek medical care but wait for a decline in symptoms 10,15 Patient delay can be due to a failure to routinely monitor symptoms or to the inability to recognize and interpret symptoms when they occur. 16 Elderly patients may neglect early symptoms such as fatigue and dyspnea by attributing them to aging or other illnesses, thereby interpreting them as less threatening and non-acute 17 , which can result in a longer delay.…”

“…2,[6][7][8][9] However, long prehospital delay times are common in HF patients. 6,7,10 In studying delay in cardiovascular patients, it is important to distinguish between 'patient delay' (time from worsening symptoms to actually contacting a health care provider) and 'transportation delay' (time from contacting a health care provider to arrival at the hospital). Prehospital delay therefore can be defined as the composition of patient-and transportation delay ( Figure 1).…”