Influencing Factors Of Decision-Making Delay In Patients With Acute Coronary Syndrome

ObjectiveTo investigate the situation of treatment delay, cognitive factors, emotional factors and coping style among patients with acute coronary syndrome (ACS); to explore the relationship between cognitive factors, emotional factors, coping style and patient delay time respectively; to explore the factors associated with patient delay (PD).MethodsA total of177patients with diagnosed ACS in four tertiary hospitals were investigated with general information questionnaire、Acute Coronary Syndrome Response Index (ACS)、Self-Rating Anxiety Scale (SAS)、Patient Health Questionnaire-9(PHQ-9)、 Coping Style Questionnaire (CSQ). A total of180questionnaires were distributed，of which177were returned and177(98.33%) were usable. SPSS15.0statistical software was used to analyze data, including descriptive statistical analysis, spearman correlation analysis，χ2test,t test and logistic regression.Results1The median time of transportation, decision, prehospital and inhospital delay was15min、70min、02min、20min.2Many patients associated chest discomfort (heaviness, burning, tenderness)(87.0%), chest pain/pressure/tightness(86.4%), weakness/fatigue(72.9%), pale/ashen/loss/change of color (60.5%), palpitations/rapid heart rate (58.2%) with ACS; mistakenly, some patients associated arm paralysis (33.3%), numbness/tingling in arm or hand (31.1%), headache (29.9%), slurred speech(15.8%), cough(14.7%), lower abdominal pain(13.6%) with ACS.3t test revealed significant differences in knowledge compared to norm t=-11.32, P<0.01). Meanwhile, PD was significantly correlated with parents’ knowledge and belief (r=0.31, P<0.01; r=-0.38, P<0.01).4Of all the subjects,14.7%patients were identifed as anxiety disorder,46.9%patients were identifed as depressive disorder,13.6%were identifed as anxiety disorder and depressive disorder. Meanwhile, PD was significantly correlated with the level of parents’anxiety disorder and depressive disorder (r=0.17, P<0.05; r=0.22, P<0.01).5The mean score of positive coping (PC) was39.08±5.93, the mean score of negative coping (NC) was26.61±7.00. PD was significantly correlated with positive coping and negative coping (r=-0.24, P<0.01; r=-0.20, P<0.01).6PD was influenced by age, employment status, educational status, prior self-administration of pain-relieving drugs, knowledge, beliefs, depression and positive coping.7Multivariate logistic regression analyses indicated that age, hypertension, the occurrence of symptoms at night and beliefs were patient delay’s factors.Conclusion1Decision-making delay existed widely in patients’treatment delay process, the median time was70min, which did not change compared past.2The level of patient’s knowledge was poor, most patients only recognized typical symptoms such as chest discomfort, chest pain/pressure/tightness, weakness/fatigue, mistakenly, some patients associated arm paralysis, numbness/tingling in arm or hand, headache, slurred speech, cough, lower abdominal pain with ACS.3Higher knowledge level, higher anxiety level, higher depressive level and negative coping were associated with longer delay in seeking medical care, higher belief level and PC were associated with shorter delay in seeking medical care，4The influencing factors of PD were age, employment status, educational status, hypertension, the occurrence of symptoms at night, prior self-administration of pain-relieving drugs, knowledge, beliefs, depression and positive coping.