The Treatment Decision-making Delay And The Influencing Factors In Patients With Acute Coronary Syndrome

Objective The purpose of this study was(1) To investigate the situation of treatment delay;(2) To explore the factors related to pre-hospital delay among the patients with ACS from the social demographic factors, clinical features, knowledge, attitudes and beliefs, etc.Methods A descriptive, cross-sectional design was used in the study.From 2013.11 to 2014.4, a convenience sample of 248 hospitalized patients with ACS in the department of Cardiology of The Second Hospital of Tianjin Medical University participated in the interview using self-designed questionnaire and scales included Chinese-Acute Coronary Syndrome Response Index(C-ACSRI), Medical Coping Modes Questionnaire(MCMQ), Hospital Anxiety Depression Scale(HADS) and the demographic questionnaire.Results The results were as follow:(1)The study findings demonstrated that the median pre-hospital delay times were 12.0、5.5、102.0 hours, for ACS、AMI、UAP.(2)The decision delay rate were different in the patients of ACS、AMI、UAP.49.2%(122) in ACS;20.2%(23) in AMI; 73.9%(99) in UAP.The decision delay rate was lowest in AMI patients.(3)Identify patients with acute coronary syndrome poor levels of knowledge, lack of recognition atypical symptoms of acute coronary syndrome, Such as arm pain or shoulder pain(28.0%),For ACS recognition of the typical symptoms in the top five is chest pain(90.9%),chest discomfort(heaviness, burning, tenderness)(88.1%); palpitations / rapid heart rate(85.5%), shortness of breath /difficulty breathing(82.6%), pale, ashen,loss/change of color(74.9%).(4) ACS patients divide about disease knowledge, attitudes, beliefs were 9.06± 4.90, 9.06 ± 2.82, 16.36± 2.13.(5) Acute coronary syndrome in patients with anxiety depression scores were 7.98±5.52, 7.24 ±4.77; 27.8%(69 cases) of patients with acute coronary syndromes exist different degrees of anxiety symptoms, 23.4% patients(58 cases) there are different levels of depressive symptoms, 16.9%(42 cases) in patients with anxiety and depression symptoms at the same time.(6)Positive coping style in patients with acute coronary syndrome score was 31.29 ±7.26, negative coping style score was 28.33 ±9.96.(7)In different groups of patients, the decision delay time was different. Female,more than 60 years old, personal monthly income is low, long-term smoking, retired,living patterns as solitary, symptoms appear with the self relaxing way and patients with diabetes,their decision delay times were long.(8)Single factor analysis showed that, the decision delay time of the patients with acute coronary syndrome was associated with the following factors: the type of disease, gender, age, personal monthly income, cultural degree, work status, treatment, the first reaction, symptoms associated with diabetes, anxiety, positive coping style and knowledge, attitude of the disease.(9)Binary logistic regression analysis showed that the type of disease, cultural degree, the first reaction,combined with diabetes and hospital treatment were the influence factors of patients with decision delay.Conclusion(1) The patients with acute coronary syndrome(ACS) decision delay times were different.The dicision delay time was shortest,the decision delay rate was lowest in the patients of acute myocardial infarction.(2) The disease type, culture degree, the first reaction of symptoms, the presence of diabetes, and the choice of treatment were lead to delay decision in patients of acute coronary syndrome, and the decision delay times were influenced by multiple factors.