| With China's fast development of economy, people's life style and diet habit changing, the incidence of acute coronary symdrome has increased tremendouly in the past ten years, which is considered as the second killer in developing countries, and a main threat to human's health. As a subgroup of acute coronary symdrome, acute myocardial infarction (AMI) is featured as sudden happening and serious prognosis. The cause of AMI usually is the sudden rupture of an atherosclerotic plaque, leading to thrombus formation and partial occlusion of the coronary artery involved, leaving part of or total corobnary flow, in which case, the myocardium's is injured due to failture to meet myocardium cells' demands for oxygen and nutrients. In the past ten years, the incidence of AMI presented an increasing trends, up to 2001, the male incidence was 0.7%, and 0.5% in female. In America, more than 50% of the 1.2 million people who suffer an AMI or coronary disease each year die in an emergencydepartment or before reaching a hospital within an hour of symptom onset, most of survivors will suffer a major disability. However, many of these deaths and significant disability could be prevented if patients received earlier treatment. By now, benefits of early treatment for AMI have been demonstrated very clearly, it can reduce mortality and morbidity, maintain the function of ventricle and save the dying myocardium cells at the most possibilites. The most disappointed is even thought many efforts have been made in the past to reduce patients' delay to seek treatment, the extent of patients' delay time did not change so much. In the world, the median time interval from symptom onset to arriving hospital ranges from 2 to 4 hours, and the average time is even longer, which is from 6-29hs. Most of patients missed the best chance of treatment due to delay. In china, researches in this field was carried out later compared to western countries, and mostly focused on demographic and clinical factors, yet decision making is much more an subjective process involving cognitive, emotional and behavioral factors. So, it is wiser to consider these together, which can help to understand better about patients' decision making process.Aims:Our study aimed at finding AMI patients' extent of delay in making treatment decision, what's more trying to explore various factors associated with decision delay such as demographic characteristics, clinical status, patients' expectation on symptoms of AMI, context of disease occurrence, bystanders, and patients' behavior, cognitive as well as emotional reaction to symptoms, hoping to provide an scientific evidence to future intervention.Methods:Sixty three patients who met our including criterias were recruited in our studyusing convenient sample from hospitals. Three questionnaires were used to get different information, they were basic information questionnaire, symptom decription questionnaire and revised reponse to symptom questionnaire (r-RSQ). All the figure was input into computer and analysed by SPSS 13.0 statistical package. Descriptive analysis was conducted on basic information, and frequences of different symptoms' occurrence, factors in revised-RSQ were first analysed by t-test, one-way ANOVA and X test to find significant factors; later using these factors as independent viriables, delay to make treatment decision as dependeny variables, establish a regression model, then getting regressive equation.Results:Our study showed that the median time for AMI patients to make a treatment decision was 180 minutes, with the average time of 1116.48minutes, which was far from the standards proposed by American Heart Association that it's better to receive treatment in less than 1h after symptoms onset.Other analysis indicated that patients who had risk factors of suffering AMI tended to make quick decision, P=0.001; in addition, patients who experienced either short of breath, sweating or dizziness would make out a decision in a short time. In the other hand, symptom severity perceived by patients was also a important factor affecting decision, the severer symptoms, the quicker decision-making. We also found that the positive reactions of witness and patients themselves reduced delay. Besides these, unable to recognize the origin of symptom, unwilling to bother others, being afraid of facing bad results from hospital and hoping/wishing symptoms could go away by themselves all increased the risk of delay, by contrary, the less ability patients felt to control situation, the faster they could make decision. Within all the variables listed above, "sweating" and "hoping symptoms go away by themselves" were the strongest factors predicting decision time, whose regressive coefficients were -3.112and 2.966 respectively.Conclusions:1. Treatment-seeking delay existed widely in patients' decision making process, the median time was 180mins, which did not change compared to past.2. Risk factors of suffering AMI could help patients do a quick decision; yet age, sex, habitation, educational background, career and history of heart disease did not impact delay.3. Short of breath, sweating and dizziness were perceived as unnormal, and leading to quick decision-making, and "sweating" was the protective factor to reduce delay.4. The more severe the symptoms perceived by patients, the more likely patients to make a quick decision.5. What witness and patients firstly acted to symptoms had critical importance on whether patients would delay or not, "going to hospital" could help to make a quick decision.6. Unable to recognize AMI, unwilling to bother others, being afraid of facing bad results from hospital and hoping/wishing symptoms could go away by themselves all increased the risk of delay in different extent. Among these factors, "hoping symptoms go away by themselves" was the strongest to predict delay.7. The less ability patients felt to control situation, the faster they could make decision. |
