背景:关于患者在因心肌梗死住院前否认心肌梗死(MI)的知识有限。
目的:本研究的目的是确定确诊MI的院前阶段MI否认的患病率和相关性。
方法:此次要分析包括166名住院患者(平均[SD]年龄,54.1[10.5]年)的患者在医疗机构外发展为MI,并且在他们的经验症状和预期症状之间具有高度一致性。测量包括简要COPE清单的否认子量表,修改后的症状反应问卷,和测量MI感知风险的李克特量表。在症状发作后至少1小时到达医院的患者被认为具有延长的院前延迟。
结果:尽管它们的症状一致性很高,77%的患者否认住院前患有MI的可能性。较低否认组的特征是心脏病史,而较高的否认组以不吸烟为特征,较低的MI风险,症状发作时焦虑减轻,以及更多关于寻求医疗帮助的担忧。与较低的否认组相比,否认程度较高组的患者更有可能低估其症状的严重性并延迟寻求医疗帮助.较高的否认组以更被动的方式对症状做出反应(例如,等待),而较低的否认组表现出更多解决问题的方法(例如,联系紧急服务)。
结论:否认MI在院前阶段非常普遍,并且与认知呈负相关,情感,和对MI症状的行为反应。
BACKGROUND: Limited knowledge exists regarding patients\' denial of myocardial infarction (MI) before hospitalization for an MI.
OBJECTIVE: The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI.
METHODS: This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived at a hospital at least 1 hour after the onset of their symptoms were considered to have prolonged prehospital delay.
RESULTS: Despite their high symptom congruence, 77% of patients denied the possibility of having an MI before hospitalization. The lower denial group was characterized by cardiac history, whereas the higher denial group was distinguished by nonsmoking, a lower perceived risk of MI, less anxiety at symptom onset, and more concerns about seeking medical help. Compared with the lower denial group, patients in the higher denial group were more likely to underestimate the seriousness of their symptoms and delay seeking medical help. The higher denial group responded to symptoms in a more passive manner (eg, waiting), whereas the lower denial group showed a more problem-solving approach (eg, contacting emergency services).
CONCLUSIONS: Denial of MI is highly prevalent in the prehospital phase and is negatively linked with cognitive, emotional, and behavioral responses to MI symptoms.