Negative attitudes toward trustworthiness of others, other factors associated with delay in care for ACS

Patients with acute coronary syndromes who had no prior revascularizations, a negative view of the trustworthiness of others and increased physical limitations were more likely to delay care for acute coronary syndromes, study results suggested.

Researchers enrolled 796 participants with suspected ischemic heart disease who were indicated for imaging stress tests in the cross-sectional study and mailed each a quality of life questionnaire. The questionnaires were designed to assess psychological stress and measure the style of attachment participants had to their care. The primary variable examined was a response to a question used in the REACT trial concerning a patient’s intention to “wait until [the self-assessment of having an MI was] very sure” before the patient sought medical care.

According to the study results, a more negative view of the trustworthiness of others (P<.001), no previous revascularization (P=.001) and physical limitations due to angina (P=.018) were independently associated with an increased tendency to delay receiving care for ACS. When the same variables were entered into a logistical linear regression model, experience with prior revascularization (OR=0.62; 95% CI, 0.42-0.92) and trustworthiness in others (OR=0.85; 95% CI, 0.78-0.94) were associated with decreased intention to wait for treatment.

“Intention to wait was not significantly associated” the researchers wrote. “This suggests that care delay is unlikely to be primarily an issue of symptom frequency or actual or self-perceived risk of having an ACS. Clearly, patients are not intending to delay because they have fewer symptoms.”

Sullivan MD.Circulation: Cardiovascular Quality and Outcomes.2009;2:148-154.