Patterns of prehospital delay and trends of behavior in response to acute myocardial infarction in Jordan
Khraim, Fadi M. A.
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Delay from the onset of acute myocardial infarction symptoms to the delivery of emergency medical care often results in poor patient prognosis. Despite what is known on predictors of healthcare seeking delay among patients in western cultural settings, little is understood about the behavior of decision delay to seek healthcare in Jordan. Therefore, the aim of this dissertation was to identify predictors of decision delay to seeking professional healthcare among Jordanians with acute myocardial infarction and then to assess agreement between patients and their surrogates in describing decision delay and its predictors. To address this research problem, a cross-sectional descriptive survey that incorporated interviews with acute myocardial infarction patients and their surrogates was conducted. Patients' interviews took place in the coronary care units of two teaching hospitals in northern Jordan. A non-probability, convenient sample of 134 patients (110 men and 24 women) admitted with acute myocardial infarction was collected. In order to assess patient-surrogate agreement, 109 patients' surrogates were interviewed. Patients and surrogates were interviewed independent of each other using the Arabic modified Response to Symptom Questionnaire to acquire information about patient delay and factors associated with it. The study showed that decision delay time among Jordanians was alarmingly long (medians were 3.5 hours for men and 3.6 hours for women). Variables that correspondingly predicted decision delay among men and women were age, waiting for symptoms to go away, anxiety due to symptom presentation, and others response to patients' symptoms. Patients surrogates agreement measured using the intraclass correlation coefficients varied across different variables and ranged from no agreement (p>0.05) to almost perfect agreement with decision delay time having the highest correlation coefficient (0.86, p< 0.05). Results showed that cognitive variables had higher agreement than emotional variables and spouse surrogates (n=60) had higher agreement with their respective patients than non-spouse surrogates (n=49). In conclusion, decision delay time among Jordanians with acute myocardial infarction requires intervention and healthcare educators must incorporate awareness of delay predictors in teaching programs aimed at reducing delay. Moreover, utilizing surrogates to proxy patients' account of decision delay time and its predictors with high agreement is feasible and comprises a practical solution to bridge the literature gap that resulted from interviewing only a limited proportion of patients with acute myocardial infarction.