Acta med. scand. Vol. 198, pp. 315-317, 1975
Selected Psychosocial Variables in the Delay of Reaching the Coronary Care Unit T. Theorell, L. R. Erhardt, E. Lind, A. Sjogren and U . Sawe From the Department of Medicine, Serafimerlnsarettet, Stockholm, Sweden
ABSTRACT. Sixty-one first admissionsto a coronary care unit have been analysed regarding “delay period” from onset of chest pain to admission to the CCU in relation to psychosocial information, collected from the closest relative. On the whole, psychosocial variables seemed to play a modest role in the determination of the delay period. However, one “type A behavior” variable, inability to relax during leisure time, was related to a shorter delay period. Young subjects tended to have a relatively short delay.
The best source of information regarding a person’s “normal” behavior is, in our opinion, the closest available relative or friend, who was therefore used as an informant for the present study. Previous personal experience of CCU care presumably affects the delay behavior. Therefore, the present study was limited to first admissions.
A major problem in patients sustaining an acute myocardial infarction (AMI) is the high initial mortality outside hospitals. One important means of reducing this would be to shorten the delay ofadmission to the coronary care unit (CCU) ( 2 ) . This delay has been investigated by other groups ( 1 , 4 , 7 , 8 , 10, 11) but studies of psychological and social variables which might be relevant to it are scant. It could be hypothesized that psychosocial variables relevant to the prognosis of coronary heart disease (CHD) may also be relevant to the delay period. Such psychosocial variables are education ( 5 ) and “type A behavior” (a striving, job-involved behavior reported to be excessively prevalent among premature CHD victims with a bad prognosis) (9). Furthermore, the way people normally “take care of their health’ when they develop symptoms of illness may be pertinent to the delay of admission after the onset of AM1 symptoms. The present study describes the relations between delay of admission to a CCU after the onset of central chest pain and each one of three clusters of psychosocial variables, namely formal educational level and documented experience or interest in medical issues (education variables), irritability (type A variables), and the way people handle their contacts with physicians and hospitals when they develop disease symptoms (illness behavior variables).
Among all the patients admitted to the CCU of Serafimerlasarettet from Sept. 1, 1971 to Feb. 28, 1972.61 first admissions were accordingly selected for a study of factors related to length of delay. Only patients with a defined onset of chest pain were included. All the interviews concerning the circumstances to do with the disease onset were conducted by one of the investigators. The following selection criteria were used: 1) Absence of previous care for a myocardial infarction. 2) Availability-by telephone or personally--of a close relative who had taken an active part during the period in question, i.e. from the start of chest pain to the CCU admission. It was considered unsuitable to interview relatives of patients who had died. Therefore, because in a few cases the relative was not available to us during the first 48 hours of the patient’s CCU stay, the patient’s survival during this period was another limiting criterion. The relatives were interviewed (personally or by telephone) by one of two interviewersociologist and a physician-who checked one-another’s five initial interviews in order to standardize the recording of answers. The variables are listed in Table 11. The questions about irritability an inability to relax are similar to those used by Jenkins et al. (6)for measuring type A behavior( 1974). The diagnostic criteria of myocardial infarction used at Serafimerlasarettet have been presented elsewhere (12).
MATERIAL AND METHODS
RESULTS Table I shows the numerical distributions of the participating patients by sex and age. Table I1 shows the distributions of answers in relation to short (0-3 hours) and long (4 hours or Acta med. scand. I98
3 16
T. Theorell et al.
Table I . Sex and a g e distribution of 61 f i r s t admissions to t h e CCU MI Age(y.) 50 51-55 56-60 6 1-65 6670 71-75 76-
Observation cases
Males 0 4
Females
Males
Females
I
5 2 3 3
0
0 2 1 2 2 2
2 8 4 2 1
1
1
2 4 2
3 2
1
1
more) delay, respectively. Two variables, age ( 6 5 or 26.5 years and presence or absence of “inability to relax during leisure time”, discriminated the two delay groups significantly from one-another @
Selected Psychosocial Variables in the Delay of Reaching the Coronary Care Unit T. Theorell, L. R. Erhardt, E. Lind, A. Sjogren and U . Sawe From the Department of Medicine, Serafimerlnsarettet, Stockholm, Sweden
ABSTRACT. Sixty-one first admissionsto a coronary care unit have been analysed regarding “delay period” from onset of chest pain to admission to the CCU in relation to psychosocial information, collected from the closest relative. On the whole, psychosocial variables seemed to play a modest role in the determination of the delay period. However, one “type A behavior” variable, inability to relax during leisure time, was related to a shorter delay period. Young subjects tended to have a relatively short delay.
The best source of information regarding a person’s “normal” behavior is, in our opinion, the closest available relative or friend, who was therefore used as an informant for the present study. Previous personal experience of CCU care presumably affects the delay behavior. Therefore, the present study was limited to first admissions.
A major problem in patients sustaining an acute myocardial infarction (AMI) is the high initial mortality outside hospitals. One important means of reducing this would be to shorten the delay ofadmission to the coronary care unit (CCU) ( 2 ) . This delay has been investigated by other groups ( 1 , 4 , 7 , 8 , 10, 11) but studies of psychological and social variables which might be relevant to it are scant. It could be hypothesized that psychosocial variables relevant to the prognosis of coronary heart disease (CHD) may also be relevant to the delay period. Such psychosocial variables are education ( 5 ) and “type A behavior” (a striving, job-involved behavior reported to be excessively prevalent among premature CHD victims with a bad prognosis) (9). Furthermore, the way people normally “take care of their health’ when they develop symptoms of illness may be pertinent to the delay of admission after the onset of AM1 symptoms. The present study describes the relations between delay of admission to a CCU after the onset of central chest pain and each one of three clusters of psychosocial variables, namely formal educational level and documented experience or interest in medical issues (education variables), irritability (type A variables), and the way people handle their contacts with physicians and hospitals when they develop disease symptoms (illness behavior variables).
Among all the patients admitted to the CCU of Serafimerlasarettet from Sept. 1, 1971 to Feb. 28, 1972.61 first admissions were accordingly selected for a study of factors related to length of delay. Only patients with a defined onset of chest pain were included. All the interviews concerning the circumstances to do with the disease onset were conducted by one of the investigators. The following selection criteria were used: 1) Absence of previous care for a myocardial infarction. 2) Availability-by telephone or personally--of a close relative who had taken an active part during the period in question, i.e. from the start of chest pain to the CCU admission. It was considered unsuitable to interview relatives of patients who had died. Therefore, because in a few cases the relative was not available to us during the first 48 hours of the patient’s CCU stay, the patient’s survival during this period was another limiting criterion. The relatives were interviewed (personally or by telephone) by one of two interviewersociologist and a physician-who checked one-another’s five initial interviews in order to standardize the recording of answers. The variables are listed in Table 11. The questions about irritability an inability to relax are similar to those used by Jenkins et al. (6)for measuring type A behavior( 1974). The diagnostic criteria of myocardial infarction used at Serafimerlasarettet have been presented elsewhere (12).
MATERIAL AND METHODS
RESULTS Table I shows the numerical distributions of the participating patients by sex and age. Table I1 shows the distributions of answers in relation to short (0-3 hours) and long (4 hours or Acta med. scand. I98
3 16
T. Theorell et al.
Table I . Sex and a g e distribution of 61 f i r s t admissions to t h e CCU MI Age(y.) 50 51-55 56-60 6 1-65 6670 71-75 76-
Observation cases
Males 0 4
Females
Males
Females
I
5 2 3 3
0
0 2 1 2 2 2
2 8 4 2 1
1
1
2 4 2
3 2
1
1
more) delay, respectively. Two variables, age ( 6 5 or 26.5 years and presence or absence of “inability to relax during leisure time”, discriminated the two delay groups significantly from one-another @
