Die innere Barriere: der Beitrag gesundheitspsychologischer Konzepte zur Erklärung der prähospitalen Verzögerungszeit beim akuten Myokardinfarkt

Zusammenfassung

Weniger als 20 % der Patienten erreicht im akuten Myokardinfarktstadium (AMI) die Klinik-Notaufnahme in einem optimalen Zeitfenster. Defizite im subjektiven Entscheidungsverhalten sind für rund 75 % der prähospitalen Verzögerungszeit verantwortlich. Im Folgenden wird der Versuch unternommen, die Wahrnehmung der Bedrohungslage in der AMI-Phase unter Zuhilfenahme von gesundheitspsychologischen Konzepten verstehbar und damit vorhersehbar zu machen. Nur wenn es dem Patienten gelingt, ein komplexes Netzwerk von Barrieren in der Wahrnehmung und Interpretation der Infarktsymptome zu überwinden, können diese Beschwerden als Stimulus für Handeln genutzt werden. Missinterpretation der Bedeutung der Warnsymptomatik und Unterschätzung des eigenen Risikos basieren auf einer passiven (Fehl-)Wahrnehmung oder auf einem aktiv fehlattribuierenden Bewältigungs-Prozess im Sinne einer verzerrenden Wahrnehmung der eigenen Bedrohungslage. Gesundheitspsychologische Konzepte bieten einen attraktiven konzeptuellen Rahmen, die widersprüchlichen Reaktionen der Infarktpatienten in diesen lebensentscheidenden Stunden besser zu verstehen.

Abstract

During onset of an acute myocardial infarction (AMI), less than 20 % of patients reach the hospital within an optimal time window. About 75 % of pre-hospital delay time is caused by deficits in the patients' subjective decision making. To date, little is known about the course of threat appraisal during AMI. We aim to show here that health psychology related concepts offer an attractive conceptual frame to understand paradoxical reactions of AMI patients during this life threatening phase of their life. Only if patients overcome a complex network of barriers in perception and interpretation of symptoms, AMI symptoms will become effective as cues-to-action. Perception of symptoms may be compromised by a wide range of nociceptive stimuli originating from the heart. Symptom vagueness and a mismatch between expected and perceived symptoms may limit interpretation of the threat, yet active misattributing coping strategies may be even more present. Negative outcome expectancies and an impaired perceived self-efficacy, predominately in subjects with co-morbid negative affectivity are likely to contribute to delay.

Key words

acute myocardial infarction - prehospital delay time - decision making processes

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