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.

acute myocardial infarction - prehospital delay time - decision making processes

Literatur

• 1 Wienbergen H, Gitt A K, Senges J. [Actual clinical practice of guideline-recommended therapy of acute ST elevation myocardial infarction].  Herz. 2005;  30 700-703
• 2 Boersma E, Maas A C, Deckers J W. et al . Early thrombolytic treatment in acute myocardial infarction: reappraisal of the golden hour.  Lancet. 1996;  348 771-775
• 3 Morgan D M. Effect of incongruence of acute myocardial infarction symptoms on the decision to seek treatment in a rural population.  J Cardiovasc Nurs. 2005;  20 365-371
• 4 Pitsavos C, Kourlaba G, Panagiotakos D B. et al . Factors associated with delay in seeking health care for hospitalized patients with acute coronary syndromes: the GREECS study.  Hellenic J Cardiol. 2006;  47 329-336
• 5 Goldberg R J, Yarzebski J, Lessard D. et al . Decade-long trends and factors associated with time to hospital presentation in patients with acute myocardial infarction: the Worcester Heart Attack study.  Arch Intern Med. 2000;  160 3217-3223
• 6 Gurwitz J H, McLaughlin T J, Willison D J. et al . Delayed hospital presentation in patients who have had acute myocardial infarction.  Ann Intern Med. 1997;  126 593-599
• 7 Sheifer S E, Rathore S S, Gersh B J. et al . Time to presentation with acute myocardial infarction in the elderly: associations with race, sex, and socioeconomic characteristics.  Circulation. 2000;  102 1651-1656
• 8 Grossman S A, Brown D F, Chang Y. et al . Predictors of delay in presentation to the ED in patients with suspected acute coronary syndromes.  Am J Emerg Med. 2003;  21 425-428
• 9 Rogers W J, Canto J G, Lambrew C T. et al . Temporal trends in the treatment of over 1.5 million patients with myocardial infarction in the US from 1990 through 1999: the National Registry of Myocardial Infarction 1, 2 and 3.  J Am Coll Cardiol. 2000;  36 2056-2063
• 10 Weaver W D. Time to thrombolytic treatment: factors affecting delay and their influence on outcome.  J Am Coll Cardiol. 1995;  25 3S-9S
• 11 Mark B, Meinertz T, Fleck E. et al . Stetige Zunahme der Prähospitalzeit beim akuten Herzinfarkt.  Deutsches Ärzteblatt. 2006;  103 A1378-A1383
• 12 McGinn A P, Rosamond W D, Goff Jr D C. et al . Trends in prehospital delay time and use of emergency medical services for acute myocardial infarction: experience in 4 US communities from 1987–2000.  Am Heart J. 2005;  150 392-400
• 13 Moser D K, Kimble L P, Alberts M J. et al . Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: a scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council.  Circulation. 2006;  114 168-182
• 14 Conner M, Norman P eds. Predicting health behaviour: Research and practice with social cognition models. Buckingham; Open University Press 1996
• 15 Schwarzer R. Gesundheitspsychologie Ein Lehrbuch (2. Aufl.). Göttingen; Hogrefe 1997
• 16 Schwarzer R, Renner B. Risikoeinschätzung und Optimismus. In: Schwarzer R, Hrsg Gesundheitspsychologie Ein Lehrbuch (2. Aufl.). Göttingen; Hogrefe 1997: 43-66
• 17 Ditto P H, Jemmott 3rd  J B, Darley J M. Appraising the threat of illness: a mental representational approach.  Health Psychol. 1988;  7 183-201
• 18 Ladwig K H, Marten-Mittag B, Lehmann G. et al . Absence of an impact of emotional distress on the perception of intracardiac shock discharges.  Int J Behav Med. 2003;  10 56-65
• 19 Baumert J, Schmitt C, Ladwig K H. Psychophysiological and affective parameters associated with pain intensity of cardiac cardioverter defibrillator shock discharges. Results from the LICAD Study.  Psychosom Med. 2006;  68 591-597
• 20 Goldberg R J, Steg P G, Sadiq I. et al . Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE Registry).  Am J Cardiol. 2002;  89 791-796
• 21 Dracup K, McKinley S M, Moser D K. Australian patients' delay in response to heart attack symptoms.  Med J Aust. 1997;  166 233-236
• 22 Goldberg R J, O'Donnell C, Yarzebski J. et al . Sex differences in symptom presentation associated with acute myocardial infarction: a population-based perspective.  Am Heart J. 1998;  136 189-195
• 23 Canto J G, Goldberg R J, Hand M M. et al . Symptom presentation of women with acute coronary syndromes: myth vs reality.  Arch Intern Med. 2007;  167 2405-2413
• 24 Löwel H, Meisinger C, Heier M. et al . Herzinfarkt und koronare Sterblichkeit in Süddeutschland.  Dtsch Ärzteblatt. 2006;  103 A 616 -622
• 25 Fukuoka Y, Dracup K, Rankin S H. et al . Prehospital delay and independent / interdependent construal of self among Japanese patients with acute myocardial infarction.  Soc Sci Med. 2005;  60 2025-2034
• 26 Kentsch M, Rodemerk U, Muller-Esch G. et al . Emotional attitudes toward symptoms and inadequate coping strategies are major determinants of patient delay in acute myocardial infarction.  Z Kardiol. 2002;  91 147-155
• 27 Bunde J, Martin R. Depression and prehospital delay in the context of myocardial infarction.  Psychosom Med. 2006;  68 51-57
• 28 Dracup K, Moser D K. Beyond sociodemographics: factors influencing the decision to seek treatment for symptoms of acute myocardial infarction.  Heart Lung. 1997;  26 253-262
• 29 Horne R, James D, Petrie K. et al . Patients' interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction.  Heart. 2000;  83 388-393
• 30 Noureddine S, Adra M, Arevian M. et al . Delay in seeking health care for acute coronary syndromes in a Lebanese sample.  J Transcult Nurs. 2006;  17 341-348
• 31 Moser D K, McKinley S, Dracup K. et al . Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms.  Patient Educ Couns. 2005;  56 45-54
• 32 Schwarzer R. Optimism, vulnerability and self-beliefs as health-related cognitions: A systematic overview.  Psychology and Health. 1994;  9 161-180
• 33 Weinstein N. Unrealistic optimism about future life events.  J Pers Soc Psychol. 1980;  39 232-234
• 34 O'Carroll R E, Smith K B, Grubb N R. et al . Psychological factors associated with delay in attending hospital following a myocardial infarction.  J Psychosom Res. 2001;  51 611-614
• 35 Kenyon L W, Ketterer M W, Gheorghiade M. et al . Psychological factors related to prehospital delay during acute myocardial infarction.  Circulation. 1991;  84 1969-1976
• 36 Ladwig K H, Lehmacher W, Roth R. et al . [Patient-specific determinants of delay in goal-oriented patient behavior in acute myocardial infarct. Results of the post-infarct late potential study].  Z Kardiol. 1991;  80 649-656
• 37 Wong C K, Tang E W, Herbison P. et al . Pre-existent depression in the 2 weeks before an acute coronary syndrome can be associated with delayed presentation of the heart attack.  QJM. 2008;  101 137-144
• 38 Bandura A. Self-efficacy: toward a unifying theory of behavioral change.  Psychol Rev. 1977;  84 191-215
• 39 Ottesen M M, Dixen U, Torp-Pedersen C. et al . Prehospital delay in acute coronary syndrome – an analysis of the components of delay.  Int J Cardiol. 2004;  96 97-103
• 40 Berglin Blohm M, Hartford M, Karlsson T. et al . Factors associated with pre-hospital and in-hospital delay time in acute myocardial infarction: a 6-year experience.  J Intern Med. 1998;  243 243-250
• 41 Yarzebski J, Goldberg R J, Gore J M. et al . Temporal trends and factors associated with extent of delay to hospital arrival in patients with acute myocardial infarction: the Worcester Heart Attack Study.  Am Heart J. 1994;  128 255-263
• 42 Schwarzer R. Self-efficacy in the adoption and maintenance of health behaviors: Theoretical approaches and a new model. In: Schwarzer R, ed Self-efficacy: Thought control of action. Washington DC; Hemisphere 1992: 217-243
• 43 Schwarzer R, Fuchs R. Self-efficacy and health behaviors. In: Conner M, Norman P, eds Predicting health behaviour: Research and practice with social cognition models. Buckingham; Open University Press 1996: 163-196
• 44 Taylor D M, Garewal D, Carter M. et al . Factors that impact upon the time to hospital presentation following the onset of chest pain.  Emerg Med Australas. 2005;  17 204-211
• 45 McKinley S, Moser D K, Dracup K. Treatment-seeking behavior for acute myocardial infarction symptoms in North America and Australia.  Heart Lung. 2000;  29 237-247
• 46 Pattenden J, Watt I, Lewin R J. et al . Decision making processes in people with symptoms of acute myocardial infarction: qualitative study.  BMJ. 2002;  324 1006-1009
• 47 Kaur R, Lopez V, Thompson D R. Factors influencing Hong Kong Chinese patients' decision-making in seeking early treatment for acute myocardial infarction.  Res Nurs Health. 2006;  29 636-646
• 48 McKinley S, Dracup K, Moser D K. et al . International comparison of factors associated with delay in presentation for AMI treatment.  Eur J Cardiovasc Nurs. 2004;  3 225-230
• 49 Burnett R E, Blumenthal J A, Mark D B. et al . Distinguishing between early and late responders to symptoms of acute myocardial infarction.  Am J Cardiol. 1995;  75 1019-1022
• 50 Ruston A, Clayton J, Calnan M. Patients' action during their cardiac event: qualitative study exploring differences and modifiable factors.  BMJ. 1998;  316 1060-1064
• 51 Hartford M, Karlson B W, Sjolin M. et al . Symptoms, thoughts, and environmental factors in suspected acute myocardial infarction.  Heart Lung. 1993;  22 64-70
• 52 Schmidt S B, Borsch M A. The prehospital phase of acute myocardial infarction in the era of thrombolysis.  Am J Cardiol. 1990;  65 1411-1415
• 53 Leslie W S, Urie A, Hooper J. et al . Delay in calling for help during myocardial infarction: reasons for the delay and subsequent pattern of accessing care.  Heart. 2000;  84 137-141
• 54 Hitchcock T, Rossouw F, McCoubrie D. et al . Observational study of prehospital delays in patients with chest pain.  Emerg Med J. 2003;  20 270-273
• 55 Krones T, Keller H, Sonnichsen A. et al . Absolute cardiovascular disease risk and shared decision making in primary care: a randomized controlled trial.  Ann Fam Med. 2008;  6 218-227