Cognitive factors that influence delayed decision to seek treatment among older patients with acute myocardial infarction in Korea

Abstract

Background: The incidence of acute myocardial infarction (AMI) is rapidly increasing among older adults in Korea. However, the factors associated with a delayed decision to visit a hospital and the reasons for this delay have not been explored adequately among older patients. Aims: To determine factors predicting a prehospital delay time of >6 h and to identify the cognitive barriers in the delayed decision of AMI patients aged >= 65 years. Methods: This study adopted a mixed methodological approach using quantitative and qualitative analyses. The sample included 94 male and 71 female patients hospitalized for first-time AMI at a university hospital in Korea. Thematic content analysis was used to identify the themes from the qualitative interview data, and multiple logistic regression analysis was used to predict delayed hospital presentation by > 6 h. Results: The median prehospital delay time was 12 h. Low education level, presence of preinfarction angina pain, and attribution of symptoms to a non-cardiac origin were found to be the predicting factors. From the qualitative data, four meaningful themes including 10 subthemes that influenced the delayed decision were identified. Some culturally peculiar themes were found in this Korean sample. Conclusions: Educational strategies that focus on these cognitive decision-making barriers should be planned for elderly Korean at high risk for AMI.