Psychological and cognitive factors related to prehospital delay in acute coronary syndrome: A systematic review
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Arrebola Moreno, Mercedes; Petrova, Dafina; García Retamero Imedio, María Del Rocío; Rivera López, Ricardo Francisco; Jordan Martínez, Laura; Arrebola Moreno, Juan Pedro; Ramírez Hernández, José Antonio; Catena Martínez, AndrésEditorial
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Materia
Acute coronary syndrome Emotions Knowledge Prehospital delay Symptoms Systematic review
Date
2020-04Referencia bibliográfica
Arrebola-Moreno, M., Petrova, D., García-Retamero, R., Rivera-López, R., Martínez, L. J., Arrebola, J. P., ... & Catena, A. (2020). Psychological and cognitive factors related to prehospital delay in acute coronary syndrome: A systematic review. International Journal of Nursing Studies, 103613. [DOI: 10.1016/j.ijnurstu.2020.103613]
Sponsorship
Juan de la Cierva Fellowship from the Spanish Ministry of Science FJCI-2016-28279; Ministerio de Economia y Competitividad (Spain) PSI2014-51842-R; Andalusian Regional Goverment SOMM17-6103-UGR; European Union (EU) SOMM17-6103-UGR; Ministerio de Economia, Industria y Competitividad, Spain RYC-2016-20155Abstract
Background: In acute coronary syndrome the time elapsed between the start of symptoms and the moment the patient receives treatment is an important determinant of survival and subsequent recovery.
However, many patients do not receive treatment as quickly as recommended, mostly due to substantial
prehospital delays such as waiting to seek medical attention after symptoms have started.
Objective: To conduct a systematic review with meta-analysis of the relationship between nine frequently
investigated psychological and cognitive factors and prehospital delay.
Design: A protocol was preregistered in PROSPERO [CRD42018094198] and a systematic review was conducted following PRISMA guidelines.
Data sources: The following databases were searched for quantitative articles published between 1997 and
2019: Medline (PubMed), Web of Science, Scopus, Psych Info, PAIS, and Open grey.
Review methods: Study risk of bias was assessed with the NIH Quality Assessment Tool for Observational,
Cohort, and Cross-Sectional Studies. A best evidence synthesis was performed to summarize the findings
of the included studies.
Results: Forty-eight articles, reporting on 57 studies from 23 countries met the inclusion criteria. Studies
used very diverse definitions of prehospital delay and analytical practices, which precluded meta-analysis.
The best evidence synthesis indicated that there was evidence that patients who attributed their symptoms to a cardiac event (n = 37), perceived symptoms as serious (n = 24), or felt anxiety in response to
symptoms (n = 15) reported shorter prehospital delay, with effect sizes indicating important clinical differences (e.g., 1.5–2 h shorter prehospital delay). In contrast, there was limited evidence for a relationship
between prehospital delay and knowledge of symptoms (n = 18), concern for troubling others (n = 18),
fear (n = 17), or embarrassment in asking for help (n = 14).
Conclusions: The current review shows that symptom attribution to cardiac events and some degree of
perceived threat are fundamental to speed up help-seeking. In contrast, social concerns and barriers in
seeking medical attention (embarrassment or concern for troubling others) may not be as important as
initially thought. The current review also shows that the use of very diverse methodological practices
strongly limits the integration of evidence into meaningful recommendations. We conclude that there is
urgent need for common guidelines for prehospital delay study design and reporting.