Treatment-seeking behavior for acute myocardial infarction symptoms in North America and Australia

OBJECTIVE: The goal of this study was to compare North American and Australian patients' sociodemographic, clinical, cognitive, emotional, and social factors associated with behavior in seeking treatment for symptoms of acute myocardial infarction. PATIENTS: Subjects included 277 North Americans (mean age, 58 +/- 12 years; 72% men) and 147 Australians (mean age, 62 +/- 13 years; 66% men) with acute myocardial infarction. METHODS: Data were obtained with the Response to Symptoms Questionnaire and from the patients' hospital records. RESULTS: In both groups, patients who delayed longer (P less than or equal to .05) had lower incomes, known diabetes mellitus, and symptom onset while at home; in addition, they appraised their symptoms as not serious, waited for symptoms to go away, and worried about troubling others. Additional factors associated with longer delay in North Americans (P less than or equal to .05) were older age, intermittent symptoms, and attribution of symptoms to a noncardiac cause; other contributing factors include not recognizing the symptoms as cardiac and fearing the consequences of seeking help. In Australians (P less than or equal to .05), contributing factors were fewer years of education, a history of hypertension, and embarrassment about seeking help. CONCLUSION: Programs to reduce delay in response to acute myocardial infarction symptoms must take account of cognitive and emotional processes and differences in response in the particular cultures of patients.