Abstract 4070: Who Listens to Our Advice? Predicting who Responds to an Intervention Designed to Decrease Delay in Seeking Treatment for Acute Coronary Syndrome
Helping patients respond appropriately to symptoms is important in clinical practice. Yet, some patients follow advice when symptoms occur and others do not. Identifying factors that predict patients least likely to respond to educational interventions would allow concentrated efforts on patients needing additional intensive intervention to achieve educational goals. We tested a model of 14 variables anticipated to predict a delayed response to acute coronary syndrome (ACS) symptoms in patients who received an educational intervention designed to reduce treatment seeking delay. In the PROMOTION trial, 1777 at-risk patients enrolled from 5 sites in the U.S. (56.4%), Australia and New Zealand were randomized to the educational intervention group. Of these, 246 patients were admitted to an emergency department (ED) at least once with suspected ACS and had data available on all the variables of interest. Hypothesized predictors of the time to first ED presentation, collected at enrollment, were demographic (age, gender, education, insurance status), clinical (history of angina, history of myocardial infarction, cardiologist provider, prior participation in cardiac rehabilitation, chest pain as symptom stimulating care), and psychosocial (ACS attitudes, ACS beliefs, anxiety, depression, perceived control). Linear regression was used to identify the best model predicting delay time. Only three of these factors were significant predictors of delay time. Patients with long delay times had a lower ACS Beliefs score (e.g., agreement with the statement: “I would be embarrassed to go to the hospital if I thought I was having a heart attack but I wasn’t.”) (standardized beta -.21), higher perceived control (standardized beta .27), and higher anxiety (standardized beta .18) (F=7.04, df=3,242, p<.001) (Table). These three variables explained only 7% of the variance in delay time. Patients who fit this psychosocial profile represent a unique group at risk for failure to respond to educational interventions designed to decrease treatment seeking delay. Different interventions may be needed for these patients. More research is needed to understand the large amount of unexplained variance.