Psychosocial Adjustment of Patients Arriving Early at the Emergency Department After Acute Myocardial Infarction Robert M. Carney, PhD, KennethE. Freedland,PhD, KarenA. Clark, BA, Judith A. Skala,RN, BA, LaurieJ. Smith, BA, AlanDelamater,PhD, and AllanS. Jaffe, MD

The psychosocial functioning of patients arriving at the emergency department with an acute myocardial infarction earfy enough to be candldates for treatment with thrombolytk agents was compared with that of those arriving later. Patients who arrived within 3 hours were significantly mere anxious when assessed 1 week after admission and had a consistently worse pattem of psychosocialadjustment 3 months after hospital discharge than did those who arrived later. The imptications of these fldngs for efforts to improve early arrival at the emergency department, as well as for medical and psychosocial outcomes after acute myocardial infarct&w, were cenddered. (AmJCardiol1992;69:160-163)

T

reatment with thrombolytic agents improves survival in patients with acute myocardial infarction (AMI).1-5 The benefit is substantially greater when patients receive thrombolytic agents early after the onset of AMI.1-5 Furthermore, early access to medical care is important regardless of whether thrombolytic therapy is administered, because deaths from malignant arrhythmias usually occur early after the onset of AMI. Unfortunately, many patients do not seek immediate treatment. Prolonged delay is the most frequent contraindication to use of thrombolytic agents.*-5 Therefore, many physicians advocate programs designed to minimize such delays. Little is known about the psychosocial functioning of patients who arrive early compared with that of those who arrive later. Because early arrival is likely to improve medical prognosis, such patients may also have a better psychosocial outcome. However, these patients may arrive early because they are anxious, depressed or somatically preoccupied. These factors are known to From Washington University School of Medicine, St. Louis, Missouri. This study w&supported in &t by USPHS Grant 1 ROl Hti2427-01 from the National Heart, Lung, and Blood Institute, and the National Research Demonstration Center Grant, SCOR in Ischemic Heart Disease, Grant HL17646, from the National Institutes of Health, Bethesda, Maryland. Manuscript received July l&1991; revised manuscript received and acceDtedSex&n&x 16,199 1. Address for r&rints: kobert M. &mey, PhD, Behavioral Medicine Center, Jewish Hospital of Saint Louis, 216 S. Kingshighway Blvd., St. Louis, im

Missouri

63 110.

THE AMERICAN

JOURNAL

OF CARDIOLOGY

VOLUME

69

predict adverse psychosocial outcomes, independent of medical status.7-9 Accordingly, we compared the psychosocial functioning during hospitalization and 3 months after discharge of patients with initial Q-wave AM1 who arrived at the emergency department early (i.e., within the window of opportunity for thrombolytic therapy) with that of those who arrived later. MErwDs Subjeetsr Subjects were recruited from a sequential series of patients with documented Q-wave AM1 who were admitted to the cardiac care unit. Patients included in the study had to be: (1) aged