Arrebola-Moreno Mercedes, Petrova Dafina, Garcia-Retamero Rocio, Rivera-López Ricardo, Jordan-Martínez Laura, Arrebola Juan Pedro, Ramírez-Hernández José Antonio, Catena Andrés
Mind, Brain and Behavior Research Center (CIMCYC), University of Granada, Spain.
Escuela Andaluza de Salud Pública, Granada, Spain; Instituto de Investigación Biosanitaria ibs.GRANADA, Granada, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Madrid, Spain.
Int J Nurs Stud. 2020 Aug;108:103613. doi: 10.1016/j.ijnurstu.2020.103613. Epub 2020 May 8.
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.
To conduct a systematic review with meta-analysis of the relationship between nine frequently investigated psychological and cognitive factors and prehospital delay.
A protocol was preregistered in PROSPERO [CRD42018094198] and a systematic review was conducted following PRISMA guidelines.
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.
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.
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).
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.
在急性冠状动脉综合征中，从症状开始出现到患者接受治疗所经过的时间是生存及后续恢复情况的一个重要决定因素。然而，许多患者并未按照推荐的速度接受治疗，这主要是由于院前延误时间过长，比如在症状出现后等待就医。
对9种经常被研究的心理和认知因素与院前延误之间的关系进行系统评价和荟萃分析。
一项方案在国际前瞻性系统评价注册库[CRD42018094198]中预先注册，并按照系统评价和荟萃分析优先报告条目（PRISMA）指南进行系统评价。
检索了以下数据库中1997年至2019年发表的定量研究文章：医学期刊数据库（PubMed）、科学引文索引、Scopus数据库、心理学文摘数据库、公共事务信息服务数据库和Open grey。
使用美国国立卫生研究院观察性、队列研究和横断面研究质量评估工具评估研究的偏倚风险。进行最佳证据综合分析以总结纳入研究的结果。
48篇文章报道了来自23个国家的57项研究，这些研究符合纳入标准。研究对院前延误的定义和分析方法差异很大，这使得荟萃分析无法进行。最佳证据综合分析表明，有证据显示，将症状归因于心脏事件的患者（n = 37）、认为症状严重的患者（n = 24）或因症状而感到焦虑的患者（n = 15）报告的院前延误时间较短，效应量表明存在重要的临床差异（例如，院前延误时间缩短1.5 - 2小时）。相比之下，院前延误与症状知识（n = 18）、担心给他人带来麻烦（n = 18）、恐惧（n = 17）或求助时感到尴尬（n = 14）之间关系的证据有限。
当前的评价表明，将症状归因于心脏事件以及一定程度的感知威胁是加快寻求帮助的关键。相比之下，社会顾虑以及就医障碍（尴尬或担心给他人带来麻烦）可能并不像最初认为的那么重要。当前的评价还表明，使用差异很大的方法极大地限制了将证据整合为有意义的建议。我们得出结论，迫切需要制定院前延误研究设计和报告的通用指南。
