Surviving to Acute Myocardial Infarction: The Role of Psychological Factors and Alexithymia in Delayed Time to Searching Care: A Systematic Review

Abstract

The time from symptom onset to reperfusion is a critical determinant of myocardial salvage and clinical outcomes in patients with acute myocardial infarction (AMI). This time period could be delayed if people do not seek help promptly and/or if the health system is not efficient in responding quickly and attending to these individuals. The aim of this study was to identify psychological factors associated with pre-hospital delay (PHD) or patients’ decisional delay (PDD) in people with an ongoing AMI. A search in PubMed/Medline from 1990 to 2021 with the keywords “pre-hospital delay” OR “prehospital delay” OR “patient delay” OR “decisional delay” OR “care seeking behavior” AND “psychological factors” OR “alexithymia” AND “myocardial infarction” was performed. Thirty-six studies were included, involving 10.389 patients. Wrong appraisal, interpretation and causal beliefs about symptoms, denial of the severity of the symptoms and high levels of alexithymia were found related to longer PHD or PDD. Alexithymia may be an overarching construct that explains the disparate findings of the studies exploring the role of psychological factors in PHD or PDD. Further studies are needed in order to analyse the role of alexithymia in patients with risk factors for AMI to prevent delay.

Alexithymia is a Determinant of Early Death in the Long-Term Course of Post-Myocardial Infarction

“…A study published over ten years ago found that, in people coming to hospital for ischemic acute heart attack (acute myocardial infarction with ST segment elevation, STEMI), a high score on the Toronto Alexithymia Scale (TAS-20), 1 was associated with an excessive delay from time of the first onset of symptoms of hearth attack to hospital arrival and treatment. 2 This result found further confirmation in systematic reviews with meta-analyses 3,4 and in a new study conducted by the same group on a larger sample size and with more restrictive inclusion criteria. 5 As known the time between early acute myocardial infarction (AMI) symptoms and the arrival in a hospital for seeking care is a crucial factor for survival.…”

Alexithymia for cardiologists: a clinical approach to the patient

“…As people with high alexithymia are more likely to experience wrong appraisal and perception of bodily sensations (emotions), and because of their difficulty in describing feelings (mental representation of emotions) to others, they can be late in seeking urgent medical help and poor in reporting symptoms at the first consultation with a physician. In that regard, there is growing evidence that low emotional and somatic awareness associated with alexithymic trait influences substantially the care-seeking behaviors of patients with acute STEMI 3,6,27–31 …”

“…In that regard, there is growing evidence that low emotional and somatic awareness associated with alexithymic trait influences substantially the care-seeking behaviors of patients with acute STEMI. 3,6,[27][28][29][30][31] Previous studies assessing patients with STEMI treated with primary angioplasty after they were discharged from the cardiac intensive care unit pointed out that high alexithymia influences patient responsiveness to cardiac symptoms, thus leading to a longer delay in calling for medical help. STEMI patients with a longer duration of prehospital delay (time to presentation 2 h) had higher alexithymia scores (TAS-20 61) in comparison with early presenters (time to presentation 2 h).…”

“…Although the patient's decision to call for help is a complex and challenging phenomenon, it depends primarily on the ability of an individual to correctly recognize the somatic side of feelings. Thus, symptom perception that an acute coronary event is occurring or that something is wrong is critical for timely reperfusion and clinical outcomes in AMI patients 2,3 . This ability is impaired in people with a specific cognitive deficit in recognizing and mentalizing emotions called alexithymia, 4,5 thus putting patients with AMI at risk of delays in seeking care 6 …”

“…Thus, symptom perception that an acute coronary event is occurring or that something is wrong is critical for timely reperfusion and clinical outcomes in AMI patients. 2,3 This ability is impaired in people with a specific cognitive deficit in recognizing and mentalizing emotions called alexithymia, 4,5 thus putting patients with AMI at risk of delays in seeking care. 6 The purpose of this article is to provide a current vision of alexithymia from the perspective of the clinical cardiologist, with a focus on the definition, meaning, a clue to early clinical recognition, and potential implications for cardiovascular health.…”