Int J Med Sci 2013; 10(9):1174-1180. doi:10.7150/ijms.5800 This issue

Research Paper

Cognitive and Emotional Factors Affecting Avoidable Decision-Making Delay in Acute Myocardial Infarction Male Adults

Giulio Vidotto1✉, Giorgio Bertolotti2, AnnaMaria Zotti2, Stefano Marchi3, Luigi Tavazzi4

1. Department of General Psychology, University of Padua, Italy;
2. Salvatore Maugeri Foundation, Clinica del Lavoro e della Riabilitazione, IRCCS, Psychology Unit, Medical Centre of Tradate, (VA), Italy;
3. MOSES Centre , 24047 Treviglio, (BG), Italy;
4. GVM Care and Research C/o Villa Maria Cecilia Hospital, 48010 Cotignola, Italy.

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Vidotto G, Bertolotti G, Zotti A, Marchi S, Tavazzi L. Cognitive and Emotional Factors Affecting Avoidable Decision-Making Delay in Acute Myocardial Infarction Male Adults. Int J Med Sci 2013; 10(9):1174-1180. doi:10.7150/ijms.5800. Available from

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Background: To study the potentially avoidable decision-making delay in acute myocardial infarction (AMI) adults male with different psychological characteristics a nationwide multicentre study was conducted in Italy by the 118 Coronary Care Units (CCUs).

Method: 929 AMI patients consecutively presented to the CCU in a conscious condition less than two hours, 2-6 hours, 6-12 hours, and more than 12 hours after symptom onset and completing the Disease Distress Questionnaire (DDQ) were enrolled in a multicentre case-control study. The DDQ collects information regarding the decision time to seek help, and includes a set of items assessing psychological factors and pain-related symptoms. The relationship between the perceived threat and the delay due to decision-making was evaluated by means of a multivariate model using LISREL 8 structural equation modelling.

Results: The delay significantly correlated with perceived threat, which was mainly related to somatic awareness. It was only slightly related to pain and was not associated with any of the other variables. Perceived threat was also related to psychological upset, fear and health worries, the first of which was considerably influenced by emotional instability.

Conclusion: Somatic awareness is the main dimension affecting perceived threat, but subjective pain intensity affects the delay both directly and indirectly. The core of the model is the relationship between perceived threat and the delay due to decision-making. The importance of subjective pain intensity is well documented, but it is still not clear how subjective and objective pain interact.

Keywords: acute myocardial infarction, decision-making, avoidable delay, pain, threat.