Patient-surrogate agreement of predictors of decision delay among patients with acute myocardial infarction: A questionnaire survey

Background: Studies that assessed predictors of patient delay to seek healthcare for acute myocardial infarction lack generalization to all patient population as it investigated patients who survived coronary events. Objectives: To evaluate utility of using surrogates to proxy patients who cannot be interviewed and to examine patients-surrogate agreement. Design: A cross-sectional descriptive survey study. The cognitive and emotional domains of the modified Response to Symptoms Questionnaire were used to interview participants. Participants and settings: A convenient sample of patient-surrogate pairs was collected (n=109). Hospitalized patients with acute myocardial infarction were eligible if they were at least 18 years old, hemodynamically stable, pain free or controlled pain during interview, and could identify a surrogate. Exclusions (n=45) were patients transferred from other hospitals or those who had acquired heart attack following their admission. A surrogate was defined as an individual who witnessed the onset of symptoms and whom the patient has articulated symptoms with prior to admission. Methods: Patient and surrogate were interviewed independently. Decision delay time was assessed by assisting participants and surrogates to triangulate the time of symptom onset and time of decision to seek help by placing it in the context of events that they would remember. The intraclass correlation coefficient was used to assess agreement. Results: Patients were mainly men (81%), married (79%) and ranged in age from 39 to 78 years while surrogates were mostly women (74%) and 55% of them were patients' spouses. Surrogates ranged in age from 18 to 75 years. Intraclass correlation coefficients levels varied across different variables ranging from lack of agreement (p>0.05) to almost perfect agreement with decision delay time having the highest correlation coefficient (86%, p<0.05). Cognitive variables had higher agreement than emotional variables. Significant emotional variables' agreement ranged form 28% to 39% and significant cognitive variables' agreement ranged form 64% to 68%. Female surrogates (n=81) had higher agreement levels with their respective patients than male surrogates (n=28). Conclusions: Utilizing surrogates to proxy patients' account of decision delay time and its cognitive predictors is practical and feasible.