Appraisal and illness delay with symptoms of ACS: A questionnaire study of illness representations

Background: Reducing patient delay is key to reducing mortality in acute coronary syndrome (ACS). Interventions to date have had little success.Aim: To explore whether illness representations (Leventhal's Commonsense Model of Self-Regulation (CS-SRM)) are associated with patient delay (appraisal or illness delay) in those with symptoms of ACS.Design: A CS-SRM questionnaire studyMethods: A random sample of 182 patients who contacted NHS 24 with symptoms of ACS completed the Revised Illness Perception Questionnaire and gave access to data from their NHS 24 records.Results: Median appraisal delay was 2 hours. Median illness delay was 75 minutes. Women were more likely than men to have long appraisal delays (>2 hours) (57% vs 43%, c2(df=1)=3.93, P=0.047) but did not differ regarding illness delay. Gender and illness representations (identity, emotion and consequences) predicted appraisal delay category (c2=19.907, df=4, P=0.001).Conclusions: Appraisal and illness delays may be associated with different factors. Interventions addressing illness representations might reduce appraisal delay, especially in women.