Is denial a maladaptive coping mechanism which prolongs pre-hospital delay in patients with ST-segment elevation myocardial infarction?

•Denial only minimally prolongs delay times to reach the coronary care unit of a hospital in overall time window.•However, denial cause an extra 40mins delay in patients in time window of 3-24 hours.•Denial has positive mood regulating effects (less depression and anxiety) in the prodromal phase of myocardial infarction.•Individuals with a higher level of denial tend to report less symptom severity during acute myocardial infarction.•Deniers are more likely to be younger and to be male.

ObjectiveDuring an acute myocardial infarction, patients often use denial as a coping mechanism which may provide positive mood regulating effects but may also prolong prehospital delay time (PHD). However, empirical evidences are still sparse.MethodsThis cross-sectional study included 533 ST-elevated myocardial infarction (STEMI) patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Data on sociodemographic, clinical and psycho-behavioral characteristics were collected at bedside. The outcome was assessed using the Cardiac Denial of Impact Scale (CDIS) with the median split as cutoff point. A total of 206 (41.8%) STEMI patients were thus classified as deniers.ResultsDeniers were less likely to suffer from major depression (p = 0.04), anxiety (p = 0.01) and suboptimal well-being (p = 0.01) compared to non-deniers during the last six months prior to STEMI. During STEMI, they were less likely to perceive severe pain strength (p = 0.04) and racing heart (p = 0.02). Male deniers were also less likely to perceive shortness of breath (p = 0.03) and vomiting (p = 0.01). Denial was not associated with overall delay time. However, in the time window of 3 to 24 h, denial accounted for roughly 40 min extra delay (356 vs. 316.5 min p = 0.02 n = 196).ConclusionsDenial not only contributes to less suffering from acute heart related symptoms and negative affectivity but also leads to a clinically significant delay in the prevalent group.