Alexithymia Affects Pre-Hospital Delay of Patients with Acute Myocardial Infarction: Meta-Analysis of Existing Studies

Antonio Preti, Federica Sancassiani, Federica Cadoni , Mauro Giovanni Carta*
Department of Public Health, Clincial and Molecular Medicine, University of Cagliari and Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari, Cagliari, Italy

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© Preti et al.; Licensee Bentham Open.

open-access license: This is an open access article licensed under the terms of the Creative Commons Attribution Non-Commercial License ( which permits unrestricted, non-commercial use, distribution and reproduction in any medium, provided the work is properly cited.

* Address correspondence to this author at the Center for Consultation-Liaison Psychiatry and Psychosomatics, University Hospital of Cagliari Via Ospedale 117, 09124 Cagliari, Italy; Tel: +39 3335 499994; Fax: +39 070 6093498; E-mail:



The time between the onset of symptoms and reperfusion is a critical determinant of the clinical course of patients with acute myocardial infarction (AMI). Any delay in seeking help will affect patient’s outcome. Alexithymia can influence the information processing but also the skills to detect the signal of an ongoing AMI.


Systematic review and meta-analysis of studies investigating the role of alexithymia in pre-hospital delay after AMI. Pubmed/Medline and PsychINFO/Ovid search from 1990 until 2012.


Out of 29 studies investigating the role of psychological factors in pre-hospital delay after AMI, 3 studies specifically assessed alexithymia, involving 258 patients. All studies used the Toronto Alexithymia Scale to group patients into clusters by time to presentation after AMI. Meta-analysis of data showed that the patients with higher emotional awareness (i.e., low alexithymia) had shorter time to presentation after AMI.


Preliminary evidence indicates that alexithymia may have a role in seeking help delay after AMI. Further studies are necessary to better appreciate how alexithymia influence help-seeking in patients with an evolving AMI and in what extent their ineffective behavior can be changed.

Keywords: Pre-hospital delay, acute myocardial infarction, alexithymia, psychological factors, care seeking behavior.