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Giordano V, Guillari A, Sansone V, Catone M, Rea T. Women Acute Myocardial Infarction-Identifying and Understanding the Gender Gap (WAMy-GAP): A Study Protocol. Healthcare (Basel) 2024; 12:972. [PMID: 38786384 PMCID: PMC11121322 DOI: 10.3390/healthcare12100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
Barriers to accessing care and misinterpretations of ischemic heart disease symptoms due to lack of awareness contribute to women's delay in seeking care. Women may delay seeking treatment for up to 3 h or even up to 5 days. They often perceive themselves to be at low risk of cardiovascular disease (CVD) and prioritize family responsibilities or household chores. The causes of this delay are multifactorial and influence the decision-making process, particularly in the pre-hospital phase. The objective of this study protocol is to evaluate prodromal symptoms and identify risk behaviors in women with acute myocardial infarction (AMI). This is a protocol for a multicenter study that will be conducted using the mixed-method methodology using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) to evaluate symptoms and semi-structured interviews to investigate behaviors. This study protocol is intended to fill an important knowledge gap on premonitory and acute symptoms of AMI in women in Italy, as well as to understand the causes and mechanisms underlying delays in accessing healthcare services during an acute event such as AMI. The investigation of this issue will facilitate the removal of gender-related inequalities in the diagnosis and treatment of acute myocardial infarction while also fostering dialogue on the barriers to behavior change.
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Affiliation(s)
- Vincenza Giordano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Assunta Guillari
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
| | - Vincenza Sansone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy;
| | - Maria Catone
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
| | - Teresa Rea
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
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2
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Sears SF, Anthony S, Naniwadekar A. Modern atrial fibrillation care: Becoming a pro at using PROs. J Cardiovasc Electrophysiol 2020; 31:3196-3198. [PMID: 33118655 DOI: 10.1111/jce.14793] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Accepted: 10/23/2020] [Indexed: 12/22/2022]
Affiliation(s)
- Samuel F Sears
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA.,Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
| | - Scarlett Anthony
- Department of Psychology, East Carolina University, Greenville, North Carolina, USA
| | - Aditi Naniwadekar
- Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina, USA
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3
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Cobb S, Assari S. Investigation of the Predictors of Self-rated Health of Economically Disadvantaged African American Men and Women: Evidence for Sponge Hypothesis. INTERNATIONAL JOURNAL OF EPIDEMIOLOGIC RESEARCH 2020; 7:25-34. [PMID: 32395609 DOI: 10.34172/ijer.2020.05] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background and aims According to the sponge hypothesis, compared to men's self-rated health (SRH), women's SRH is more likely to reflect conditions other than chronic medical conditions (CMCs) such as psychiatric disorders (PDs). As a result, poor SRH is a weaker predictive factor for mortality risk for women than men. Most of this literature, however, is done in samples that are predominantly middleclass White. To test the sponge hypothesis among economically disadvantaged African Americans (AAs), this study compared low-income AA men and women for the effects of the number of PDs and CMCs on SRH. Materials and Methods This cross-sectional study recruited a non-random sample (n = 150) of economically disadvantaged AA adults with PD(s). Structured face-to-face interviews were used to collect data. SRH was measured using a single-item measure. PDs and CMCs were also self-reported. We applied linear regression models to test the interactions between SRH and the number of PDs and CMC as well as gender. Results The number of PDs and CMCs were associated with SRH in the pooled sample of low-income AA adults with PD(s). However, we found a significant interaction between the number of PDs and gender. This interaction suggested a stronger association between PDs and SRH for AA women than AA men. Gender did not alter the association between the number of CMCs and SRH. Conclusion The number of PDs is a determinant of SRH for low-income AA women but not AA men, supporting the sponge hypothesis.
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Affiliation(s)
- Sharon Cobb
- School of Nursing, Charles R. Drew University of Medicine and Science, Los Angeles, USA
| | - Shervin Assari
- Department of Family Medicine, Charles R. Drew University of Medicine and Science, Los Angeles, USA
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Pate A, Leeman-Castillo BA, Krantz MJ. Treatment-Seeking Delay Among Hispanic and Non-Hispanic Women with Acute Myocardial Infarction. Health Equity 2019; 3:287-296. [PMID: 31312779 PMCID: PMC6634169 DOI: 10.1089/heq.2018.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: Women and minorities with acute myocardial infarction (AMI) often fail to recognize prodromal symptoms leading to delays in care. The objective of this study was to conduct a mixed method assessment of the impact of ethnicity on symptom description, recognition, and treatment-seeking behavior in Hispanic and non-Hispanic women before hospitalization for AMI. Methods: We explored differences in symptomatology, treatment-seeking behavior, and delay patterns among a convenience sample of 43 women diagnosed with AMI (17 Hispanic women, 26 non-Hispanic women) in seven rural and urban Colorado hospitals. We performed in-depth interviews to establish patterns (typologies) of treatment-seeking behaviors. Chart abstraction provided delay times as a function of ethnicity. Results: Most (28/43) women reported prodromal symptoms in the weeks before their index AMI. Overall, fewer Hispanic women presented within 24 h of symptom onset (3/18, 17% vs. 15/18, 83%, p<0.01). A typology of treatment-seeking behavior emerged: women who (1) recognized symptoms and promptly sought care; (2) did not recognize symptoms, yet promptly sought care; (3) recognized symptoms and promptly sought care, but providers misconstrued symptoms as noncardiac; and (4) misinterpreted symptoms due to an underlying chronic disease. Conclusion: Women and primary care providers often underappreciate prodromal AMI symptoms. Hispanic women are more likely to misinterpret ischemic symptoms and delay care, suggesting a need for tailored patient and provider education.
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Affiliation(s)
- Amy Pate
- Department of Family Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado
| | | | - Mori J. Krantz
- Department of Family Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado
- Colorado Prevention Center, Aurora, Colorado
- Cardiology Division, Denver Health Medical Center, Denver, Colorado
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5
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Lichtman JH, Leifheit EC, Safdar B, Bao H, Krumholz HM, Lorenze NP, Daneshvar M, Spertus JA, D'Onofrio G. Sex Differences in the Presentation and Perception of Symptoms Among Young Patients With Myocardial Infarction: Evidence from the VIRGO Study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Circulation 2019; 137:781-790. [PMID: 29459463 DOI: 10.1161/circulationaha.117.031650] [Citation(s) in RCA: 199] [Impact Index Per Article: 39.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 12/11/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Some studies report that women are less likely to present with chest pain for acute myocardial infarction (AMI). Information on symptom presentation, perception of symptoms, and care-seeking behaviors is limited for young patients with AMI. METHODS We interviewed 2009 women and 976 men aged 18 to 55 years hospitalized for AMI at 103 US hospitals participating in the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Structured patient interviews during the index AMI hospitalization were used to collect information on symptom presentation, perception of symptoms, and care-seeking behaviors. We compared patient characteristics and presentation information by sex. Multivariable hierarchical logistic regression was used to evaluate the association between sex and symptom presentation. RESULTS The majority of women (87.0%) and men (89.5%) presented with chest pain (defined as pain, pressure, tightness, or discomfort). Women were more likely to present with ≥3 associated symptoms than men (eg, epigastric symptoms, palpitations, and pain or discomfort in the jaw, neck, arms, or between the shoulder blades; 61.9% for women versus 54.8% for men, P<0.001). In adjusted analyses, women with an ST-segment-elevation AMI were more likely than men to present without chest pain (odds ratio, 1.51; 95% confidence interval, 1.03-2.22). In comparison with men, women were more likely to perceive symptoms as stress/anxiety (20.9% versus 11.8%, P<0.001) but less likely to attribute symptoms to muscle pain (15.4% versus 21.2%, P=0.029). Approximately 29.5% of women and 22.1% of men sought medical care for similar symptoms before their hospitalization (P<0.001); however, 53% of women reported that their provider did not think these symptoms were heart-related in comparison with 37% of men (P<0.001). CONCLUSIONS The presentation of AMI symptoms was similar for young women and men, with chest pain as the predominant symptom for both sexes. Women presented with a greater number of additional non-chest pain symptoms regardless of the presence of chest pain, and both women and their healthcare providers were less likely to attribute their prodromal symptoms to heart disease in comparison with men.
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Affiliation(s)
- Judith H Lichtman
- Department of Chronic Disease Epidemiology (J.H.L., E.C.L.) .,Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.)
| | | | | | - Haikun Bao
- Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.)
| | - Harlan M Krumholz
- Department of Health Policy and Management (H.M.K.).,Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.).,Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.), Yale School of Medicine, New Haven, CT
| | - Nancy P Lorenze
- Yale School of Public Health, New Haven, CT. Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, CT (J.H.L., H.B., H.M.K., N.P.L.)
| | - Mitra Daneshvar
- Department of Physical Medicine and Rehabilitation, Hospital of the University of Pennsylvania, Philadelphia (M.D.)
| | - John A Spertus
- St. Luke's Mid America Heart Institute, Kansas City, MO (J.A.S.).,University of Missouri-Kansas City (J.A.S.)
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Bowles JR, McEwen MM, Rosenfeld AG. Acute Myocardial Infarction Experience Among Mexican American Women. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:62-69. [PMID: 29886775 DOI: 10.1177/1540415318779926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Health disparities in cardiovascular disease risk factors affect a burgeoning segment of the U.S. population-Mexican American (MA) women. MAs experience disparities in the prevalence of heart disease risk factors. However, there are no studies describing acute myocardial infarction (AMI) symptoms unique to this Hispanic subgroup. The aim of the study was to describe MA women's AMI symptom experience. METHODS A qualitative descriptive design guided the study. Data were collected in semistructured interviews with eight MA women who reported having an AMI within the past 18 months. Data were analyzed using qualitative content analysis. RESULTS The overall theme was "The nature of my AMI experience." This theme, composed of four categories, described their prodromal and AMI symptom experience: my perception of AMI, having a heart attack, AMI symptoms, and actions taken. No participants recognized prodromal or symptoms of AMI. Asphyxiatia (asphyxiating) and menos fuerza (less strength) were commonly described symptoms. CONCLUSION Participants attributed both prodromal and AMI symptoms to noncardiac causes, self-managed symptoms, and delay in seeking health care. Findings suggest that community engagement through culturally tailored family-focused heart health education for MA women and their family members may improve recognition of prodromal symptoms.
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Ouellet GM, Geda M, Murphy TE, Tsang S, Tinetti ME, Chaudhry SI. Prehospital Delay in Older Adults with Acute Myocardial Infarction: The ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction Study. J Am Geriatr Soc 2017; 65:2391-2396. [PMID: 29044463 DOI: 10.1111/jgs.15102] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND/OBJECTIVES Timely administration of antiischemic therapies improves outcomes in individuals with acute myocardial infarction (AMI). Prior literature on delays in AMI care has largely focused on in-hospital delay ("door to balloon" time). Our objective was to identify factors associated with prehospital delay in a contemporary national cohort of older adults with AMI. DESIGN Cross-sectional analysis of data from the ComprehenSIVe Evaluation of Risk Factors in Older Patients with Acute Myocardial Infarction (SILVER-AMI) study, an observational study of older adults hospitalized for AMI. SETTING U.S. academic and community hospitals (N = 94). PARTICIPANTS Individuals aged 75 and older hospitalized for AMI (N = 2,500). MEASUREMENTS Prehospital delay was defined as symptom duration of 6 hours or longer before hospital presentation and was obtained according to participant or caregiver report during AMI hospitalization. Potential predictors of delay from demographic, clinical presentation, comorbid conditions, function, and social support domains were obtained through in-person assessment during the index hospitalization and medical record abstraction. RESULTS Nonwhite race (adjusted odds ratio (aOR) = 1.54, P = .002), atypical symptoms (aOR = 1.41, P = .001), and heart failure (HF) (aOR = 1.35, P = .006 for HF) were significantly associated with delay. CONCLUSION In contrast with younger AMI populations, female sex and diabetes mellitus were not associated with delay in this older cohort, but factors from other domains (nonwhite race, atypical symptoms, and HF) were significantly associated with delay. These results can be used to customize future public health efforts to encourage early presentation for older adults with AMI.
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Affiliation(s)
- Gregory M Ouellet
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Mary Geda
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Terrence E Murphy
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Sui Tsang
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Mary E Tinetti
- Section of Geriatrics, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
| | - Sarwat I Chaudhry
- Section of General Internal Medicine, Department of Medicine, School of Medicine, Yale University, New Haven, Connecticut
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8
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Coventry LL, van Schalkwyk JW, Thompson PL, Hawkins SA, Hegney DG. Myocardial infarction, patient decision delay and help-seeking behaviour: a thematic analysis. J Clin Nurs 2017; 26:1993-2005. [DOI: 10.1111/jocn.13607] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Linda L Coventry
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands WA Australia
- School of Nursing and Midwifery; Edith Cowan University; Joondalup WA Australia
| | | | - Peter L Thompson
- Sir Charles Gairdner Hospital and Deputy Director Harry Perkins Institute of Medical Research and Clinical Professor of Medicine; The University of Western Australia; Perth WA Australia
| | | | - Desley G Hegney
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands WA Australia
- Central Queensland University; North Rockhamptom Qld Australia
- School of Nursing and Midwifery; The University of Southern Queensland; Toowoomba Qld Australia
- School of Nursing, Adelaide University; Adelaide SA Australia
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9
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Hwang SY, Jeong MH. Cognitive factors that influence delayed decision to seek treatment among older patients with acute myocardial infarction in Korea. Eur J Cardiovasc Nurs 2017; 11:154-9. [DOI: 10.1016/j.ejcnurse.2010.11.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Seon Young Hwang
- Department of Nursing, College of Medicine, Chosun University, Gwangju, South Korea
| | - Myung Ho Jeong
- Heart Research Center of Chonnam National University Hospital, Gwangju, South Korea
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10
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Madsen R, Birkelund R. Women's experiences during myocardial infarction: systematic review and meta-ethnography. J Clin Nurs 2016; 25:599-609. [PMID: 26771091 DOI: 10.1111/jocn.13096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this review is to identify, analyse and synthesise existing knowledge concerning female experiences during myocardial infarction. BACKGROUND There is a lack of knowledge about women's experiences during myocardial infarction, and a meta-synthesis is needed to synthesise existing evidence. DESIGN A systematic review and meta-ethnography. METHOD A systematic review was undertaken in September 2013. Four databases were searched. Grey literature and reference lists were screened for relevant studies. Four hundred and eighty-one papers were identified and 14 were included. The method of Noblit and Hare was used in the process of conducting this review and meta-ethnography. RESULTS Three themes were identified. 1. 'Feeling the changes in my body', 2. 'Understanding the changes in my body' and 3. 'Acting on the changes in my body'. The majority of women did not experience their body changes as being severe and threatening. Therefore, the women chose to wait or self-medicate before consulting others. The women who initially experienced the symptoms related to myocardial infarction as being severe and threatening, chose to consult others earlier than the majority of women. CONCLUSION Women's experiences and interpretation of body symptoms during myocardial infarction vary. Most commonly women do not initially recognise their body symptoms as being severe and life threatening. The theory of Merleau-Ponty's 'current and habituated body' is relevant for explaining women's ways of understanding and acting on their body changes during myocardial infarction. RELEVANCE FOR CLINICAL PRACTICE This review is relevant in a preventive and rehabilitating perspective for professionals working in health care. It helps professionals to understand women's experiences during myocardial infarction, optimises their ability to suspect myocardial infarction and teach women to react on these body changes.
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Affiliation(s)
- Rikke Madsen
- Horsens Regional Hospital and Aarhus University, Horsens, Denmark
| | - Regner Birkelund
- University of Southern Denmark & Lillebaelt Hospital, Vejle, Denmark
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11
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Abed MA, Khalil AA, Moser DK. The Contribution of Symptom Incongruence to Prehospital Delay for Acute Myocardial Infarction Symptoms Among Jordanian Patients. Res Nurs Health 2015; 38:213-21. [DOI: 10.1002/nur.21658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Mona A. Abed
- Assistant Professor; College of Nursing; Hashemite University; Zarqa 13115 Jordan
| | - Amani A. Khalil
- Associate Professor; Faculty of Nursing; The University of Jordan; Amman Jordan
| | - Debra K. Moser
- Professor; College of Nursing; University of Kentucky; Lexington KY
- School of Nursing; University of Ulster; Belfast Ireland
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12
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Lichtman JH, Leifheit-Limson EC, Watanabe E, Allen NB, Garavalia B, Garavalia LS, Spertus JA, Krumholz HM, Curry LA. Symptom recognition and healthcare experiences of young women with acute myocardial infarction. Circ Cardiovasc Qual Outcomes 2015; 8:S31-8. [PMID: 25714826 DOI: 10.1161/circoutcomes.114.001612] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Prompt recognition of acute myocardial infarction symptoms and timely care-seeking behavior are critical to optimize acute medical therapies. Relatively little is known about the symptom presentation and care-seeking experiences of women aged ≤55 years with acute myocardial infarction, a group shown to have increased mortality risk as compared with similarly aged men. Understanding symptom recognition and experiences engaging the healthcare system may provide opportunities to reduce delays and improve acute care for this population. METHODS AND RESULTS We conducted a qualitative study using in-depth interviews with 30 women (aged 30-55 years) hospitalized with acute myocardial infarction to explore their experiences with prodromal symptoms and their decision-making process to seek medical care. Five themes characterized their experiences: (1) prodromal symptoms varied substantially in both nature and duration; (2) they inaccurately assessed personal risk of heart disease and commonly attributed symptoms to noncardiac causes; (3) competing and conflicting priorities influenced decisions about seeking acute care; (4) the healthcare system was not consistently responsive to them, resulting in delays in workup and diagnosis; and (5) they did not routinely access primary care, including preventive care for heart disease. CONCLUSIONS Participants did not accurately assess their cardiovascular risk, reported poor preventive health behaviors, and delayed seeking care for symptoms, suggesting that differences in both prevention and acute care may be contributing to young women's elevated acute myocardial infarction mortality relative to men. Identifying factors that promote better cardiovascular knowledge, improved preventive health care, and prompt care-seeking behaviors represent important target for this population.
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Affiliation(s)
- Judith H Lichtman
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
| | - Erica C Leifheit-Limson
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Emi Watanabe
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Norrina B Allen
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Brian Garavalia
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Linda S Garavalia
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - John A Spertus
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Harlan M Krumholz
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
| | - Leslie A Curry
- From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.)
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Cheng TO. In China women uphold half of the sky, but only a quarter of them received reperfusion therapy for acute coronary syndrome. Int J Cardiol 2014; 177:317-9. [DOI: 10.1016/j.ijcard.2014.06.064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2014] [Accepted: 06/29/2014] [Indexed: 12/26/2022]
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Noureddine S, Dumit NY, Saab M. Deciding to Seek Emergency Care for Acute Myocardial Infarction. Clin Nurs Res 2014; 24:487-503. [PMID: 25165070 DOI: 10.1177/1054773814548508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this qualitative descriptive study was to explore how patients who experience acute myocardial infarction (AMI) decide to seek emergency care. Fifty patients with AMI were interviewed at two hospitals in Lebanon. The perspective of 22 witnesses of the attack was also sought about the cardiac event. The themes that transpired from the data were as follows: making sense of the symptoms, waiting to see what happens, deciding to come to the hospital, and the family influenced the decision to seek care. The witnesses of the cardiac event, mostly family members, supported the decision to seek emergency care. Deciding to seek emergency care for AMI is complex. Nurses must solicit their patients' perception of the cardiac event to provide them with tailored education and counseling about heart attack symptoms and how to respond to them in case they recur. Family members must be included in the education process.
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Mackay MH, Ratner PA, Nguyen M, Percy M, Galdas P, Grunau G. Inconsistent measurement of acute coronary syndrome patients' pre-hospital delay in research: a review of the literature. Eur J Cardiovasc Nurs 2014; 13:483-93. [PMID: 24532675 DOI: 10.1177/1474515114524866] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients' treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research. METHODS AND RESULTS We reviewed the English-language literature from 1998-2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing. CONCLUSION We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.
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Affiliation(s)
- Martha H Mackay
- School of Nursing, University of British Columbia, Canada St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | - Michelle Nguyen
- St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | | | - Gilat Grunau
- School of Nursing, University of British Columbia, Canada
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Davis LL, Mishel M, Moser DK, Esposito N, Lynn MR, Schwartz TA. Thoughts and behaviors of women with symptoms of acute coronary syndrome. Heart Lung 2013; 42:428-35. [PMID: 24011604 PMCID: PMC3818316 DOI: 10.1016/j.hrtlng.2013.08.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2012] [Revised: 07/23/2013] [Accepted: 08/01/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Women delay seeking care for symptoms of acute coronary syndrome (ACS) because of atypical symptoms, perceptions of invulnerability, or keeping symptoms to themselves. The purpose of this study was to explore how women recognized and interpreted their symptoms and subsequently decided whether to seek treatment within the context of their lives. METHOD Grounded theory was used to provide the methodological basis for data generation and analysis. Data were collected using in-depth interviews with 9 women with ACS. RESULTS All participants went through a basic social process of searching for the meaning of their symptoms which informed their decisions about seeking care. Stages in the process included noticing symptoms, forming a symptom pattern, using a frame of reference, finding relief, and assigning causality. The evolving MI group (n = 5) experienced uncertainty about bodily cues, continued life as usual, until others moved them toward care. The immediately recognizable MI group (n = 4) labeled their condition quickly, yet delayed, as they prepared themselves and others for their departure. CONCLUSIONS All women delayed, regardless of their ability to correctly label their symptoms. Education aimed at symptom recognition/interpretation addresses only part of the problem. Women should also be educated about the potential danger of overestimating the time they have to seek medical attention.
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Affiliation(s)
- Leslie L Davis
- University of North Carolina, Greensboro School of Nursing, 308 Moore Building, PO Box 26170, Greensboro, NC, 27402-6170
| | - Merle Mishel
- University of North Carolina at Chapel Hill,School of Nursing, 4012 Carrington Hall, CB #7460, Chapel Hill, NC 27599, Tel: 919.966.4274,
| | - Debra K. Moser
- Center for Biobehavioral Research in Self-Management of Cardiopulmonary, Diseases University of Kentucky, College of Nursing, 527 CON, 751 Rose Street, Lexington, KY 40536-0232, 859-323-6687,
| | - Noreen Esposito
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, CB #7460, Chapel Hill, NC 27599, Phone: 919-843-4603,
| | - Mary R. Lynn
- University of North Carolina at Chapel Hill, School of Nursing, Carrington Hall, CB #7460, Chapel Hill, NC 27599, Phone: 919-966-5450,
| | - Todd A. Schwartz
- University of North Carolina at Chapel Hill, Department of Biostatistics and School of Nursing, Carrington Hall, CB #7460, Chapel Hill, NC 27599, Phone: (919) 966-7280,
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Alshahrani H, McConkey R, Wilson J, Youssef M, Fitzsimons D. Female gender doubles pre-hospital delay times for patients experiencing ST segment elevation myocardial infarction in Saudi Arabia. Eur J Cardiovasc Nurs 2013; 13:399-407. [DOI: 10.1177/1474515113507159] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Hassan Alshahrani
- Institute of Nursing & Health Research & School of Nursing, University Of Ulster, Belfast, UK
- King Saud Medical City, Riyadh, Saudi Arabia
| | - Roy McConkey
- Institute of Nursing & Health Research & School of Nursing, University Of Ulster, Belfast, UK
| | - Julie Wilson
- Belfast Health & Social Care Trust, Northern Ireland
| | - Mostafa Youssef
- King Fahad Medical City, Prince Salman Heart Center, Riyadh, Saudi Arabia
| | - Donna Fitzsimons
- Institute of Nursing & Health Research & School of Nursing, University Of Ulster, Belfast, UK
- Belfast Health & Social Care Trust, Northern Ireland
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Henry L, Hunt S, Holmes SD, Martin LM, Ad N. Are There Gender Differences in Outcomes after the Cox-Maze Procedure for Atrial Fibrillation? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Linda Henry
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Sharon Hunt
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Sari D. Holmes
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Lisa M. Martin
- Inova Heart and Vascular Institute, Falls Church, VA USA
| | - Niv Ad
- Inova Heart and Vascular Institute, Falls Church, VA USA
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Are There Gender Differences in Outcomes after the Cox-Maze Procedure for Atrial Fibrillation? INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:190-8. [DOI: 10.1097/imi.0b013e3182a2306c] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Objective Atrial fibrillation (AF) management suggests that women do not tolerate medication rhythm control strategies as well as men do; however, AF percutaneous catheter ablation has been found to be favorable. The study purpose was to compare the sex-based outcomes for patients who undergo the Cox-Maze procedure for AF. Methods Data were collected through our AF surgical ablation registry. Rhythm was verified by electrocardiogram and 24-hour holter at 6 and 12 months. General health-related quality of life (Short-Form 12) and specific AF symptom burden (Atrial Fibrillation Symptom Checklist: Frequency and Severity, version 3) were obtained at baseline and 12 months. Results Since 2005, a total of 540 patients have undergone a Cox-Maze procedure (34% were women). The women presented with higher operative risk [additive European System for Cardiac Operative Risk Evaluation (EuroSCORE), 6.71 ± 2.61 vs 5.25 ± 2.80, t = 5.85, P < 0.001], higher rates of congestive heart failure (49% vs 32%, P < 0.001), and more concomitant mitral valve procedures (32% vs 19%, P = 0.001). Perioperative outcomes were similar. Return to sinus rhythm off antiarrhythmics were not different at 6 and 12 months (78% vs 75%, P = 0.53, and 81% vs 80%, P = 1.00, respectively). Cumulative 2-year survival (93.9% for the men and 89.3% for the women) was not different for all-cause mortality (hazard ratio, 1.47; confidence interval, 0.68–3.21; P = 0.33) and cardiac-related mortality [women: 10/14 (71%) vs men 7/11 (64%), P = 1.00]. Health-related quality of life showed significant improvement; AF symptoms significantly decreased across the sexes. Conclusions Outcomes after the Cox-Maze procedure are similar across sex. Atrial fibrillation surgical ablation should be considered a treatment option for women—it is safe and effective, improves general health-related quality of life, and reduces AF symptom burden.
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Baxter SK, Allmark P. Reducing the time-lag between onset of chest pain and seeking professional medical help: a theory-based review. BMC Med Res Methodol 2013; 13:15. [PMID: 23388093 PMCID: PMC3570316 DOI: 10.1186/1471-2288-13-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 02/04/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Research suggests that there are a number of factors which can be associated with delay in a patient seeking professional help following chest pain, including demographic and social factors. These factors may have an adverse impact on the efficacy of interventions which to date have had limited success in improving patient action times. Theory-based methods of review are becoming increasingly recognised as important additions to conventional systematic review methods. They can be useful to gain additional insights into the characteristics of effective interventions by uncovering complex underlying mechanisms. METHODS This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies exploring the issue of why people having a heart attack delay seeking professional medical help. The study used standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data relating to theoretical underpinnings. RESULTS Thirty six papers from the 53 in the original systematic review referred to a particular theoretical perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this model including different coping mechanisms, strategies of denial and varying models of treatment seeking. Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and referred to models of maintaining integrity, ways of knowing, and the influence of gender. CONCLUSIONS The review highlights the need to examine an individual's subjective experience of and response to health threats, and confirms the gap between knowledge and changed behaviour. Interventions face key challenges if they are to influence patient perceptions regarding seriousness of symptoms; varying processes of coping; and obstacles created by patient perceptions of their role and responsibilities. A theoretical approach to review of these papers provides additional insight into the assumptions underpinning interventions, and illuminates factors which may impact on their efficacy. The method thus offers a useful supplement to conventional systematic review methods.
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Affiliation(s)
- Susan K Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, UK.
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Stevens S, Thomas SP. Recovery of Midlife Women From Myocardial Infarction. Health Care Women Int 2012; 33:1096-113. [DOI: 10.1080/07399332.2012.684815] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Riegel B, Elmi A, Moser DK, McKinley S, Meischke H, Doering LV, Davidson P, Pelter M, Baker H, Dracup K. Who listens to our advice? A secondary analysis of data from a clinical trial testing an intervention designed to decrease delay in seeking treatment for acute coronary syndrome. PATIENT EDUCATION AND COUNSELING 2011; 85:e33-e38. [PMID: 21300515 PMCID: PMC3097294 DOI: 10.1016/j.pec.2011.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 01/06/2011] [Accepted: 01/07/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Prolonged prehospital delay in persons experiencing acute coronary syndrome (ACS) remains a problem. Understanding which patients respond best to particular interventions designed to decrease delay time would provide mechanistic insights into the process by which interventions work. METHODS In the PROMOTION trial, 3522 at-risk patients were enrolled from 5 sites in the United States (56.4%), Australia and New Zealand; 490 (N=272 intervention, N=218 control) had an acute event within 2 years. Focusing on these 490, we (1) identified predictors of a rapid response to symptoms, (2) identified intervention group subjects with a change in these predictors over 3 months of follow-up, and (3) compared intervention group participants with and without the favorable response pattern. Hypothesized predictors of rapid response were increased perceived control and decreased anxiety. Knowledge, attitudes, and beliefs were hypothesized to differ between responders and non-responders. RESULTS Contrary to hypothesis, responders had low anxiety and low perceived control. Only 73 (26.8%) subjects showed this pattern 3 months following the intervention. No differences in ACS knowledge, attitudes, or beliefs were found. CONCLUSION The results of this study challenge existing beliefs. PRACTICE IMPLICATIONS New intervention approaches that focus on a realistic decrease in anxiety and perceived control are needed.
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Affiliation(s)
- Barbara Riegel
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104-4217, USA.
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DeVon HA, Saban KL, Garrett DK. Recognizing and Responding to Symptoms of Acute Coronary Syndromes and Stroke in Women. J Obstet Gynecol Neonatal Nurs 2011; 40:372-82. [DOI: 10.1111/j.1552-6909.2011.01241.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Cao Y, Davidson PM, DiGiacomo M, Yang M. Prehospital Delay for Acute Coronary Syndrome in China. J Cardiovasc Nurs 2010; 25:487-96. [DOI: 10.1097/jcn.0b013e3181dae42d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Wiltshire JC, Person SD, Kiefe CI, Allison JJ. Disentangling the influence of socioeconomic status on differences between African American and white women in unmet medical needs. Am J Public Health 2009; 99:1659-65. [PMID: 19608942 PMCID: PMC2724438 DOI: 10.2105/ajph.2008.154088] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/08/2008] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We sought to disentangle the relationships between race/ethnicity, socioeconomic status (SES), and unmet medical care needs. METHODS Data from the 2003-2004 Community Tracking Study Household Survey were used to examine associations between unmet medical needs and SES among African American and White women. RESULTS No significant racial/ethnic differences in unmet medical needs (24.8% of Whites, 25.9% of African Americans; P = .59) were detected in bivariate analyses. However, among women with 12 years of education or less, African Americans were less likely than were Whites to report unmet needs (odds ratio [OR] = 0.57; 95% confidence interval [CI] = 0.42, 0.79). Relative to African American women with 12 years of education or less, the odds of unmet needs were 1.69 (95% CI = 1.24, 2.31) and 2.18 (95% CI = 1.25, 3.82) among African American women with 13 to 15 years of education and 16 years of education or more, respectively. In contrast, the relationship between educational level and unmet needs was nonsignificant among White women. CONCLUSIONS Among African American women, the failure to recognize unmet medical needs is related to educational attainment and may be an important driver of health disparities, representing a fruitful area for future interventions.
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Affiliation(s)
- Jacqueline C Wiltshire
- Institute of Public Health, College of Pharmacy and Pharmaceutical Sciences, Florida A & M University, Tallahassee, FL 32301, USA.
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Turris SA. Women's Decisions to Seek Treatment for the Symptoms of Potential Cardiac Illness. J Nurs Scholarsh 2009; 41:5-12. [DOI: 10.1111/j.1547-5069.2009.01245.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Lutfiyya MN, Cumba MT, McCullough JE, Barlow EL, Lipsky MS. Disparities in adult African American women's knowledge of heart attack and stroke symptomatology: an analysis of 2003-2005 Behavioral Risk Factor Surveillance Survey data. J Womens Health (Larchmt) 2008; 17:805-13. [PMID: 18479229 DOI: 10.1089/jwh.2007.0599] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Heart disease and stroke are the first and third leading causes of death of American women, respectively. African American women experience a disproportionate burden of these diseases compared with Caucasian women and are also more likely to delay seeking treatment for acute symptoms. As knowledge is a first step in seeking care, this study examined the knowledge of heart attack and stroke symptoms among African American women. METHODS This was a cross-sectional study analyzing 2003-2005 Behavioral Risk Factor Surveillance Survey (BRFSS) data. A composite heart attack and stroke knowledge score was computed for each respondent from the 13 heart attack and stroke symptom knowledge questions. Multivariate logistic regression was performed using low scores on the heart attack and stroke knowledge questions as the dependent variable. RESULTS Twenty percent of the respondents were low scorers, and 23.8% were high scorers. Logistic regression analysis showed that adult African American women who earned low scores on the composite heart attack and stroke knowledge questions (range 0-8 points) were more likely to be aged 18-34 (OR = 1.36, CI 1.35, 1.37), be uninsured (OR = 1.32, CI 1.31, 1.33), have an annual household income <$35,000 (OR = 1.46, CI 1.45, 1.47), and have a primary healthcare provider (OR = 1.22, CI 1.20, 1.23). CONCLUSIONS The findings indicated that knowledge of heart attack and stroke symptoms varied significantly among African American women, depending on socioeconomic variables. Targeting interventions to African American women, particularly those in lower socioeconomic groups, may increase knowledge of heart attack and stroke symptoms, subsequently improving preventive action taken in response to these conditions.
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Affiliation(s)
- May Nawal Lutfiyya
- Department of Family and Community Medicine, University of Illinois-Chicago College of Medicine at Rockford, Rockford, Illinois 61107, USA.
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Reed DB, Rayens MK, Winter K, Zhang M. Health Care Delay of Farmers 50 Years and Older in Kentucky and South Carolina. J Agromedicine 2008; 13:71-9. [DOI: 10.1080/10599240802202711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Sjöström-Strand A, Fridlund B. Women's descriptions of symptoms and delay reasons in seeking medical care at the time of a first myocardial infarction: A qualitative study. Int J Nurs Stud 2008; 45:1003-10. [PMID: 17803997 DOI: 10.1016/j.ijnurstu.2007.07.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 07/04/2007] [Accepted: 07/05/2007] [Indexed: 10/22/2022]
Abstract
BACKGROUND Coronary heart disease (CHD) is a major cause of mortality in women. Women have also been identified as late presenters in seeking medical care. AIM The aim of this study was to explore and describe women's symptoms and the reasons for delay in seeking medical care at the time of the first myocardial infarction (MI). METHODS The study had an explorative and descriptive design based on content analysis approach. Nineteen women were interviewed at the hospital 2 or 3 days after hospitalisation. RESULTS The result showed that the women had difficulties interpreting, understanding and linking the symptoms to CHD. They tried to handle the discomfort and even the chest pain, rather then ask for professional help. The women had problems with making the final decision. CONCLUSION Women need to be made aware of the clinical symptoms of CHD, in order to understand the consequences of delay in seeking medical care following an MI.
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