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Ivynian SE, Ferguson C, Newton PJ, DiGiacomo M. The role of illness perceptions in delayed care-seeking in heart failure: A mixed-methods study. Int J Nurs Stud 2024; 150:104644. [PMID: 38016267 DOI: 10.1016/j.ijnurstu.2023.104644] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 10/30/2023] [Accepted: 11/04/2023] [Indexed: 11/30/2023]
Abstract
BACKGROUND Unclear illness perceptions are common in heart failure. The self-regulation model of illness behaviour highlights factors that may impact how people with chronic illness choose to cope with or manage their condition and has been used to study pre-hospital delay for stroke and acute myocardial infarction. The principles of self-regulation can be applied in heart failure to help illuminate the link between unclear illness perceptions and sub-optimal symptom self-management. OBJECTIVE Informed by the self-regulation model of illness behaviour, this study examines the role of illness perceptions in coping responses that lead to delayed care-seeking for heart failure symptoms. DESIGN Mixed-methods phenomenological study. SETTING(S) Quaternary referral hospital - centre of excellence for cardiovascular care and heart transplantation. PARTICIPANTS Seventy-two symptomatic patients with heart failure participated in a survey assessing illness perceptions. A subset of fifteen individuals was invited to participate in semi-structured interviews. METHODS Illness perceptions were assessed using the Brief Illness Perception Questionnaire. In-depth semi-structured interviews were conducted to elicit previous care-seeking experiences and decision-making that led to a passive, or active coping response to worsening symptoms. Descriptive statistics were used to report questionnaire findings, and open-ended responses were grouped into descriptive categories. Interpretative phenomenological analysis was undertaken on interview transcripts. RESULTS Participants perceived little personal control over their condition and mostly attributed heart failure to lifestyle factors such as diet and lack of activity. Cognitive dissonance between perceived self-identity and heart failure-identity led to a highly emotional response which drove coping towards avoidance strategies and denial. CONCLUSIONS This study demonstrates the use of the principles of self-regulation in heart failure and offers a framework to understand how patient representations and emotional responses can inform behaviour in illness. Findings highlight the value of empowering patients to take control of their health and the need to help align values (e.g. independence) with behaviours (e.g. actively addressing problems) to facilitate optimal symptom self-management.
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Affiliation(s)
- Serra E Ivynian
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia.
| | - Caleb Ferguson
- School of Nursing, University of Wollongong and Centre for Chronic & Complex Care, Blacktown Hospital, Western Sydney Local Health District, NSW, Australia
| | - Phillip J Newton
- School of Nursing & Midwifery, University of Newcastle, Australia
| | - Michelle DiGiacomo
- Improving Palliative, Aged and Chronic Care through Clinical Research and Translation (IMPACCT), Faculty of Health, University of Technology Sydney, Australia
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Jeon CY, Adeniran E, Stewart C, Papachristou GI, Pisegna JR, Kuc AA, Buxbaum JL, Pandol SJ, Yadav D. Female patients delay seeking medical care with alcohol-associated acute pancreatitis. Pancreatology 2023; 23:761-766. [PMID: 37567847 DOI: 10.1016/j.pan.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/13/2023]
Abstract
BACKGROUND/OBJECTIVE Alcohol consumption is increasing in women, who more frequently report abdominal symptoms compared to men. We aimed to examine differences in presentation of acute pancreatitis [AP] in male and female patients hospitalized with alcohol-associated AP. METHODS We analyzed 138 patients enrolled in an ongoing case-crossover study of alcohol-associated AP conducted across 5 medical centers in the U.S. Patients meeting the Revised Atlanta Classification of AP and who scored 3 or higher on the AUDIT-C instrument were invited to participate in the study and were interviewed while hospitalized with AP. Sex differences in the timing and type of pancreas-associated pain, alcohol consumption, clinical presentation, and quality of life were examined by Chi-squared tests, Wilcoxon rank sum tests and t-tests. RESULTS Female patients reported significantly longer interval from onset of pain to deciding to seek medical attention (median 40 h, interquartile range [IQR] 14, 74) as compared to males (14 h, IQR 4, 50; p = 0.005). While male patients were more likely to have been admitted to the intensive care unit [ICU] (21%) as compared to female patients (7%; p = 0.04), the incidence of SIRS or severe AP did not differ by sex. Quality of life measures as reported through the PROMIS-29 instrument were equally suboptimal in both sexes. Anxiety disorders were diagnosed more frequently among females (61%) than in males (41%, p = 0.009). CONCLUSION In a large case series of alcohol-associated AP, we found that female patients delayed seeking medical care compared to males. However, there were no differences in the type, location and intensity of abdominal pain.
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Affiliation(s)
- Christie Y Jeon
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA; Department of Epidemiology, UCLA Fielding School of Public Health, Los Angeles, CA, USA.
| | - Esther Adeniran
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Connor Stewart
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Georgios I Papachristou
- Division of Gastroenterology, Hepatology, and Nutrition, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Joseph R Pisegna
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - Alma A Kuc
- Division of Gastroenterology, Hepatology and Parenteral Nutrition, Department of Medicine, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA
| | - James L Buxbaum
- Division of Gastroenterology, Department of Medicine, Keck School of Medicine of the University of Southern California, Los Angeles, CA, USA
| | - Stephen J Pandol
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Dhiraj Yadav
- Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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Yoon CW, Oh H, Lee J, Rha J, Woo S, Lee WK, Jung H, Ban B, Kang J, Kim BJ, Kim W, Yoon C, Lee H, Kim S, Kim SH, Kang EK, Her A, Cha J, Kim D, Kim M, Lee JH, Park HS, Kim K, Kim RB, Choi N, Hwang J, Park H, Park KS, Yi S, Cho JY, Kim N, Choi K, Kim Y, Kim J, Han J, Choi JC, Kim S, Choi J, Kim J, Jee SJ, Sohn MK, Choi SW, Shin D, Lee SY, Bae J, Lee K, Bae H. Comparisons of Prehospital Delay and Related Factors Between Acute Ischemic Stroke and Acute Myocardial Infarction. J Am Heart Assoc 2022; 11:e023214. [PMID: 35491981 PMCID: PMC9238627 DOI: 10.1161/jaha.121.023214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background
Prehospital delay is an important contributor to poor outcomes in both acute ischemic stroke (AIS) and acute myocardial infarction (AMI). We aimed to compare the prehospital delay and related factors between AIS and AMI.
Methods and Results
We identified patients with AIS and AMI who were admitted to the 11 Korean Regional Cardiocerebrovascular Centers via the emergency room between July 2016 and December 2018. Delayed arrival was defined as a prehospital delay of >3 hours, and the generalized linear mixed‐effects model was applied to explore the effects of potential predictors on delayed arrival. This study included 17 895 and 8322 patients with AIS and AMI, respectively. The median value of prehospital delay was 6.05 hours in AIS and 3.00 hours in AMI. The use of emergency medical services was the key determinant of delayed arrival in both groups. Previous history, 1‐person household, weekday presentation, and interhospital transfer had higher odds of delayed arrival in both groups. Age and sex had no or minimal effects on delayed arrival in AIS; however, age and female sex were associated with higher odds of delayed arrival in AMI. More severe symptoms had lower odds of delayed arrival in AIS, whereas no significant effect was observed in AMI. Off‐hour presentation had higher and prehospital awareness had lower odds of delayed arrival; however, the magnitude of their effects differed quantitatively between AIS and AMI.
Conclusions
The effects of some nonmodifiable and modifiable factors on prehospital delay differed between AIS and AMI. A differentiated strategy might be required to reduce prehospital delay.
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Caltabellotta T, Magne J, Salerno B, Pradel V, Petitcolin PB, Auzemery G, Virot P, Aboyans V. Characteristics associated with patient delay during the management of ST-segment elevated myocardial infarction, and the influence of awareness campaigns. Arch Cardiovasc Dis 2020; 114:305-315. [PMID: 33272857 DOI: 10.1016/j.acvd.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/03/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The delay between the occurrence of symptoms and the call seeking medical assistance is an important component of the pain-to-balloon delay in patients with ST-segment elevation myocardial infarction (STEMI). Factors affecting this "patient delay" have been poorly studied, and campaigns to raise emergency call awareness have barely been evaluated. AIMS To evaluate the factors related to patient delay, and the effects of public awareness campaigns undertaken in our region. METHODS Data from the regional registry of STEMI in Limousin, France, were analysed, and we performed a survey to assess medical history, clinical signs, context, socioeconomic situation and perception and behaviour of the patient. "Late callers" (i.e. third tertile,>154minutes) were compared with "early callers" (i.e. first and second tertiles,≤154minutes) using univariate and multivariable statistical methods. The influence of public awareness campaigns was studied by comparing the patient delays before and after a regional campaign. RESULTS Among 481 patients, the median patient delay was 87minutes. "Late callers" were older (odds ratio [OR] 1.02 per year, 95% confidence interval [CI] 1.00 to 1.03), more often had symptom onset between 00:00 and 05:59 a.m. (OR 1.86, 95% CI 1.10 to 3.12) and more often sought assistance from a general practitioner (OR 2.58, 95% CI 1.66 to 4.04) or attended the emergency room (OR 4.10, 95% CI 2.04 to 8.32). Sweats and considering the situation to be severe were factors associated with a reduced delay. After awareness campaigns, there was no change in patient delay, but the proportion of patients calling the Emergency Medical Services increased from 55% to 62% (P<0.001). CONCLUSIONS Patient delay is multifactorial. The impact of previous campaigns is mixed. Psychological and behavioural aspects are determinant, and should be taken into consideration to develop awareness messages that target specific groups.
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Affiliation(s)
- Thibaut Caltabellotta
- Department of Medicine, Monts-et-Barrages Hospital, 87400 Saint-Léonard de Noblat, France
| | - Julien Magne
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France
| | - Baptiste Salerno
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | - Valerie Pradel
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | | | - Gilles Auzemery
- Agence Régionale de Santé-Nouvelle-Aquitaine, 33000 Bordeaux, France
| | - Patrice Virot
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France.
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Implanted Monitor Alerting to Reduce Treatment Delay in Patients With Acute Coronary Syndrome Events. J Am Coll Cardiol 2020; 74:2047-2055. [PMID: 31623762 DOI: 10.1016/j.jacc.2019.07.084] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 06/16/2019] [Accepted: 07/17/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Increased pre-hospital delay during acute coronary syndrome (ACS) events contributes to worse outcome. OBJECTIVES The purpose of this study was to assess the effectiveness of an implanted cardiac monitor with real-time alarms for abnormal ST-segment shifts to reduce pre-hospital delay during ACS events. METHODS In the ALERTS (AngeLmed Early Recognition and Treatment of STEMI) pivotal study, subjects at high risk for recurrent ACS events (n = 907) were randomized to control (Alarms OFF) or treatment groups for 6 months, after which alarms were activated in all subjects (Alarms ON). Emergency department (ED) visits with standard-of-care cardiac test results were independently adjudicated as true- or false-positive ACS events. Alarm-to-door (A2D) and symptom-to-door (S2D) times were calculated for true-positive ACS ED visits triggered by 3 possible prompts: alarm only, alarms + symptoms, or symptoms only. RESULTS The Alarms ON group showed reduced delays, with 55% (95% confidence interval [CI]: 46% to 63%) of ED visits for ACS events <2 h compared with 10% (95% CI: 2% to 27%) in the Alarms OFF group (p < 0.0001). Results were similar when restricted to myocardial infarction (MI) events. Median pre-hospital delay for MI was 12.7 h for Alarms OFF and 1.6 h in Alarms ON subjects (p < 0.0089). Median A2D delay was 1.4 h for asymptomatic MI. Median S2D delay for symptoms-only MI (no alarm) in Alarms ON was 4.3 h. CONCLUSIONS Intracardiac monitoring with real-time alarms for ST-segment shift that exceeds a subject's self-normative ischemia threshold level significantly reduced the proportion of pre-hospital delays >2 h for ACS events, including asymptomatic MI, compared with symptoms-only ED visits in Alarms OFF. (AngeLmed for Early Recognition and Treatment of STEMI [ALERTS]; NCT00781118).
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Peltzer S, Hellstern M, Genske A, Jünger S, Woopen C, Albus C. Health literacy in persons at risk of and patients with coronary heart disease: A systematic review. Soc Sci Med 2019; 245:112711. [PMID: 31855729 DOI: 10.1016/j.socscimed.2019.112711] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 11/08/2019] [Accepted: 11/30/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND Health literacy (HL) plays a crucial role in the maintenance and improvement of individual health. Empirical findings highlight the relation between a person's HL-level and clinical outcomes. However, the role of HL in persons at risk for coronary heart disease (CHD) and patients with CHD has not been researched conclusively. OBJECTIVE The aim of this study was to review systematically the current evidence on HL, its dimensions (access to, understanding, appraisal and apply of health-related information), and its important influencing factors, with regard to CHD risk. METHOD We used a mixed-methods approach. Eligible articles needed to employ a validated tool for HL or mention the concept and at least one of its dimensions. After the screening process, 14 quantitative and 27 qualitative studies were included and referred to one or more dimensions of HL. Six observational studies measured HL with a validated tool. RESULTS Findings suggest that patients with lower HL feel less capable to perform lifestyle changes, exhibit fewer proactive coping behaviors, are more likely to deny CHD, are generally older, are less often employed, have lower educational levels and lower socioeconomic status, experience faster physical decline, and use the healthcare system less, compared to patients with higher HL. Barriers to HL include inadequate provision of information by health providers, lack of awareness of the risk factors for CHD, perceived impairment of quality of life due to lifestyle changes, and negative experiences with the healthcare system. Facilitators include a good patient-physician relationship based on good communicative competences of health providers. CONCLUSIONS The concept of HL yields a promising potential to understand the process from obtaining information to actual health behavior change, and the results clearly indicate the need for more systematic research on HL in CHD patients and persons at risk.
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Affiliation(s)
- Samia Peltzer
- University Hospital Cologne, Department of Psychosomatics and Psychotherapy, Weyertal 76, 50931, Cologne, Germany.
| | - Marc Hellstern
- University Hospital Cologne, Department of Psychosomatics and Psychotherapy, Weyertal 76, 50931, Cologne, Germany.
| | - Anna Genske
- University of Cologne, Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), Albertus-Magnus-Platz, 50923, Cologne, Germany.
| | - Saskia Jünger
- University of Cologne, Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), Albertus-Magnus-Platz, 50923, Cologne, Germany.
| | - Christiane Woopen
- University of Cologne, Cologne Center for Ethics, Rights, Economics, and Social Sciences of Health (ceres), Albertus-Magnus-Platz, 50923, Cologne, Germany.
| | - Christian Albus
- University Hospital Cologne, Department of Psychosomatics and Psychotherapy, Weyertal 76, 50931, Cologne, Germany.
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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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Symptom Perception, Evaluation, Response to Symptom, and Delayed Care Seeking in Patients With Acute Heart Failure. J Cardiovasc Nurs 2019; 34:36-43. [DOI: 10.1097/jcn.0000000000000526] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Kawuma R, Seeley J, Mupambireyi Z, Cowan F, Bernays S. "Treatment is not yet necessary": delays in seeking access to HIV treatment in Uganda and Zimbabwe. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2018; 17:217-225. [PMID: 30132397 DOI: 10.2989/16085906.2018.1490785] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
We examined the logic that individuals use to account for delaying HIV testing and/or initiating HIV treatment. Our qualitative study, situated within the REALITY trial (Reduction of EArly mortaLITY in HIV infected adults and children starting antiretroviral therapy), was conducted in Uganda and Zimbabwe in 2015. Forty-eight participants (different age groups, sex and viral load/WHO disease stage) were included. Each participant had 2 interviews (1 after 4 weeks of participation in the trial the other after 12 weeks). If a person could manage presenting symptoms, they felt they had "more time" before starting antiretroviral therapy (ART). Their reluctance to have an HIV test (despite deteriorating health) arose from a belief that they were not "sick", that treatment was "not yet necessary". People in our study did not consider themselves as presenting "late", and treatment was not considered urgent as long as they considered their health to be "good enough".
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Affiliation(s)
- Rachel Kawuma
- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) , Uganda Research Unit , Entebbe , Uganda
| | - Janet Seeley
- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) , Uganda Research Unit , Entebbe , Uganda.,b Global Health and Development Department , London School of Hygiene and Tropical Medicine , London , UK
| | - Zivai Mupambireyi
- c Centre for Sexual Health and HIV/AIDS Research , Harare , Zimbabwe
| | - Frances Cowan
- d International Public Health Department , Liverpool School of Tropical Medicine , Liverpool , UK.,e Centre for Sexual Health and HIV/AIDS Research , Harare , Zimbabwe
| | - Sarah Bernays
- f School of Public Health , University of Sydney , Sydney , Australia
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- a Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) , Uganda Research Unit , Entebbe , Uganda
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Patient-physician gender concordance and increased mortality among female heart attack patients. Proc Natl Acad Sci U S A 2018; 115:8569-8574. [PMID: 30082406 DOI: 10.1073/pnas.1800097115] [Citation(s) in RCA: 282] [Impact Index Per Article: 47.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We examine patient gender disparities in survival rates following acute myocardial infarctions (i.e., heart attacks) based on the gender of the treating physician. Using a census of heart attack patients admitted to Florida hospitals between 1991 and 2010, we find higher mortality among female patients who are treated by male physicians. Male patients and female patients experience similar outcomes when treated by female physicians, suggesting that unique challenges arise when male physicians treat female patients. We further find that male physicians with more exposure to female patients and female physicians have more success treating female patients.
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Delays in Treatment-Seeking Decisions Among Women With Myocardial Infarction. Dimens Crit Care Nurs 2017; 36:298-303. [DOI: 10.1097/dcc.0000000000000260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Johansson I, Swahn E, Strömberg A. Manageability, vulnerability and interaction: A qualitative analysis of acute myocardial infarction patients’ conceptions of the event. Eur J Cardiovasc Nurs 2016; 6:184-91. [PMID: 16997634 DOI: 10.1016/j.ejcnurse.2006.08.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 07/31/2006] [Accepted: 08/17/2006] [Indexed: 11/17/2022]
Abstract
Background Delay in seeking care remains a problem for many patients with myocardial infarction. There is a great deal of knowledge available about clinical factors contributing to this delay, while studies focusing on the patients’ own experiences are few. Aim Describe variations in how individuals perceived suffering symptoms of an acute myocardial infarction. Design A qualitative method using phenomenographic design was applied. Interviews were conducted with 15 strategically selected patients with myocardial infarction. Findings Eight sub-categories in the pre-hospital phase were summarised into three categories: manageability, vulnerability, and interaction. To manage their situation, patients expressed a need to understand it and to have a similar situation to compare with. They also described coping with the arising threat to their lives by self-medication or denying their symptoms. Patients expressed vulnerability, with feelings of anxiety, both as triggers and barriers to seeking medical care. In interaction with others, psychosocial support and guidance from the environment, was fundamental in helping the patients to manage the situation. Conclusions There were large variations in myocardial infarction patients’ conceptions of the event. To improve disease management in the pre-hospital phase, the awareness of this large variation in conceptions about suffering symptoms of an myocardial infarction could be used in the dialogue between patients and health care professionals, in cardiac prevention programmes, as well as in health care education.
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Affiliation(s)
- Ingela Johansson
- Department of Cardiology, University Hospital, Linköping, Sweden; Department of Medicine and Care, Linköping University, Linköping, Sweden.
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Abstract
The primary aim of this study was to describe and compare the experience of fatigue in a group of elderly women and men with severe chronic heart failure. A sample of 158 patients (66 women and 92 men, with a mean age of 83 and 78 years, respectively) was invited to participate in a study on admission to a hospital outpatient heart failure clinic. A registered nurse interviewed patients using a modified version of the Fatigue Interview Schedule (FIS). Descriptions of the experiences of fatigue generally showed good agreement between men and women; however, some gender differences were found. Women expressed a clear role to fulfil because they were engaged in maintenance activities of their household. Although we still have only limited knowledge about the impact of gender on the experiences and coping strategies in disease and aging, it is important for care providers to consider gender differences when planning caring interventions.
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Affiliation(s)
- Inger Ekman
- The Sahlgrenska Academy at Göteborg University, Faculty of Health and Caring Sciences, Institute of Nursing, Box 457, S-405 30, Göteborg, Sweden.
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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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15
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Ivynian SE, DiGiacomo M, Newton PJ. Care-seeking decisions for worsening symptoms in heart failure: a qualitative metasynthesis. Heart Fail Rev 2015; 20:655-71. [DOI: 10.1007/s10741-015-9511-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Galick A, D'Arrigo-Patrick E, Knudson-Martin C. Can Anyone Hear Me? Does Anyone See Me? A Qualitative Meta-Analysis of Women's Experiences of Heart Disease. QUALITATIVE HEALTH RESEARCH 2015; 25:1123-1138. [PMID: 25924615 DOI: 10.1177/1049732315584743] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Female heart patients are underdiagnosed and undertreated. The purpose of this qualitative meta-data-analysis was to explain how societal expectations related to gender and the treatment environment influence women's experiences and can inform optimal care. The authors used grounded theory methodology and a social constructionist gender lens to analyze 43 studies (1993-2012) of women's experiences of heart disease. The analysis illustrates how social expectations within both medical and relational contexts led to women experiencing barriers to diagnosis and treatment and inadvertent minimization of their experience and knowledge. Women's descriptions of their experiences suggest three kinds of health care strategies that have the potential to increase women's engagement with heart disease treatment and rehabilitation: (a) support give and take in relational connections, (b) identify and acknowledge unique health-promoting behavior, and (c) focus on empowerment. These findings have interdisciplinary implications for practice with women with heart disease.
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Affiliation(s)
- Aimee Galick
- University of Louisiana at Monroe, Monroe, Louisiana, USA
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Mather CM, King KM, Leblanc P. Meanings of the heart among a group of older Sikh immigrant women with cardiovascular disease. ACTA ACUST UNITED AC 2014. [DOI: 10.5172/mra.455.1.1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Padilla García CI, Sáenz Montoya X. Respuestas de la mujer frente a los síntomas de Síndrome Coronario Agudo basados en el Modelo Conceptual del Manejo de los Síntomas. AVANCES EN ENFERMERÍA 2014. [DOI: 10.15446/av.enferm.v32n1.46068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Neubeck L, Maiorana A. Time to get help? Acute myocardial infarction and delay in calling an ambulance. Heart Lung Circ 2014; 24:1-3. [PMID: 25201029 DOI: 10.1016/j.hlc.2014.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lis Neubeck
- Sydney Nursing School, Charles Perkins Centre, Building D17, University of Sydney, Camperdown, NSW 2006; The George Institute for Global Health, 83-117 Missenden Road, Camperdown, NSW 2050.
| | - Andrew Maiorana
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, WA, 6000; School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, 6102
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Allana S, Khowaja K, Ali TS, Moser DK, Khan AH. Gender differences in factors associated with prehospital delay among acute coronary syndrome patients in Pakistan. J Transcult Nurs 2014; 26:480-90. [PMID: 26541388 DOI: 10.1177/1043659614524787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify gender differences in prehospital delay time (PDT) and its associated factors among acute coronary syndrome (ACS) patients. DESIGN Descriptive cross-sectional comparative study. METHODS This study was conducted among 249 ACS patients at two tertiary care hospitals of a large metropolitan city of Pakistan. Data were collected through the modified Response to Symptoms Questionnaire. RESULTS The median PDT of women was found to be 7 hours, compared to 3.5 hours among men (p = .001). Results of the regression analysis indicated that most women delayed because of social factors, such as attendants' responses to their symptoms (p = .002), and because they were worried about expenses required for the treatment (p = .002); yet, most men delayed owing to individual factors, such as waiting for symptoms to subside (p< .001), and not recognizing the symptoms as being cardiac related (p< .001). Having anxiety and lack of knowledge about symptoms was associated with extended PDT among both genders. CONCLUSION Women delayed longer than men in seeking treatment for their ACS symptoms. Different factors were associated with PDT in women and men. This study may provide important insights for designing interventional studies to reduce PDT in Pakistani ACS patients.
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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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Al-Hassan MA. Cognitive representations of symptoms of acute coronary syndrome and coping responses to the symptoms as correlates to pre-hospital delay in Omani women and men patients. J Res Nurs 2014. [DOI: 10.1177/1744987113519634] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The major purpose of this study was to describe gender-related cognitive representations of symptoms of acute coronary syndrome and coping responses to the symptoms as correlates to pre-hospital delay. Data were collected from 131 hospitalised Omani patients for acute coronary syndrome (81 men and 50 women) using a structured interview. Statistical analyses indicated that women perceived themselves as less susceptible to acute coronary syndrome than men. They reported the symptoms, shortness of breath and nausea/vomiting, more frequently than did men. Men who reported shorter pre-hospital delay were more likely to be free from diabetes, report neck pain, not experience left arm pain, attribute the symptoms to cardiac origin and not use the coping responses, ‘wait and see’ and ‘attempted to relax’. Whereas, women with shorter pre-hospital delay were more likely to experience sweating, perceive greater overall intensity of the symptoms and not report fear of diagnostic procedures as a barrier to seek healthcare early. The findings of this study suggest that, in women, the emotional aspect of the symptoms dominates the cognitive appraisal process, whereas the pathological aspect of the symptoms dominates the appraisal process in men.
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Affiliation(s)
- Mousa A Al-Hassan
- Department of Adult Health Nursing, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
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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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Kunadian V, Qiu W, Bawamia B, Veerasamy M, Jamieson S, Zaman A. Gender comparisons in cardiogenic shock during ST elevation myocardial infarction treated by primary percutaneous coronary intervention. Am J Cardiol 2013; 112:636-41. [PMID: 23711807 DOI: 10.1016/j.amjcard.2013.04.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 11/24/2022]
Abstract
Among patients hospitalized with acute myocardial infarction (AMI), cardiogenic shock (CS) is the leading cause of death, complicating up to 10% of admissions. Introduction of early revascularization strategies and mechanical ventricular support have seen short-term mortality associated with CS fall from 70% to 80% in the 1970s to approximately 50% to 60% in the 1990s. Previous studies reported a higher incidence of CS after AMI in women (11.6% vs 8.3%). The aims of this study were to determine hospital mortality outcomes and gender differences following primary percutaneous coronary intervention (PPCI) in the setting of CS. Data were collected prospectively among all patients undergoing PPCI for AMI at a large UK tertiary cardiac center between April 2008 and October 2011. A sample of 2,864 patients (women: 844 [29.5%]) underwent PPCI, of which 141 (4.9%) had a confirmed diagnosis of CS. Eighty-one of 2,019 [4.0%] male patients (mean age: 64.2 years) and 60 of 844 [7.1%]) female patients (mean age: 69.9 years) with CS underwent PPCI (p <0.001). The overall hospital mortality was 35.5% with no gender difference (male: 35.8% vs female: 35%, p >0.99). In conclusion, this analysis demonstrates that in the contemporary PPCI era, there is a reduction in the incidence of CS with reduced hospital mortality rates and no gender difference. The absence of a gender difference is remarkable because higher proportions of women presented with CS and were older than their male counterparts. Long-term follow-up data are required to determine if this difference is sustained.
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Smorti M, Cappelli F, Bergesio F, Perfetto F. Anxiety and depression among AL amyloidosis patients: the role of cardiac symptoms. Amyloid 2012; 19:123-8. [PMID: 22624655 DOI: 10.3109/13506129.2012.687420] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
UNLABELLED Light-chain (AL) amyloidosis has the worst prognosis out of the different forms of cardiac amyloidosis, However, data are not available about the incidence of the disease-related psychological impact of AL amyloidosis in this population. In particular, no data are available about the impact of diagnosis communication or about the impact of cardiac symptom onset and severity on anxiety and depression levels among AL patients. AIM To evaluate the role of time that has passed since the diagnosis was communicated, time that has passed since the onset of cardiac symptoms, and actual cardiac symptom severity have on level of anxiety, depression and psychological stress among cardiology patients with AL. Thirty-two AL patients with cardiac-related symptoms were administered General Health Questionnaire, State-Trait Anxiety Inventory and Centre for Epidemiological Study-Depression Scale. Clinical variables such as months gone by since diagnosis, months gone by since the onset of cardiac symptoms, and cardiac symptom severity (New York Heart Association (NYHA) class) were measured. Troponin, NT-pro BNP levels, Mayo Stage and echocardiographic characteristics were also collected. RESULTS According to questionnaire normative values, AL patients presented severe psychological distress, severe anxiety and clinical depression. Moreover, anxiety levels were determined by psychological distress (p < 0.001) and months gone by since the onset of cardiac symptoms (p < 0.01) while depression levels were influenced by NYHA class (p < 0.001). CONCLUSIONS Our results suggest that there is a need to plan psychological support for these patients with consideration for the onset of cardiac symptoms and symptom severity.
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Affiliation(s)
- Martina Smorti
- Faculty of Education, Free University of Bolzano, Bressanone, Italy.
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Almond SC, Salisbury H, Ziebland S. Women's experience of coronary heart disease: why is it different? ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjca.2012.7.4.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Susanna C Almond
- Health Experiences Research Group, University of Oxford, 2nd Floor, 23–38 Hythe Bridge Street, Oxford, OX1 2ET
| | | | - Sue Ziebland
- Health Experiences Research Group, University of Oxford
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Women's Experiences and Behaviour at Onset of Symptoms of ST Segment Elevation Acute Myocardial Infarction. Eur J Cardiovasc Nurs 2011; 10:241-7. [DOI: 10.1016/j.ejcnurse.2010.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 10/07/2010] [Accepted: 10/08/2010] [Indexed: 11/20/2022]
Abstract
Background: Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay). Studies indicate that women delay longer than men and insights into this area could lead to improved health education programmes aimed at reducing patient delay in women with STEMI. Method: Open interviews with 14 women with STEMI were held during their hospital stay from June to September 2009. The interviews were aimed at exploring determinants of treatment delay, and were carried out and analysed within a phenomenological framework. Findings: Three themes emerged important for the delay in seeking medical assistance: (1) Knowledge and ideas of AMI symptoms and risks. (2) Ambivalence whether to call for medical assistance or to cope with the situation. (3) Actions and strategies taken after onset of symptoms. Conclusions: Three factors determined whether women showed appropriate behaviour for reduced patient delay after onset of symptoms: (1) identifying the symptoms as being of cardiac origin, (2) having a prepared action plan in case of an emergency situation, and (3) living with someone or contacting other persons.
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Wikman A, Messerli-Bürgy N, Molloy GJ, Randall G, Perkins-Porras L, Steptoe A. Symptom experience during acute coronary syndrome and the development of posttraumatic stress symptoms. J Behav Med 2011; 35:420-30. [DOI: 10.1007/s10865-011-9369-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2011] [Accepted: 06/29/2011] [Indexed: 11/30/2022]
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Banner D. Becoming a coronary artery bypass graft surgery patient: a grounded theory study of women's experiences. J Clin Nurs 2011; 19:3123-33. [PMID: 21040017 DOI: 10.1111/j.1365-2702.2010.03424.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
AIM To explore women's experiences of becoming a coronary artery bypass graft surgery patient. BACKGROUND Coronary heart disease is a leading cause of morbidity and mortality for both sexes worldwide and is associated with significant human, fiscal and personal burden. There are growing numbers of women undergoing coronary artery bypass graft surgery; however, little is known about their experiences of being diagnosed, referred and waiting for surgery. DESIGN Grounded theory. METHODS A grounded theory study of 30 UK women with coronary heart disease waiting to undergo coronary artery bypass graft surgery. Data were collected using semi-structured interviews and were contextualised through informal observation of the main clinical areas. RESULTS Coronary heart disease and associated symptoms had extensive physical, social and emotional ramifications for the women. A substantive theory of the public-private dialogue around maintaining and renegotiating normality emerged and demonstrated that women faced significant disruption to their lives as they attempted to normalise and make sense of their illness experiences. Six categories emerged from the data: help seeking, diagnosis and referral, conceptualising surgery, living with coronary heart disease and waiting for surgery. CONCLUSION This study has uncovered women's experiences of becoming a coronary artery bypass graft patient. It has highlighted the extensive ramifications of heart disease and the need for more gender-sensitive information and support. RELEVANCE TO CLINICAL PRACTICE The findings of this study provide health care professionals with a greater understanding of the experiences and needs of women through their journey to becoming a coronary artery bypass graft surgery. The study demonstrates that women need meaningful information particularly in relation to domestic and physical functioning. Nurses are in an important position to contribute to the care and support of women undergoing this process by providing appropriate and gender-sensitive information that can improve health outcomes and quality of life.
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Affiliation(s)
- Davina Banner
- University of Northern British Columbia, Prince George, Canada.
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DeVon HA, Ryan CJ, Rankin SH, Cooper BA. Classifying subgroups of patients with symptoms of acute coronary syndromes: A cluster analysis. Res Nurs Health 2010; 33:386-97. [PMID: 20672306 DOI: 10.1002/nur.20395] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The purpose of the study was to identify subgroups of patients presenting with acute coronary syndromes based on symptom clusters. Two hundred fifty-six patients completed a symptom assessment in their hospital rooms. Latent class cluster analysis and analysis of variance were used to classify subgroups of patients according to selected clinical characteristics. Four subgroups were identified and labeled as Heavy Symptom Burden, Chest Pain Only, Sweating and Weak, and Short of Breath and Weak (model fit χ(2) [130,891, n = 256] = 867.5, p = 1.00). The largest group of patients experienced classic symptoms of chest pain and shortness of breath but not sweating. Younger patients were more likely to cluster in the Heavy Symptom Burden group (F = 5.08, p = .002). Interpretation of the clinical significance of these groupings requires further study.
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Affiliation(s)
- Holli A DeVon
- Betty Irene Moore School of Nursing, University of California Davis, Sacramento, CA 95817, USA
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Abstract
BACKGROUND AND RESEARCH OBJECTIVES : Multiple sociodemographic and environmental factors have been associated with urgent treatment-seeking behaviors for patients experiencing acute coronary syndromes (ACSs). However, variables that directly affect the decision to seek care in the emergency department (ED) have been less well defined. The objective of this study was to explore the factors associated with a decision to seek care for symptoms of ACSs and to describe patient characteristics associated with time to presentation. SUBJECTS AND METHODS : A cross-sectional, descriptive design was used. The nonprobability sample included 256 patients admitted to the hospital with ACSs. The study was conducted on cardiac step-down units at 2 large urban medical centers. Reasons for seeking care were elicited during structured interviews in the patient's room. These factors and other patient characteristics were treated as predictor variables in an analysis of time from symptom onset to arrival in the ED. RESULTS AND CONCLUSIONS : Five categories of decision making were identified through descriptive content analyses and were labeled new onset of chest pain, ongoing evaluation of symptom severity, symptoms other than chest pain that worsened or were unrelieved, externally motivated, and internally motivated. Median time from symptom onset to arrival in the ED was 9.5 hours for women and 6 hours for men. Patients who experienced constant pain (hazard ratio, 1.44; P =.01) and those with ST-segment elevation myocardial infarction (hazard ratio, 1.59; P = .004) sought treatment significantly sooner than patients with intermittent pain. Older patients sought treatment later (hazard ratio, 0.99; P = .02). Patients who are older and experience intermittent pain should be encouraged to seek emergent treatment for symptoms that may represent ACSs. New evidence of patients' decision-making processes and dangerous delay in time to treatment provides knowledge needed to counsel patients about the benefits of seeking care quickly when symptoms begin.
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Affiliation(s)
- Holli A DeVon
- Niehoff School of Nursing, Loyola University Chicago, Illinois, USA.
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Fox-Wasylyshyn SM, El-Masri M, Artinian NT. Testing a Model of Delayed Care-Seeking for Acute Myocardial Infarction. Clin Nurs Res 2009; 19:38-54. [DOI: 10.1177/1054773809353163] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A theory-testing approach to the study of delay in seeking treatment for acute myocardial infarction (AMI) was performed using a descriptive design with 135 AMI patients. Participants provided information pertaining to history of AMI, symptom congruence, responses to symptoms, cardiac symptom attribution, and AMI care-seeking delay. Structural equation modeling fit indices suggested that the independent predictors of AMI care-seeking delay were cardiac symptom attribution and emotion-focused coping. History of AMI had a direct relationship with AMI care-seeking delay, but its total effect through symptom attribution and symptom congruence was not significant. The total effect of symptom congruence on AMI care-seeking delay was significant. In conclusion, the study findings highlight the importance of targeting cardiac symptom attribution and emotion-focused coping in interventions that are aimed at reducing AMI care-seeking delay.
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Jurgens CY, Hoke L, Byrnes J, Riegel B. Why do elders delay responding to heart failure symptoms? Nurs Res 2009; 58:274-82. [PMID: 19609179 DOI: 10.1097/nnr.0b013e3181ac1581] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Elders with heart failure (HF) are at risk for frequent hospitalizations for symptom management. Repeated admissions are partly related to delay in responding to HF symptoms. Contextual factors such as prior illness experiences and social/emotional factors may affect symptom interpretation and response. The Self-Regulation Model of Illness guided this study as it acknowledges the dynamic nature of illness and influence of contextual factors and social environment on the interpretation and response to symptoms. OBJECTIVE The purpose of this study was to describe contextual factors related to symptom recognition and response among elders hospitalized with decompensated HF. METHODS A mixed-methods design was used. The HF Symptom Perception Scale (physical factors), Specific Activity Scale (functional performance), and Response to Symptoms Questionnaire (cognitive/emotional factors) were administered to participants aged >or=65 years. Symptom duration and clinical details were collected by interview and chart review. Open-ended questions addressing the symptom experience, including the context in which symptoms occurred, were audiotaped, transcribed, analyzed, and compared across cases to inform the quantitative data. RESULTS The convenience sample (n = 77) was 48% female, 85.7% were non-Hispanic White, and mean age was 75.9 years (SD = 7.7 years). Functional performance was low (81% class III/IV). The most frequently reported symptoms were dyspnea, dyspnea on exertion, and fatigue. Median duration of early symptoms of HF decompensation was 5 to 7 days, but dyspnea duration ranged from 30 minutes to 90 days before action was taken. Longer dyspnea duration was associated with higher physical symptom distress (r = .30) and lower anxiety (r = -.31). Sensing and attributing meaning to early symptoms of HF decompensation were problematic. DISCUSSION The physical symptom experience and the cognitive and emotional response to HF symptoms were inadequate for timely care seeking for most of this older aged sample.
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Affiliation(s)
- Corrine Y Jurgens
- School of Nursing, Stony Brook University, Stony Brook, NY 11794-8240, USA.
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Khraim FM, Carey MG. Predictors of pre-hospital delay among patients with acute myocardial infarction. PATIENT EDUCATION AND COUNSELING 2009; 75:155-161. [PMID: 19036551 DOI: 10.1016/j.pec.2008.09.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 09/11/2008] [Accepted: 09/17/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate current literature on predictors of pre-hospital delay among patients with acute myocardial infarction (AMI). METHODS Medline, CINHAL, and Psych Info databases were searched using keywords: attitude to illness/health, health beliefs, help/health seeking behavior, health behavior, psychosocial factors, treatment delay, socioeconomic factors, time factors, pre-hospital delay, and symptoms. These keywords were combined with AMI to identify literature published during 1995-2008. RESULTS Twenty-six data-based research articles were identified. Delay varied across literature and median pre-hospital delay was often reported due to distribution skewness resulting from extremely prolonged values (1.5-15.2h). Six categories of predictors influenced pre-hospital delay; socio-demographic, symptom onset context, cognitive, affective/psychological, behavioral, and clinical factors. Pre-hospital delay was shortest when the decision to seek healthcare was facilitated by family members or coworkers and when symptoms suggestive of heart attack were continuous and severe. CONCLUSION AND PRACTICE IMPLICATIONS Developing interventions programs to reduce pre-hospital delay for high-risk patients is warranted. Because decision delay is the only modifiable part by intervention, it is recommended that future investigations and interventions attend to decision time as the primary variable of interest instead of combining it with transportation time. Moreover, content of patient education need to emphasize on symptom awareness and recognition, and prompt and proper patient actions for optimum results. Also, in order to eliminate sampling bias resulting from investigating surviving AMI patients, it is recommended that future studies incorporate data from both surviving and surrogates of non-surviving AMI patients.
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Affiliation(s)
- Fadi M Khraim
- School of Nursing, The State University of New York at Buffalo, United States.
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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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Turris SA, Johnson JL. Maintaining integrity: women and treatment seeking for the symptoms of potential cardiac illness. QUALITATIVE HEALTH RESEARCH 2008; 18:1461-1476. [PMID: 18849508 DOI: 10.1177/1049732308325824] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
Cardiac disease is the number one killer of Canadian women. Therapy is highly time-dependent, yet treatment-seeking delay persists. The purpose of this grounded theory study was to explore how women seeking treatment for the symptoms of potential cardiac illness interpreted their symptoms, made decisions about seeking treatment, and understood experiences of care in the emergency department. Data were drawn from 100 hours of naturalistic observation, in-depth interviews with 16 women who visited one of two urban emergency departments between June 2005 and June 2006, and three interviews with nurses. The basic social psychological process of maintaining integrity was identified, encompassing three distinct phases: "resisting disruption," "suspending agency," and "integrating experiences and knowledge." The findings suggest that in the face of a threat to life, women are first and foremost striving to maintain both the integrity of their sense of self and their ability to carry out role responsibilities.
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Affiliation(s)
- Sheila A Turris
- British Columbia Institute of Technology, Burnaby, British Columbia, Canada
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Abstract
Few studies have explored the factors affecting women's decisions to seek medical assistance at the onset of cardiac symptoms. Although some studies have shown that there are gender differences between men and women in terms of how they cope with having a myocardial infarction (MI) and heart disease, few have explored how women actually experience MI and what influences their help-seeking behaviour. Those studies that have, suggest that women often fail to recognize the signs of MI and delay seeking treatment for symptoms of MI longer than men do. This qualitative study explores the female experience of MI, focusing on some of the thought processes and coping strategies used by women when having an MI. Using a grounded theory research approach, 25 post-MI female patients were interviewed about their experiences during acute MI. Through analysing and coding data, a number of categories emerged that provide insight into the health seeking behaviour of women at the onset of MI. Emergent categories were: a delay in seeking help (main category); an engendered perception of heart disease (sub-category); not recognizing symptoms (sub-category); maintaining control through self-medication (sub-category). Analysis of the data suggests that when experiencing an MI, women delay seeking help for a number of reasons, including not recognizing symptoms, perceiving heart disease as a 'male' problem and preferring to self-medicate.
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Affiliation(s)
- Ray Higginson
- Critical Care, School of Care Sciences, University of Glamorgan
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DeVon HA, Penckofer S, Larimer K. The association of diabetes and older age with the absence of chest pain during acute coronary syndromes. West J Nurs Res 2008; 30:130-44. [PMID: 18182562 DOI: 10.1177/0193945907310241] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cardiac autonomic neuropathy associated with diabetes can cause silent myocardial ischemia and may influence the way that patients perceive symptoms of acute coronary syndromes (ACS). The purpose of this study was to examine symptoms of ACS in patients with and without diabetes while controlling for length of time with diabetes. A convenience sample of 256 patients from two large medical centers in the Midwest participated. Patients with diabetes comprised 33.2% of the sample and reported significantly less chest pain and more unusual fatigue. Patients with diabetes of longer duration (10 or more years) reported more difficulty breathing than did patients with diabetes of shorter duration (fewer than 10 years). Older patients with the same diabetes status also reported less chest pain. For older patients and for patients with diabetes, lack of chest pain during ACS could delay treatment and is thus a concern.
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Grande G. Genderspezifische Aspekte der Gesundheitsversorgung und Rehabilitation nach Herzinfarkt. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2008; 51:36-45. [DOI: 10.1007/s00103-008-0417-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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DeVon HA, Ryan CJ, Ochs AL, Shapiro M. Symptoms Across the Continuum of Acute Coronary Syndromes: Differences Between Women and Men. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.1.14] [Citation(s) in RCA: 109] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Background The urgency and level of care provided for acute coronary syndromes partially depends on the symptoms manifested.
Objectives To detect differences between women and men in the type, severity, location, and quality of symptoms across the 3 clinical diagnostic categories of acute coronary syndromes (unstable angina, myocardial infarction without ST-segment elevation, and myocardial infarction with ST-segment elevation) while controlling for age, diabetes, functional status, anxiety, and depression.
Methods A convenience sample of 112 women and 144 men admitted through the emergency department and hospitalized for acute coronary syndromes participated. Recruitment took place at 2 urban teaching hospitals in the Midwest. Data were collected during structured interviews in each patient’s hospital room. Forty-eight symptom descriptors were assessed. Demographic characteristics, health history, functional status, anxiety, and depression levels also were measured.
Results Regardless of clinical diagnostic category, women reported significantly more indigestion (β = 0.25; confidence interval [CI] = 0.01–0.49), palpitations (β = 0.31; CI = 0.06–0.56), nausea (β = 0.37; CI = 0.10–0.65), numbness in the hands (β = 0.29; CI = 0.02–0.57), and unusual fatigue (β = 0.60; CI = 0.27–0.93) than men reported. Differences between men and women in dizziness, weakness, and new-onset cough did differ by diagnosis. Reports of chest pain did not differ between men and women.
Conclusions Women with acute coronary syndromes reported a higher intensity of 5 symptoms (but not chest pain) than men reported. Whether differences between the sexes in less typical symptoms are clinically significant remains unclear.
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Affiliation(s)
- Holli A. DeVon
- Holli A. DeVon is an associate professor and Amy L. Ochs is a research assistant at Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. Catherine J. Ryan is a research assistant professor at the University of Illinois at Chicago. Moshe Shapiro is a bio-statistician at Hines VA Hospital, Hines, Illinois
| | - Catherine J. Ryan
- Holli A. DeVon is an associate professor and Amy L. Ochs is a research assistant at Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. Catherine J. Ryan is a research assistant professor at the University of Illinois at Chicago. Moshe Shapiro is a bio-statistician at Hines VA Hospital, Hines, Illinois
| | - Amy L. Ochs
- Holli A. DeVon is an associate professor and Amy L. Ochs is a research assistant at Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. Catherine J. Ryan is a research assistant professor at the University of Illinois at Chicago. Moshe Shapiro is a bio-statistician at Hines VA Hospital, Hines, Illinois
| | - Moshe Shapiro
- Holli A. DeVon is an associate professor and Amy L. Ochs is a research assistant at Niehoff School of Nursing, Loyola University Chicago, Maywood, Illinois. Catherine J. Ryan is a research assistant professor at the University of Illinois at Chicago. Moshe Shapiro is a bio-statistician at Hines VA Hospital, Hines, Illinois
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Noureddine S, Arevian M, Adra M, Puzantian H. Response to Signs and Symptoms of Acute Coronary Syndrome: Differences Between Lebanese Men and Women. Am J Crit Care 2008. [DOI: 10.4037/ajcc2008.17.1.26] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Signs and symptoms of acute coronary syndromes differ between men and women, but whether men and women respond differently to these indications is not well understood. Such responses influence health outcomes because success of treatment depends on how quickly healthcare is sought.
Objective To explore differences between Lebanese men and women in cognitive, emotional, and behavioral responses to signs and symptoms of acute coronary syndromes.
Methods A convenience sample of 149 men and 63 women with unstable angina or acute myocardial infarction were interviewed within 72 hours of admission to coronary care in a tertiary center by using the Response to Symptoms Questionnaire. Demographic and clinical data were obtained from medical records.
Results Women were older, less educated, and more often widowed than men. More women had hypertension but more men were current smokers. Women had shoulder pain, dyspnea, nausea and vomiting, and palpitations more often than men did. Women’s signs and symptoms were rated more severe by the women than men’s were by the men. Women were less likely to know signs and symptoms of myocardial infarction than were men and delayed coming to the hospital longer than men did. Delay correlated with the characteristics of the signs and symptoms and not realizing their importance in men and with dyspnea and taking the “wait and see” approach in women.
Conclusion Factors related to promptness in seeking care for acute coronary syndromes differ between Lebanese men and women.
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Affiliation(s)
- Samar Noureddine
- Samar Noureddine is an associate professor, Mary Arevian is a clinical associate professor, Marina Adra is a clinical assistant professor, and Houry Puzantian is a clinical research coordinator at the American University of Beirut, Beirut, Lebanon
| | - Mary Arevian
- Samar Noureddine is an associate professor, Mary Arevian is a clinical associate professor, Marina Adra is a clinical assistant professor, and Houry Puzantian is a clinical research coordinator at the American University of Beirut, Beirut, Lebanon
| | - Marina Adra
- Samar Noureddine is an associate professor, Mary Arevian is a clinical associate professor, Marina Adra is a clinical assistant professor, and Houry Puzantian is a clinical research coordinator at the American University of Beirut, Beirut, Lebanon
| | - Houry Puzantian
- Samar Noureddine is an associate professor, Mary Arevian is a clinical associate professor, Marina Adra is a clinical assistant professor, and Houry Puzantian is a clinical research coordinator at the American University of Beirut, Beirut, Lebanon
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Woith WM, Larson JL. Delay in seeking treatment and adherence to tuberculosis medications in Russia: a survey of patients from two clinics. Int J Nurs Stud 2007; 45:1163-74. [PMID: 17854809 DOI: 10.1016/j.ijnurstu.2007.07.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2007] [Revised: 07/17/2007] [Accepted: 07/19/2007] [Indexed: 11/24/2022]
Abstract
BACKGROUND Tuberculosis is a global problem, especially in high burden countries such as Russia, that is fueled by delay in seeking treatment and nonadherence to prescribed medications. Stigma and illness representation (a person's mental image of a specific illness) have the potential to affect treatment seeking and adherence. OBJECTIVES To describe the illness representation of tuberculosis in Russians with active pulmonary tuberculosis, and to determine if stigma and illness representation are predictors of delay in seeking treatment and adherence to tuberculosis medications. DESIGN Cross-sectional, descriptive survey. SETTING Two outpatient clinics in the Vladimir Region, Russia. PARTICIPANTS A total of 105 adults, 18 years and older, being treated for active pulmonary tuberculosis, and on outpatient therapy for a minimum of four weeks participated in this study. METHODS Delay was measured with a question asking length of time between onset of symptoms and appointment with a physician. Stigma was measured using the Social Impact Scale. Illness representation was measured using the Revised Illness Perception Questionnaire. Participants' outpatient medication records were reviewed for medication adherence. RESULTS Symptoms reported were not consistent with those described in the medical literature and other studies. Only four subjects suspected tuberculosis based on their symptoms; 60% believed they had other respiratory infections. Multiple regression showed that illness identity (an attribute of illness representation) (beta=0.23) was a significant predictor of delay, accounting for 29% of the variance (p=0.008); and financial insecurity (beta=-0.28) and internalized shame (beta=0.27) (measures of stigma) were both significant predictors of medication adherence, accounting for 23% of the variance (p=0.003). CONCLUSIONS Illness identity was associated with delay. Internalized shame was associated with increased medication adherence while financial insecurity was associated with decreased adherence. Results point to the need for broad, culturally specific patient, family, and community education programs.
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Affiliation(s)
- Wendy Mann Woith
- Mennonite College of Nursing at Illinois State University, Normal, IL 61761, USA.
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Albarran JW, Clarke BA, Crawford J. 'It was not chest pain really, I can't explain it!' An exploratory study on the nature of symptoms experienced by women during their myocardial infarction. J Clin Nurs 2007; 16:1292-301. [PMID: 17584348 DOI: 10.1111/j.1365-2702.2007.01777.x] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES This study sought to explore the presenting nature of cardiac symptoms as experienced by women diagnosed with a myocardial infarction. The objectives were to use the participants' own words to gain a detailed understanding of how they perceived their evolving symptoms. BACKGROUND Women with coronary heart disease tend to delay seeking help despite experiencing symptoms. The classic hallmarks used to diagnose a myocardial infarction have been based on research primarily involving white middle-aged men with a focus on specific descriptions of chest pain. Whether these hallmarks apply to women in the same way as they apply to men is an area of increasing contention. DESIGN Using a purposive sample, a qualitative design was used to investigate the nature of cardiac symptoms experienced by women prior to and at the time of their myocardial infarction. METHOD Twelve women participated in semi-structured in-depth tape-recorded interviews conducted while they were in hospital. RESULTS Three interlinking themes emerged, which reflect a changing dynamic status in health, mediated by the perceived threat of individual symptoms. These included gradual awareness, not having pain in the chest and reactions to symptoms. CONCLUSIONS It would appear that symptom presentation and distribution amongst women may not follow the pattern traditionally associated with current understanding of a 'typical' myocardial infarction. These differences together with perceptions about their cardiac symptoms may influence their health-seeking behaviours. RELEVANCE TO CLINICAL PRACTICE Women with a myocardial infarction may present with non-specific chest symptoms, which are difficult to interpret or recognize by patients and health professionals alike. Skill in recording history and in performing a comprehensive assessment of initial and current symptoms will enable nurses to identify women with a differential diagnosis of chest pain readily. Additionally, to increase awareness of coronary heart disease, nurses must use any opportunity to educate women of all age groups.
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Affiliation(s)
- John W Albarran
- Faculty of Health and Social Care, University of the West of England, Bristol, UK.
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Harralson TL. Factors influencing delay in seeking treatment for acute ischemic symptoms among lower income, urban women. Heart Lung 2007; 36:96-104. [PMID: 17362790 DOI: 10.1016/j.hrtlng.2006.08.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Accepted: 08/14/2006] [Indexed: 11/30/2022]
Abstract
OBJECTIVE We examined factors associated with delay in seeking emergency medical attention for acute ischemic symptoms in a sample of predominantly African American women. METHOD Female patients who presented with symptoms of acute myocardial infarction (AMI) were interviewed. Qualitative and quantitative methods were used to examine barriers associated with delay. RESULTS The mean hours of delay were 20.4 (median = 4.5 hours). Sixty-nine percent of the patients delayed 1 hour or more. These delays were associated with younger age, African American ethnicity, poorer self-rated health, and the belief that one could not personally ever have an AMI. In a multiple logistic regression model, the belief that one could not ever have an AMI significantly increased the odds of delay compared with other patient characteristics. CONCLUSION The results indicate that efforts should be made to increase women's awareness of personal risk for AMI and the need for development of cognitive representations of AMI.
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Affiliation(s)
- Tina L Harralson
- Center for Urban Health Policy and Research, Philadelphia, PA 19144, USA
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Ryan CJ, DeVon HA, Horne R, King KB, Milner K, Moser DK, Quinn JR, Rosenfeld A, Hwang SY, Zerwic JJ. Symptom clusters in acute myocardial infarction: a secondary data analysis. Nurs Res 2007; 56:72-81. [PMID: 17356437 DOI: 10.1097/01.nnr.0000263968.01254.d6] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Early recognition of acute myocardial infarction (AMI) symptoms and reduced time to treatment may reduce morbidity and mortality. People having AMI experience a constellation of symptoms, but the common constellations or clusters of symptoms have yet to be identified. OBJECTIVES To identify clusters of symptoms that represent AMI. METHODS This was a secondary data analysis of nine descriptive, cross-sectional studies that included data from 1,073 people having AMI in the United States and England. Data were analyzed using latent class cluster analysis, an a theoretical method that uses only information contained in the data. RESULTS Five distinct clusters of symptoms were identified. Age, race, and sex were statistically significant in predicting cluster membership. None of the symptom clusters described in this analysis included all of the symptoms that are considered typical. In one cluster, subjects had only a moderate to low probability of experiencing any of the symptoms analyzed. DISCUSSION Symptoms of AMI occur in clusters, and these clusters vary among persons. None of the clusters identified in this study included all of the symptoms that are included typically as symptoms of AMI (chest discomfort, diaphoresis, shortness of breath, nausea, and lightheadedness). These AMI symptom clusters must be communicated clearly to the public in a way that will assist them in assessing their symptoms more efficiently and will guide their treatment-seeking behavior. Symptom clusters for AMI must also be communicated to the professional community in a way that will facilitate assessment and rapid intervention for AMI.
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Affiliation(s)
- Catherine J Ryan
- College of Nursing, University of Illinois at Chicago, Chicago, IL 60612, USA.
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