Prehospital behaviour of patients admitted with acute coronary syndrome or witnessed cardiac arrest

Women's help-seeking behaviour during a first acute myocardial infarction

Studies indicate that the time from onset of symptoms to medical treatment has decreased in acute myocardial infarction (AMI). However, there are still variations indicating that women wait longer than men before making the decision to seek medical care. Multidimensional factors hindering and facilitating the decision have been identified in previous studies, though few have fully explored how social context affects women's expectations, interpretations and actions and so influences the decision-making process. The aim of this study was therefore to identify how women's experiences interacted and influenced the decision to seek medical care at their first AMI. Seventeen women, aged 38-75 years, were interviewed, at home or in the hospital, between June 2011 and May 2012. Grounded theory was used as a method, and data collection and analysis were carried out simultaneously. The results showed that before deciding to seek medical care, these women went through three defined but interrelated processes that together hindered their normal activities and made them act according to existential needs. The women's experiences of the progression of the disease, in terms of both symptoms and time, were very different, so they sought medical care at different times, sometimes life-threateningly late and sometimes before developing an AMI. Three mechanisms had to coincide if the women were to receive medical care. First, the women had to acknowledge their symptoms as something more than common bodily changes. Second, the healthcare system had to be accessible when the women made their decision to seek care. Third, the women must have come into contact with healthcare providers when the heart muscle had taken enough damage to measure.

Women's Experiences and Behaviour at Onset of Symptoms of ST Segment Elevation Acute Myocardial Infarction

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.

Prehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction

BACKGROUND

In patients with acute myocardial infarction (AMI), the delay between the onset of symptoms and hospital admission is a critical factor in reducing morbidity and mortality.

AIMS

To assess gender differences in prehospital delay among women and men with first time AMI, generate more knowledge about aspects influencing this delay and investigate responses to acute symptoms.

METHODS AND RESULT

Of 738 eligible patients, 149 women and 384 men responded to a questionnaire (72%). Over half of both women and men waited over one hour before they called for medical assistance and more than half the patients had a total prehospital delay exceeding two hours. Rapid development of symptoms and symptoms matching expectations reduced, self medication and consulting the spouse increased patient delay in both genders. Calling the Emergency Medical Service (EMS) reduced and calling a general practitioner increased total prehospital delay in both genders. ST-ELEVATION: (STEMI), symptoms experienced as unbearable and attributed as cardiac reduced patient delay, and symptoms from the back, shoulders or between scapulae increased prehospital delay, only in men.

CONCLUSION

How patients responded to symptoms had vital impact on prehospital delay among both genders, but the experience and interpretation of symptoms had more influence in men than in women.

Are There Gender Differences Related to Symptoms of Acute Myocardial Infarction? A Norwegian Perspective

The purpose of this study was to compare symptom presentation and illness behavior among women and men with acute myocardial infarction and assess various aspects that influence prehospital delay. This is a cross-sectional, retrospective study using self-reported questionnaires. The sample consisted of 82 women and men in Norway, up to 65 years of age, with first-time acute myocardial infarction between March and October 1999. The findings demonstrated that the most commonly reported symptom in both genders was chest pain. More than 90% of women and men experienced chest pain, with no difference between the genders. More women than men had nausea as well as pain located in their arms, back, jaw, and throat. More men than women attributed their symptoms to be cardiac in origin. Experiencing pain in the shoulders, attributing symptoms to be noncardiac, consulting a family member, and contacting several medical practitioners increased prehospital delay. During the year before the event, women were more likely to experience fatigue than men. The conclusion of this study is that women experienced a greater diversity of symptoms than men. Acute symptoms, interpretation of symptoms, and illness behavior may influence prehospital delay.