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Jensen B, Vardinghus-Nielsen H, Mills EHA, Møller AL, Gnesin F, Zylyftari N, Kragholm K, Folke F, Christensen HC, Blomberg SN, Torp-Pedersen C, Bøggild H. "I just haven't experienced anything like this before": A qualitative exploration of callers' interpretation of experienced conditions in telephone consultations preceding a myocardial infarction. PATIENT EDUCATION AND COUNSELING 2023; 109:107643. [PMID: 36716564 DOI: 10.1016/j.pec.2023.107643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 01/13/2023] [Accepted: 01/18/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES Callers with myocardial infarction presenting atypical symptoms in telephone consultations when calling out-of-hours medical services risk misrecognition. We investigated characteristics in callers' interpretation of experienced conditions through communication with call-takers. METHODS Recording of calls resulting in not having an ambulance dispatched for 21 callers who contacted a non-emergency medical helpline, Copenhagen (Denmark), up to one week before they were diagnosed with myocardial infarction. Qualitative content analysis was applied. RESULTS Awareness of illness, remedial actions and previous experiences contributed to callers' interpretation of the experienced condition. Unclear symptoms resulted in callers reacting to their interpretation by being unsure and worried. Negotiation of the interpretation was seen when callers tested the call-taker's interpretation of the condition and when either caller or call-taker suggested: "wait and see". CONCLUSION Callers sought to interpret the experienced conditions but faced challenges when the conditions appeared unclear and did not correspond to the health system's understanding of symptoms associated with myocardial infarction. It affected the communicative interaction with the call-taker and influenced the call-taker's choice of response. PRACTICE IMPLICATIONS Call-takers, as part of the decision-making process, could ask further questions about the caller's insecurity and worry. It might facilitate faster recognition of conditions warranting hospital referral.
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Affiliation(s)
- Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark.
| | - Henrik Vardinghus-Nielsen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | | | | | - Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Nertila Zylyftari
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark
| | - Kristian Kragholm
- Unit of Clinical Biostatistics and Epidemiology, Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Hellerup, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Denmark
| | | | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Hillerød, Denmark; Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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Asghari E, Gholizadeh L, Kazami L, Taban Sadeghi M, Separham A, Khezerloy-aghdam N. Symptom recognition and treatment-seeking behaviors in women experiencing acute coronary syndrome for the first time: a qualitative study. BMC Cardiovasc Disord 2022; 22:508. [PMID: 36443668 PMCID: PMC9703419 DOI: 10.1186/s12872-022-02892-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Women are more likely to delay medical help-seeking for ACS symptoms. Understanding patients' experience of the symptoms and their response is essential in improving help-seeking behaviors and timely diagnosis and treatment for ACS. This study aimed to explore women's experience of ACS, their response to the symptoms, and treatment-seeking decisions. METHODS This qualitative descriptive study was conducted in a tertiary referral specialized heart hospital affiliated with Tabriz University of Medical Sciences, Iran. Participants included 39 women who had experienced ACS for the first time. RESULTS Four main themes emerged from the analysis of interview transcripts: (1) the onset of symptoms, (2) the types of symptoms, (3) response to symptoms and (4) arriving at the hospital. These themes and associated sub-themes explained women's experience of ACS symptoms, their response to the symptoms, and decision to seek medical help. CONCLUSIONS This study identified and discussed factors contributing to the prehospital delay in women and their decision-making to seek medical care for ACS symptoms. The results are consistent with previous research indicating that ACS symptoms in women are somewhat different from men, and women tend to underestimate their symptoms and attribute them to non-cardiac causes. Women should be supported to develop awareness and understanding of ACS symptoms and appreciate the importance of early treatment-seeking in the disease outcomes.
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Affiliation(s)
- Elnaz Asghari
- grid.412888.f0000 0001 2174 8913Faculty of Nursing and Midwifery, Tabriz University of Medical Science, South Shariati St., Tabriz, 51368 East Azerbaijan Iran
| | - Leila Gholizadeh
- grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, 15 Broadway, Sydney, NSW 2007 Australia
| | - Leila Kazami
- grid.412888.f0000 0001 2174 8913Shahid Madani Hospital, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammadreza Taban Sadeghi
- grid.412888.f0000 0001 2174 8913Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Ahmad Separham
- grid.412888.f0000 0001 2174 8913Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Naser Khezerloy-aghdam
- grid.412888.f0000 0001 2174 8913Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
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Andersen LS, Lorentzen V, Beedholm K. From Suspicion to Recognition-Being a Bystander to a Relative Affected by Acute Coronary Syndrome. QUALITATIVE HEALTH RESEARCH 2022; 32:307-316. [PMID: 34866472 DOI: 10.1177/10497323211050911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Within cardiac research, an overwhelming number of studies have explored factors related to pre-hospital delay. However, there is a knowledge gap in studies that explore the bystander's experiences or significance when an individual is affected by acute coronary syndrome (ACS). We conducted an interview study with 17 individuals affected by ACS and the bystander(s) involved and performed a qualitative thematic analysis. In the pre-hospital phase, the bystander moved from suspicion of illness to recognition of illness while trying to convince the individual affected by ACS (p-ACS) to respond to bodily sensations. This led to conflicts and dilemmas which affected the bystander both before and after the p-ACS was hospitalized. Bystanders may influence pre-hospital delay in both positive and negative direction depending on their own knowledge, convictions, and the nature of their interaction with the p-ACSs. The bystander's influence during the pre-hospital delay is more extensive than previously recognized.
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Affiliation(s)
| | - Vibeke Lorentzen
- Centre for Research in Clinical Nursing, Viborg, Denmark
- Deakin University, Melbourne, Australia
- Aarhus University, Aarhus, Denmark
| | - Kirsten Beedholm
- Department of for Public Health, Aarhus University, Aarhus, Denmark
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Beedholm K, Andersen LS, Lorentzen V. From Bodily Sensations to Symptoms: Health Care-Seeking Practices Among People Affected by Acute Coronary Syndrome. QUALITATIVE HEALTH RESEARCH 2019; 29:1651-1660. [PMID: 31274049 DOI: 10.1177/1049732319857057] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The reduction of prehospital delay for patients with acute coronary syndrome (ACS) is widely discussed within cardiac research. Medically informed literature generally considers patient hesitancy in seeking treatment a significant barrier to accessing timely treatment. With this starting point, we conducted an interview study with people previously hospitalized for ACS and with the bystanders involved in their decision to contact the health care system. The analysis was conducted in two stages: first, a systematic extraction of key information; second, an in-depth analysis informed by medical anthropology. This led us to understand the prehospital period as an interpretation process where bodily sensations appeared as symptoms. Informants vacillated between sensations, knowledge, interpretations, and emotions as they struggled to preserve everyday ordinariness. They were led to contact the health care system by bodily discomfort rather than a rational decision to reduce risk. The paradigmatic implications from medical anthropology proved an important alternative to the medical paradigm.
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Affiliation(s)
| | | | - Vibeke Lorentzen
- 1 Aarhus University, Aarhus, Denmark
- 3 Center for Research in Clinical Nursing, Viborg, Denmark
- 4 Deakin University, Melbourne, Victoria, Australia
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Mirzaei S, Steffen A, Vuckovic K, Ryan C, Bronas U, Zegre-Hemsey J, DeVon HA. The Quality of Symptoms in Women and Men Presenting to the Emergency Department With Suspected Acute Coronary Syndrome. J Emerg Nurs 2019; 45:357-365. [PMID: 30738603 DOI: 10.1016/j.jen.2019.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Revised: 12/30/2018] [Accepted: 01/01/2019] [Indexed: 01/23/2023]
Abstract
INTRODUCTION More than 5.5 million patients present to emergency departments in the United States annually for potential acute coronary syndrome (ACS); however, diagnosing ACS remains a challenge in emergency departments. Our aim was to describe the quality of symptoms (chest discomfort/description of pain, location/radiation, and overall symptom distress) reported by women and men ruled-in and ruled-out for ACS in emergency departments. METHODS The sample consisted of 1,064 patients presenting to emergency departments with symptoms that triggered cardiac workups. Trained research staff obtained data using the ACS Patient Information Questionnaire upon patient presentation to emergency departments. RESULTS The sample (n = 1,064) included 474 (44.55%) patients ruled-in and 590 (55.45%) patients ruled-out for ACS. Symptom distress was significantly higher in patients ruled-in versus ruled-out for ACS (7.3 ± 2.6 vs. 6.8 ± 2.5; P = 0.002) and was a significant predictor for an ACS diagnosis in men (odds ratio [OR], 1.10; confidence interval [CI], 1.03-1.17; P = 0.003). Women also reported more chest pressure (51.75% vs. 44.65; P = 0.02) compared with men, and chest pressure was a significant predictor for a diagnosis of ACS (OR, 1.61; CI, 1.03-2.53; P = 0.02). DISCUSSION Higher levels of symptom distress may help ED personnel in making a decision to evaluate a patient for ACS, and the presence of chest pressure may aid in making a differential diagnosis of ACS.
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O'Donnell S, Monahan P, McKee G, McMahon G, Curtin E, Farrell S, Moser D. Towards prompt electrocardiogram acquisition in triage: Preliminary testing of a symptom-based clinical prediction rule for the Android tablet. Eur J Cardiovasc Nurs 2019; 18:289-298. [PMID: 30620215 DOI: 10.1177/1474515118821023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND For patients with suspected acute coronary syndrome, international guidelines indicate that an Electrocardiogram (ECG) should be performed within 10 min of first medical contact, however success at achieving these guidelines is limited. AIMS The purpose of this study was to develop and perform initial testing of a clinical prediction rule embedded in a tablet application, and to expedite the identification of patients who require an electrocardiogram within 10 min. METHODS This derivation of the Acute Coronary Syndrome Application (AcSAP) comprised of three local studies, an unpublished audit and literature critique. The AcSAP was prospectively tested over four months in patients presenting to the Emergency Department (ED) of a Dublin teaching hospital. An audit form retrieved data pertaining to times of: registration to the emergency department, triage, first electrocardiogram and diagnosis. The AcSAP was subsequently evaluated by experienced triage nurses ( n=18) who had utilised it. RESULTS The AcSAP was activated 379 times. Patients with ST Elevation Myocardial Infarction (STEMI) and non-ST Elevation Myocardial Infarction (NSTEMI) were significantly more likely to return a categorisation of 'immediate ECG' or 'ECG within 10 min' ( p<0.001). There was a significant difference in 'triage to ECG' times across categories, the 'immediate ECG' categorisation resulting in the shortest time ( p=0.002). Evaluations suggest that staff found the tool quick and easy to use and results seemed accurate. CONCLUSION Testing of the AcSAP suggests that it accurately identifies patients who require an ECG within 10 min. As such, it has the potential to support the meeting of clinical guidelines for ECG acquisition.
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Affiliation(s)
- Sharon O'Donnell
- 1 School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | | | - Gabrielle McKee
- 1 School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | | | | | - Sean Farrell
- 3 Emergency Department, St James's Hospital, Ireland
| | - Debra Moser
- 4 College of Nursing, University of Kentucky, Lexington, Kentucky, USA
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Smith R, Frazer K, Hyde A, O'Connor L, Davidson P. “Heart disease never entered my head”: Women's understanding of coronary heart disease risk factors. J Clin Nurs 2018; 27:3953-3967. [DOI: 10.1111/jocn.14589] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2018] [Revised: 05/23/2018] [Accepted: 06/24/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Rita Smith
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Kate Frazer
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Abbey Hyde
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
| | - Laserina O'Connor
- UCD School of Nursing, Midwifery and Health Systems; University College Dublin; Dublin 4 Ireland
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Ma J, Wang J, Zheng W, Zheng J, Wang H, Wang G, Zhang H, Xu F, Chen Y. Usage of ambulance transport and influencing factors in acute coronary syndrome: a cross-sectional study at a tertiary centre in China. BMJ Open 2017; 7:e015809. [PMID: 28827246 PMCID: PMC5629702 DOI: 10.1136/bmjopen-2016-015809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore the choice of transportation mode to hospital in patients with acute coronary syndrome (ACS) and to determine the factors influencing the use of ambulance. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study was conducted in a tertiary and teaching hospital in China. The study was carried out between 24 August 2015 and 24 July 2016. A total of 828 patients with ACS presented at the emergency department (ED) were included. The study population was dichotomised according to their primary mode of transport (ambulance or self-transport) to hospital. Social demographics, cardiovascular history, risk factors, prehospital medications, clinical characteristics and symptom characteristics were collected. Multivariable logistic regression was used to examine the factors associated with ambulance use. RESULTS We found that only 179 (21.6%) patients with ACS chose taking ambulance to hospital. Factors associated with ambulance use were single (OR 1.66, 95% CI 1.07 to 2.57), taking Suxiaojiuxin pills (OR 1.91, 1.31 to 2.80) or nitrates (OR 2.91, 1.70 to 4.99) before going to hospital, diagnosed as ST-elevation myocardial infarction (STEMI) (OR 2.43, 1.45 to 4.05), with persistent symptoms (OR 1.95, 1.33 to 2.86) and symptoms accompanied with vomiting (OR 2.35, 1.19 to 4.62). The patients who had symptoms precipitated or aggravated by exercise (OR 0.37, 0.14 to 0.98) tended to choose self-transport. CONCLUSION The usage of ambulance in patients with ACS presenting to the ED was low in China. Factors like single, taking Suxiaojiuxin pills or nitrates before going to hospital, diagnosed as STEMI, accompanied with vomiting and persistent symptoms were independently associated with ambulance use. Future education programmes should focus on these factors and increase people's knowledge on ACS and the benefits of ambulance use.
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Affiliation(s)
- Jingjing Ma
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Jiali Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Wen Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Jiaqi Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Hao Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Guangmei Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - He Zhang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Feng Xu
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Yuguo Chen
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
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Ahmed S, Khan A, Ali SI, Saad M, Jawaid H, Islam M, Saiyed H, Fatima S, Khan A, Basham MA, Hussain SA, Akhtar M, Kausar F, Hussain A, Fatima K. Differences in symptoms and presentation delay times in myocardial infarction patients with and without diabetes: A cross-sectional study in Pakistan. Indian Heart J 2017; 70:241-245. [PMID: 29716701 PMCID: PMC5993922 DOI: 10.1016/j.ihj.2017.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/16/2017] [Accepted: 07/25/2017] [Indexed: 11/23/2022] Open
Abstract
Objective A short pre-hospital delay, from the onset of symptoms to rapid initiation of reperfusion therapy, is a crucial factor in determining prognosis of myocardial infarction (MI). The purpose of this study was to evaluate symptoms and presentation delay times in MI patients with and without diabetes. Methods This cross-sectional study was conducted in 3 tertiary care hospitals of Pakistan over a period of 6 months. The study sample consisted of 280 consenting individuals diagnosed with ST-elevation MI (STEMI) or Non-ST elevation MI (NSTEMI), out of which 130 were diabetic and 150 were non-diabetic. Data was collected using a standardized questionnaire, investigating MI symptoms along with causes and duration of pre-hospital delay within 72 hours of admission. Results No significant difference was found in the intensity of chest pain between diabetics and non-diabetics. Atypical symptoms of MI such as anxiety (p < 0.001), cold sweats (p = 0.034) and epigastric pain (p = 0.017) were more frequently reported in diabetics. MI patients with diabetes had a significantly longer presentation delay time with 75% of the patients presenting after elapse of 3 h. Only a few patients reported to the hospital within an hour of onset of symptoms (n = 23, 8.2%), out of which majority were non-diabetics (n = 18). A majority of patients (n = 146, 52%) in both groups did not use emergency medical services. Conclusion This study provides an incentive for further research, aiming to reduce pre hospital delay along with investigating the effectiveness of emergency medical services.
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Affiliation(s)
- Saba Ahmed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ariba Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Syed Ibaad Ali
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Saad
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hafsa Jawaid
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mahnoor Islam
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hanieya Saiyed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sarosh Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Aiman Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Maleeha A Basham
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Maheen Akhtar
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Fatima Kausar
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Afshan Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Kaneez Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Coventry LL, van Schalkwyk JW, Thompson PL, Hawkins SA, Hegney DG. Myocardial infarction, patient decision delay and help-seeking behaviour: a thematic analysis. J Clin Nurs 2017; 26:1993-2005. [DOI: 10.1111/jocn.13607] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2016] [Indexed: 12/01/2022]
Affiliation(s)
- Linda L Coventry
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands WA Australia
- School of Nursing and Midwifery; Edith Cowan University; Joondalup WA Australia
| | | | - Peter L Thompson
- Sir Charles Gairdner Hospital and Deputy Director Harry Perkins Institute of Medical Research and Clinical Professor of Medicine; The University of Western Australia; Perth WA Australia
| | | | - Desley G Hegney
- Centre for Nursing Research; Sir Charles Gairdner Hospital; Nedlands WA Australia
- Central Queensland University; North Rockhamptom Qld Australia
- School of Nursing and Midwifery; The University of Southern Queensland; Toowoomba Qld Australia
- School of Nursing, Adelaide University; Adelaide SA Australia
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Abstract
BACKGROUND Most studies show that women with symptoms of acute coronary syndrome (ACS) delay seeking care longer than men do. Contributing factors include women being more likely to experience diverse symptoms, to experience symptoms that do not match preexisting symptom expectations, to interpret symptoms as noncardiac, and to minimize symptoms until they become incapacitating. OBJECTIVE The aim of the study is to identify factors influencing women's ability to recognize and accurately interpret symptoms of suspected ACS. METHODS This qualitative study used in-depth interviews with 18 women diagnosed with ACS to determine how they recognized, interpreted, and acted on symptoms. An interview guide developed from the author's initial research was used to provide structure for the process. RESULTS All of the women went through a process of recognizing and interpreting their symptoms. Eight women had symptoms arise abruptly. Most of these women recognized a change immediately, "knew" to go for treatment, and did so quickly. Three women had vague symptoms that started slowly, converting unexpectedly to intense symptoms prompting them to seek care urgently. The remaining 7 women had evolving symptoms, were more likely to interpret symptoms as unrelated to their heart, and avoided disclosing symptoms to others. Despite recognizing that the situation may be serious, women with evolving symptoms adopted a wait-and-see approach. CONCLUSION Women with less severe, intermittent, or evolving symptoms are at increased risk for delayed presentation, diagnosis, and treatment for ACS. These women should be targeted for educational and behavioral interventions.
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Ängerud KH, Thylén I, Sederholm Lawesson S, Eliasson M, Näslund U, Brulin C. Symptoms and delay times during myocardial infarction in 694 patients with and without diabetes; an explorative cross-sectional study. BMC Cardiovasc Disord 2016; 16:108. [PMID: 27386934 PMCID: PMC4937542 DOI: 10.1186/s12872-016-0282-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 05/14/2016] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND In myocardial infarction (MI) a short pre-hospital delay, prompt diagnosis and timely reperfusion treatment can improve the prognosis. Despite the importance of timely care seeking, many patients with MI symptoms delay seeking medical care. Previous research is inconclusive about differences in symptom presentation and pre-hospital delay between patients with and without diabetes during MI. The aim of this study was to describe symptoms and patient delay during MI in patients with and without diabetes. METHODS Swedish cross-sectional multicentre survey study enrolling MI patients in 5 centres within 24 h from admittance. RESULTS Chest pain was common in patients both with and without diabetes and did not differ after adjustment for age and sex. Patients with diabetes had higher risk for shoulder pain/discomfort, shortness of breath, and tiredness, but lower risk for cold sweat. The three most common symptoms reported by patients with diabetes were chest pain, pain in arms/hands and tiredness. In patients without diabetes the most common symptoms were chest pain, cold sweat and pain in arms/hands. Median patient delay time was 2 h, 24 min for patients with diabetes and 1 h, 15 min for patients without diabetes (p = 0.024). CONCLUSION Chest pain was common both in patients with and without diabetes. There were more similarities than differences in MI symptoms between patients with and without diabetes but patients with diabetes had considerably longer delay. This knowledge is important not only for health care personnel meeting patients with suspected MI, but also for the education of people with diabetes.
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Affiliation(s)
| | - Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Sofia Sederholm Lawesson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Mats Eliasson
- Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden
| | - Ulf Näslund
- Department of Public Health and Clinical Medicine, Cardiology, Heart Centre, Umeå University, Umeå, Sweden
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Ängerud KH, Brulin C, Eliasson M, Näslund U, Hörnsten Å. The Process of Care-seeking for Myocardial Infarction Among Patients With Diabetes. J Cardiovasc Nurs 2015; 30:E1-8. [PMID: 25325370 PMCID: PMC4540334 DOI: 10.1097/jcn.0000000000000195] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND People with diabetes have a higher risk for myocardial infarction (MI) than do people without diabetes. It is extremely important that patients with MI seek medical care as soon as possible after symptom onset because the shorter the time from symptom onset to treatment, the better the prognosis. OBJECTIVE The aim of this study was to explore how people with diabetes experience the onset of MI and how they decide to seek care. METHODS We interviewed 15 patients with diabetes, 7 men and 8 women, seeking care for MI. They were interviewed 1 to 5 days after their admission to hospital. Five of the participants had had a previous MI; 5 were being treated with insulin; 5, with a combination of insulin and oral antidiabetic agents; and 5, with oral agents only. Data were analyzed according to grounded theory. RESULTS The core category that emerged, "becoming ready to act," incorporated the related categories of perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Our results suggest that responses in each of the categories affect the care-seeking process and could be barriers or facilitators in timely care-seeking. Many participants did not see themselves as susceptible to MI and MI was not expressed as a complication of diabetes. CONCLUSIONS Patients with diabetes engaged in a complex care-seeking process, including several delaying barriers, when they experienced symptoms of an MI. Education for patients with diabetes should include discussions about their increased risk of MI, the range of individual variation in symptoms and onset of MI, and the best course of action when possible symptoms of MI occur.
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Affiliation(s)
- Karin Hellström Ängerud
- Karin Hellström Ängerud, RN, MSc PhD Student, Department of Nursing, Umeå University, Umeå, Sweden. Christine Brulin, RNT, PhD Professor, Department of Nursing, Umeå University, Umeå, Sweden. Mats Eliasson, MD, PhD Professor, Department of Public Health and Clinical Medicine, Sunderby Research Unit, Umeå University, Umeå, Sweden. Ulf Näslund, MD, PhD Professor, Department of Public Health and Clinical Medicine, Cardiology, Heart Centre, Umeå University, Umeå, Sweden. Åsa Hörnsten, RN, PhD Associate Professor, Department of Nursing, Umeå University, Umeå, Sweden
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Carter-Harris L. An introduction to key event mapping: A primer for nurse researchers. Appl Nurs Res 2015; 28:83-5. [PMID: 25908543 DOI: 10.1016/j.apnr.2015.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/12/2015] [Accepted: 01/13/2015] [Indexed: 11/19/2022]
Abstract
To fully understand the events leading to a diagnosis, retrospective recall can help nurse researchers reconstruct important health behavior-related events. However, retrospective recall can be a challenge. Key event mapping offers nurse researchers a method beyond retrospective chart review to elicit date data to explore the pre-diagnosis time frame of an illness. The purpose of this paper is to introduce the key event mapping method to nurse researchers in search of a method of eliciting date data from participants when designing research studies that include a retrospective recall component.
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Affiliation(s)
- Lisa Carter-Harris
- Indiana University School of Nursing, 1111 Middle Drive, NU 418, Indianapolis, IN 46202, USA.
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Abed MA, Khalil AA, Moser DK. The Contribution of Symptom Incongruence to Prehospital Delay for Acute Myocardial Infarction Symptoms Among Jordanian Patients. Res Nurs Health 2015; 38:213-21. [DOI: 10.1002/nur.21658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Mona A. Abed
- Assistant Professor; College of Nursing; Hashemite University; Zarqa 13115 Jordan
| | - Amani A. Khalil
- Associate Professor; Faculty of Nursing; The University of Jordan; Amman Jordan
| | - Debra K. Moser
- Professor; College of Nursing; University of Kentucky; Lexington KY
- School of Nursing; University of Ulster; Belfast Ireland
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Mooney M, O'Brien F, McKee G, O'Donnell S, Moser D. Ambulance use in acute coronary syndrome in Ireland: A cross-sectional study. Eur J Cardiovasc Nurs 2015; 15:345-54. [PMID: 25805100 DOI: 10.1177/1474515115579134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/06/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND As myocardial salvage is time dependent, prompt emergency department attendance is imperative in the presence of unresolved acute coronary syndrome symptoms. Although ambulance use is the recommended mode of transport during an acute coronary syndrome event, people regularly have misperceptions about its role. Consequently, many fail to use this service when warranted. AIM To evaluate factors associated with ambulance usage among patients admitted to emergency departments with acute coronary syndrome symptoms in Ireland. METHODS Patients (N=1947) diagnosed with acute coronary syndrome were recruited across five hospitals. The ACS Response Index was used to identify mode of transport to access the emergency department, symptom context and experience and the rationale for non-ambulance use. Using logistic regression, predictors of ambulance use were identified. RESULTS Only 40.1% of the sample used an ambulance. The primary reason for non-ambulance use was the perception that it was unwarranted (31%). A further 23.8% thought another mode of transportation would be faster. Independent predictors of ambulance usage differed among the three sub-diagnoses of acute coronary syndrome. For each group, visiting the general practitioner with symptoms was associated with a greater likelihood of not using an ambulance. CONCLUSION The use of ambulance services is not positively embraced by the public. Furthermore, it appears that general practitioners may not always promote its use, particularly in the early stages of acute coronary syndrome symptom onset. The findings from our study suggest that a public education drive is necessary to promote ambulance usage during an acute coronary syndrome event.
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Affiliation(s)
| | | | | | | | - Debra Moser
- College of Nursing, University of Kentucky, Lexington, USA
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Noureddine S, Dumit NY, Saab M. Deciding to Seek Emergency Care for Acute Myocardial Infarction. Clin Nurs Res 2014; 24:487-503. [PMID: 25165070 DOI: 10.1177/1054773814548508] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this qualitative descriptive study was to explore how patients who experience acute myocardial infarction (AMI) decide to seek emergency care. Fifty patients with AMI were interviewed at two hospitals in Lebanon. The perspective of 22 witnesses of the attack was also sought about the cardiac event. The themes that transpired from the data were as follows: making sense of the symptoms, waiting to see what happens, deciding to come to the hospital, and the family influenced the decision to seek care. The witnesses of the cardiac event, mostly family members, supported the decision to seek emergency care. Deciding to seek emergency care for AMI is complex. Nurses must solicit their patients' perception of the cardiac event to provide them with tailored education and counseling about heart attack symptoms and how to respond to them in case they recur. Family members must be included in the education process.
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Slow-onset and Fast-onset Symptom Presentations In Acute Coronary Syndrome (ACS): New Perspectives on Prehospital Delay in Patients with ACS. J Emerg Med 2014; 46:507-15. [DOI: 10.1016/j.jemermed.2013.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 03/19/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022]
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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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