Women's help-seeking behaviour at the onset of myocardial infarction

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.     

A review of symptoms of coronary artery disease in women

BACKGROUND: Research on heart disease has increasingly included information on women's experiences. A number of recent studies present frequencies and comparisons of symptoms between men and women and there appears to be some variability in the symptoms especially among women. Even with acute myocardial infarction (AMI) where anticipated symptoms are more clear-cut, women can have vague or nonclassic symptoms. AIM AND METHOD: Selected medical and nursing research on cardiac symptoms is examined for information on the cardiac warning symptom experiences unique to women. A search of the literature between 1995 and 2000 was done using CINAHL and MEDLINE. Terms used for the search included: cardiac symptoms, women's symptoms and symptom perception. The findings from this review are used to suggest implications for clinical practice. FINDING: Women experiencing AMI present with a variety of symptoms including chest pain. Less obvious symptoms include; fatigue, shortness of breath, back pain, oedema, and transient non-specific chest discomfort. These less dramatic and non-specific symptoms do not necessarily prompt further assessment for coronary disease in women. CONCLUSION: Cardiac screening of women who present with cardiac risk factors and careful attention to less anticipated symptoms are critical factors that can improve the rapid identification of coronary disease in women. The unique physiological and sociological differences between women and men make further study of women's symptom experiences and perceptions important for health care providers. Further study of gender and ethnic differences in symptom patterns and recognition will help to improve screening and earlier identification of cardiac problems in women patients especially those without chest pain as a prodromal symptom.     

Gender differences in knowledge, attitudes, and beliefs about heart disease

The purpose of this article is to review the literature on gender differences in knowledge, attitudes, and beliefs about heart disease. Despite the significant problem of cardiac disease among women, surveys of women's knowledge, attitudes, and beliefs about the risks of heart disease have continually identified substantial gaps in women's knowledge. Overall, knowledge of heart disease, identification of risk factors for coronary artery disease, signs and symptoms of acute myocardial infarction (AMI) was poor for both men and women. The perception that women are less knowledgeable than men about heart disease was not consistent in the literature reviewed. In fact, in some studies, women were more knowledgeable than men in the identification of risk factors and less common symptoms of AMI.     

首诊为冠心病的64例绝经期妇女临床资料分析

目的:探讨绝经期妇女临床症状、静息心电图的特点以及这些临床资料与冠心病诊断的相关性。方法:收集本院64例具有心血管症状的绝经期妇女住院患者临床资料,进行分析。结果:绝经期妇女冠心病危险因素少、症状不典型,心电图多数仅表现为T波改变,多伴随失眠、胃肠功能不良等自主神经功能紊乱症状,冠脉造影阳性率为10.9%。结论:绝经期妇女冠心病发病率低,对于心悸、胸闷、心电图非特异性ST-T改变的患者,临床诊断冠心病应慎重。     

Why do women underestimate the risk of cardiac disease? A literature review

BACKGROUND: Despite the quantity of information available to women about risk factors for cardiovascular disease (CVD), many women do not perceive this risk. AIM: This paper seeks to identify factors in the published literature that influence women's risk perception of heart disease, and how these perceptions influence health outcomes. METHOD: A literature search from 1985 to 2006 using the CINAHL, Medline, Embase and PsycINFO electronic databases was undertaken. The keywords used were 'perceived risk', 'cardiac risk factors', 'cardiovascular disease', 'risk misconception', and 'heart disease', combined with 'women' and/or 'gender'. Additional data was obtained by manual searches of bibliographies of articles identified in the electronic searches, and Internet searches. FINDINGS: Until the late 1980s, CVD was perceived as a disease which primarily affected men, as few large clinical trials recruited women. This resulted in a lack of data documenting the relationship between known risk factors and gender. Until recently, health professionals have not focused on disseminating gender-specific information about CVD risks to women, causing women to underestimate their risk of developing CVD even when risk factors are clearly evident. Furthermore, women are less likely than men to recognise the signs and symptoms of CVD, delay in seeking treatment, and fail to adopt healthy lifestyles, all of which increase the incidence of mortality and morbidity in a disease that is largely preventable. CONCLUSION: This review highlights the need for health professionals to 'bridge the gap' between perceived and actual risk of CVD in women, and to develop educational programs that specifically target women.     

Women, men and coronary heart disease: a review of the qualitative literature

AIM: This paper presents a review of the qualitative literature which examines the experiences of patients with coronary heart disease. The paper also assesses whether the experiences of both female and male patients are reflected in the literature and summarizes key themes. BACKGROUND: Understanding patients' experiences of their illness is important for coronary heart disease prevention and education. Qualitative methods are particularly suited to eliciting patients' detailed understandings and perceptions of illness. As much previous research has been 'gender neutral', this review pays particular attention to gender. METHODS: Published papers from 60 qualitative studies were identified for the review through searches in MEDLINE, EMBASE, CINAHL, PREMEDLINE, PsychINFO, Social Sciences Citation Index and Web of Science using keywords related to coronary heart disease. FINDINGS: Early qualitative studies of patients with coronary heart disease were conducted almost exclusively with men, and tended to generalize from 'male' experience to 'human' experience. By the late 1990s this pattern had changed, with the majority of studies including women and many being conducted with solely female samples. However, many studies that include both male and female coronary heart disease patients still do not have a specific gender focus. Key themes in the literature include interpreting symptoms and seeking help, belief about coronary 'candidates' and relationships with health professionals. The influence of social roles is important: many female patients have difficulties reconciling family responsibilities and medical advice, while male patients worry about being absent from work. CONCLUSIONS: There is a need for studies that compare the experiences of men and women. There is also an urgent need for work that takes masculinity and gender roles into account when exploring the experiences of men with coronary heart disease.     

A nursing intervention to reduce prehospital delay in acute coronary syndrome: a randomized clinical trial

Prehospital delay in patients experiencing symptoms of acute coronary syndrome (ACS) has proved to be a significant and intractable public health problem, with minimal change in delay time over the past 2 decades despite numerous community education programs designed to reduce delay. With each 30-minute increment of delay, 1-year mortality increases by 7.5%, thus reinforcing the importance of helping patients label symptoms correctly and take appropriate action steps to seek definitive treatment. We therefore are conducting a multicenter, international clinical trial in 3,500 patients with documented coronary heart disease to determine whether a brief education and counseling intervention delivered by a nurse can reduce prehospital delay in the face of symptoms of ACS. The main outcome being studied is time from ACS symptom onset to arrival at the emergency department. Secondary outcomes include use of the emergency medical system; aspirin use; and knowledge, attitudes, and beliefs about heart attack symptoms. Patients are being followed for 2 years from the time of enrollment. The purpose of this article is to describe the intervention and its theoretical framework, and to outline the design of this randomized controlled trial.     

The silent worker

The patient in this case was diagnosed as having a myocardial infarction, exacerbated over time. It has been reported in medical literature that women in such cases may have atypical symptoms that mimic those of other medical conditions and deceive providers into misdiagnosis. A few women present with the classical chest pain, a symptom most people relate to a feeling of a heart attack. This symptom is more typical in males. EMS providers should have a high suspicion of heart disease in any patient who describes their symptoms as common or relative to acute coronary syndromes. Patients at risk include those with high blood pressure, coronary artery disease, increased cholesterol, obesity and diabetes, among others. Given that this patient was resting comfortably and complaining of abdominal pain, the providers could have interpreted her symptoms as mere gastrointestinal discomfort. In this instance, that could have led to an error in diagnosis and serious complications. The receiving ED could have had a cardiac arrest to manage rather than an early, silent acute coronary event. In this instance, contacting medical command, obtaining a focused history and providing general treatment contributed to a positive outcome for the patient.     

Do you know them when you see them? Women's prodromal and acute symptoms of myocardial infarction

This study described women's prodromal and acute symptoms associated with myocardial infarction (MI) based on interviews with 76 women who had experienced an MI in the previous year. Sixty-eight women experienced prodromal symptoms including unusual fatigue (70%), shortness of breath (53%), and pain in the shoulder blade/upper back (47%). All women experienced acute symptoms including chest pain/discomfort (90%), unusual fatigue (59%), shortness of breath (59%), and shoulder blade/upper back discomfort (42%). Although women in this study reported numerous prodromal symptoms, none had received a new diagnosis of coronary heart disease (CHD) prior to MI. Practitioners must develop an awareness of and a more comprehensive approach to treating women at risk for CHD. Further research to elucidate prodromal and acute symptom clusters is needed to assist practitioners in early diagnosis of CHD in women.     

Response to signs and symptoms of acute coronary syndrome: differences between Lebanese men and women.

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.     

The construction of a modern epidemic: the implications for women of the gendering of coronary heart disease

AIM: This aim of this paper is to examine critically the implications for women of a gendered construction of coronary heart disease. DESIGN: The paper takes the form of a literature review between 1969 and 2002 of nursing, medical and social science literature written in the English language that explores the experience of women with coronary heart disease. FINDINGS: Coronary heart disease has been constructed during the 20th century as a disease of affluence that affects high achieving men. However coronary heart disease is a major cause of morbidity and mortality among women. The literature suggests that this gendered construction has influenced not only health professionals' perceptions of coronary heart disease but also lay theories of candidature, so that the collective consciousness sees women as being at low risk. Moreover, that this construction of coronary heart disease as a male disease has led to a service provision engineered to meet male needs that arguably can be seen to militate against women. This has resulted in women being diagnosed when they are further along the disease trajectory. It also means that once diagnosis has made then they are less likely to be referred for investigations, treatment and rehabilitation. CONCLUSION: The implications of this construction for the care of women with coronary heart disease may result in 'gender-neutral' care. This may mean that decisions about care are made in the light of nurses' own knowledge and experience of nursing male patients, with the consequence that women patients' individual needs are not met.     

Is there a gender difference in aetiology of chest pain and symptoms associated with acute myocardial infarction?

Many previous studies have shown that there is a gender difference in terms of the use of diagnostic procedures and the treatment of patients with chest pain. The mechanisms behind these observations are less well described. This survey describes gender differences in the aetiology of chest pain and symptoms associated with acute myocardial infarction (AMI). Among the patients with symptoms of acute chest pain, in the emergency medical department women less frequently develop an AMI and are less frequently given a diagnosis of ischaemic heart disease. Among patients developing an AMI, women differ from men by less frequently reporting chest pain, more frequently reporting nausea, vomiting, abdominal complaints, fatigue and dyspnoea and less frequently reporting sweating. With regard to the localization of pain in AMI, women differ from men by more frequently reporting pain in the back, neck and jaw. In terms of electrocardiographic changes, women seem to have less marked ST deviations than men. However, we do not believe that these differences between women and men are substantial enough and, as a result, we do not recommend that the initial medical care of patients seeking medical attention with chest pain or other symptoms raising a suspicion of AMI should be differentiated with regard to gender. The differences described here might partly explain the prolonged delay until hospital admission in women suffering from AMI.     

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.     

Women's perceptions of coronary heart disease: an integrative review

Coronary heart disease (CHD) is the leading cause of death in American women and is a major cause of morbidity. The American Heart Association (AHA) reports that in the year 2000, 515,661 women died from all categories of cardiovascular disease. An estimated 254,630 women suffer a myocardial infarction annually. Women diagnosed with CHD experienced greater morbidity and mortality than men. Women's perceptions of their risk for heart disease can greatly influence their decision-making process in regard to healthcare decisions. The general public still perceives heart disease as primarily a health problem for men. Evidence shows that women perceive breast cancer as a greater risk than CHD. These misperceptions may lead women to underestimate their risk for CHD and fail to seek early interventions to prevent unnecessary morbidity and mortality. The purpose of this article is to report the results of an integrative review of nursing research related to women's perceptions of risks for heart disease. CINAHL, Medline, EBSCO host, and Proquest databases were searched for nursing research conducted between the years of 1985 and 2002. Key search terms were women, heart disease, coronary artery disease, perceptions, risk factors, and health promotion behaviors. Study selection was limited to the first author being a nurse researcher. Twenty articles and dissertations were retrieved that met the key search terms. Eleven articles were excluded because the first author was not a nurse researcher. This integrative review includes 5 articles and 4 dissertations. Results revealed that women's perceptions of their CHD risks are underestimated, that health-promoting behaviors are not influenced by risk perceptions, that society imposes barriers that prevent participation in health promotion behavior, and that communication between women and their healthcare providers is lacking.     

Why people experiencing acute myocardial infarction delay seeking medical assistance

Background: Delay time from onset of symptoms of myocardial infarction to seeking medical assistance can have life-threatening consequences. A number of factors have been associated with delay, but there is little evidence regarding the predictive value of these indices. Aim: To explore potential predictors of patient delay from onset of symptoms to time medical assistance was sought in a consecutive sample of patients admitted to CCU with acute myocardial infarction. Methods: The Cardiac Denial of Impact Scale, Health Locus of Control Scale, Health Value Scale and Pennebaker Inventory of Limbic Languidness were administered to 62 patients between 3 and 6 days after admission. Results: Attribution of symptoms to heart disease and health locus of control had a significant predictive effect on patients seeking help within 60 min, while previous experience of heart disease did not. Conclusion: Assisting individuals to recognise the potential for symptoms to have a cardiac origin is an important objective. Interventions should take into account the variety of cognitive and behavioural factors involved in decision making.