A comparative study of differences in the referral behaviour patterns of men and women who have experienced cardiac-related chest pain

doi:10.1016/S0964-3397(98)80525-9

Intensive and Critical Care Nursing

Volume 14, Issue 4, August 1998, Pages 192-202

https://doi.org/10.1016/S0964-3397(98)80525-9 Get rights and content

Survival and long-term prognosis after a myocardial infarction are directly related to the individual's decision to seek medical help. Early medical intervention is imperative if thrombolytic therapy is to be effective. Emerging research has indicated that women frequently have longer pre-hospital delays than men.

Incorporating a comparative descriptive design, this research compared the pre-hospital admission behaviour patterns of women and men, following the onset of acute chest pain. A convenience sample of 12 women and 12 men were selected following admission to a local coronary care unit. Structured interviews and the examination of medical notes/relevant documentation provided the data. Findings were examined and compared through the use of content analysis and descriptive statistics.

Severity of symptoms proved to be the strongest influence in shortening pre-hospital delay. Despite this, overall, men were admitted to hospital more quickly than women. Men were more ready than women to believe that they might be having a heart attack and this belief led them to seek treatment promptly. In order to improve female mortality and morbidity following a myocardial infarction, it is recommended that there is an urgent need to target women, through health promotion and media interventions.

References (47)

AlonzoAA
An illness behaviour paradigm: a conceptual exploration of a situational-adaptation perspective
Social Science Medicine
(1984)
AlonzoAA
The impact of the family and lay others on care-seeking during life threatening episodes of suspected coronary artery disease
Social Science Medicine
(1986)
BeeryTA
Gender bias in the diagnosis and treatment of coronary heart disease
Heart and Lung
(1995)
DracupK et al.
Causes of delay in seeking treatment for heart attack symptoms
Social Science Medicine
(1995)
HsiaJ
Gender differences in diagnosis and management of coronary heart disease
Journal of Women's Health
(1993)
LeventhalH et al.
Illness representations and coping with health threats
McGovernPG et al.
Trends in survival of hospital myocardial infarction patients between 1970 and 1985; the Minnesota heart survey
Circulation
(1992)
MeischkeH et al.
Utilisation of emergency medical services for symptoms of acute myocardial infarction
Heart and Lung
(1995)
MisinskiM
Role of conventional management alternative therapies in limiting infarct size in acute myocardial infarction
Heart and Lung
(1987)
SteingartRM et al.
Sex differences in the management of coronary artery disease
The New England Journal of Medicine
(1991)

AlonzoAA

Acute illness behaviour: a conceptual exploration and specification

Social Science Medicine

(1980)

BerelsonB

Content Analysis in Communication Research

(1971)

Boehringer Ingleheim Ltd

Trials of Life — the evolution of thrombolytic therapy

(1994)

British Heart Foundation

Women and Heart Disease

Factfile Newsletter

(1996)

CarterC

Descriptive Research

ClarkeKW et al.

Do women with acute myocardial infarction receive the same treatment as men?

British Medical Journal

(1994)

CochraneBL

Acute myocardial infarction in women

Critical Care Nursing Clinics of North America

(1992)

Deaton-WarnerC

Somatic awareness and coronary artery disease in women with chest pain

Heart and Lung

(1995)

DemseySJ et al.

Women's decision to seek care for symptoms of acute myocardial infarction

Heart and Lung

(1995)

DracupK et al.

Treatment seeking behaviour among those with signs and symptoms of acute myocardial infarction

Heart and Lung

(1991)

GaspozJM et al.

Impact of a public health campaign on pre-hospital delay, patients reporting chest pain

Heart

(1996)

GISSI-1

Gruppo Italiano per lo Studio deila Stretochinasi nell Infarto

Intravenous thrombolytic therapy in acute myocardial infarction

Lancet

(1986)

Cited by (30)

Thoughts and behaviors of women with symptoms of acute coronary syndrome
2013, Heart and Lung: Journal of Acute and Critical Care
Citation Excerpt :
A major issue for women, however, is that the symptom experience is highly variable. Women are more likely than men to experience atypical symptoms,16–18 increasing the likelihood that they will attribute symptoms to non-cardiac etiologies, which in turn is associated with treatment delay.3,15,19–22 Women are also more likely to experience symptoms that do not match their expectations of a myocardial infarction,3,15 to perceive themselves at low risk for heart disease,17,20,23 and to worry about troubling others with their symptoms24–26; thus they may dismiss or minimize symptoms until these symptoms prevent continuation of their usual activities.15,27
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.
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.
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.
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.
Perceived coping, social support, and quality of life 1 month after myocardial infarction: A comparison between Swedish women and men
2005, Heart and Lung: Journal of Acute and Critical Care
The study objective was to compare coping, social support, and quality of life in Swedish women and men 1 month after myocardial infarction.
The study design was cross-sectional and descriptive-comparative.
The study took place in 1 hospital service area in the middle of Sweden.
The sample consisted of 74 women and 97 men.
The Jalowiec Coping Scale, the Social Network and Social Support Questionnaire, the Short Form-36 Health Survey, and the Quality of Life Index-Cardiac Version were used.
Compared with men, women used more evasive and supportive coping and rated psychologic aspects of the heart disease as more problematic to manage. More women perceived available support from friends and grandchildren, and more men perceived available support from their partner. Women rated lower levels in physical and psychologic dimensions of quality of life.
The first month after myocardial infarction is a susceptible period especially for women. They used more evasive and supportive coping and experienced a lower quality of life compared with men.
Prehospital delay in acute coronary syndrome - An analysis of the components of delay
2004, International Journal of Cardiology
Background: Prompt hospital admission is essential when treating acute coronary syndrome. Delay prior to admission is unnecessarily long. Therefore, a thorough scrutiny of the influence of characteristics, circumstantial and subjective variables on elements of prehospital delay among patients admitted with acute coronary syndrome is warranted. Methods: A structured interview was conducted on 250 consecutive patients admitted alive with acute coronary syndrome. Results: Median prehospital, decision, physician and transportation delays were 107, 74, 25 and 22 min, respectively. Women (n=77) had more frequently atypical symptoms and increased prehospital delay caused by prolonged physician and transportation delay. Physician delay among women and men were 69 and 16 min, respectively. Patients with prior myocardial infarction had reduced prehospital delay, which was caused by shorter decision and physician delay; whereas patients with prior mechanical revascularisation or typical symptoms had prolonged prehospital delay due to long decision delay. When symptoms were interpreted as cardiac the decision and prehospital delay were reduced. Conclusion: The medical profession underestimates the risk of acute coronary syndrome among women, and thereby contributes to unnecessary long delay to treatment. The patient's prior experience and interpretation has a significant influence on behaviour.
Managing thrombolysis in the accident and emergency department
2003, Accident and Emergency Nursing
The optimal management of acute myocardial infarction (AMI) today is founded upon the ‘open artery’ theory and driven by the need for early reperfusion strategies. Numerous randomised controlled trials demonstrate the unequivocal benefit of thrombolytic therapy in reducing mortality and improving long-term prognosis. These benefits are most striking when the thrombolytic therapy is given early. The National Service Framework for Coronary Heart Disease introduced national standards to reduce both ‘call to needle’ and ‘door to needle’ times to further augment early treatment. Subsequently many hospitals established ‘fast track’, ‘nurse-led’ or ‘nurse initiated’ thrombolysis within both the Accident and Emergency and Coronary Care Departments. This paper reviews these strategies and considers the benefits and limitations associated with the role of the ‘thrombolysis nurse’. Thrombolysis nurses work to agreed protocols and play a fundamental role in the assessment and appropriate management of patients with acute MI. The evidence suggests that thrombolysis nurses are safe and effective in their practice and make a significant contribution to patient outcomes and enhance interprofessional education and practice.
Is the radiation of chest pain a useful indicator of myocardial infarction? A prospective study of 541 patients
2002, Accident and Emergency Nursing
In recent years it has been claimed that in those presenting with chest pain, the extent of pain radiation may be predictive of MI and that women's and men's pattern of pain radiation differs. This prospective study therefore investigated whether there were differences in pain radiation between those with and without MI and according to gender. Patients (n=541) presenting to a CCU with an episode of chest pain were asked to indicate on a body map the region of pain radiation they experienced at the time of symptom onset. As expected, radiation to the left and/or to right shoulder/arm was significantly higher in the MI group. Women with MI experienced more chest pain radiating to the right arm/shoulder (P=0.0005), upper right region (P=0.0006) and arm/shoulder than those without MI. Additionally, women with MI also described more pain radiation in the front neck (P=0.015) area, and the right shoulder/arm (P=0.02) than their male counterparts. A third of these women also experienced more pain radiating to the back (P=0.005). The premise of greater chest pain distribution amongst those with an MI could not be confirmed. Nevertheless, the study identified significant differences amongst women with MI, the discussion analyses the implications for practice.
Are manual gestures, verbal descriptors and pain radiation as reported by patients reliable indicators of myocardial infarction? Preliminary findings and implications
2000, Intensive and Critical Care Nursing
Patients experiencing an episode of acute chest pain need to be assessed promptly and effectively to ensure optimal management. The aim of this study was to investigate whether there were specific aspects of patients’ symptom reports which could be viewed as additional indicators of myocardial infarction (MI) and contribute to the assessment process.
The sample consisted of 267 patients who presented with an episode of acute chest pain. Methods of data collection were based on, or modified from, previous studies which had investigated the use of manual gestures, choice of verbal descriptors and extent of pain radiation in patients with and without MI. To determine whether these variables were of significance in the diagnosis, the responses of those with (n = 118) and without MI (n = 149) were compared.
The results suggest that it is currently impossible to draw any conclusions as to whether the variables studied can be judged as reliable indicators of MI. The findings indicate that there are some differences between the groups particularly in the language used. Moreover, women with MI characterized their symptoms through stronger emotive words such as ‘worrying’ (P = 0.014) ‘frightening’ and ‘intolerable’ and also differed from their male counterparts in their reports regarding pain radiation. Implications for practice and for research are discussed.

View all citing articles on Scopus

View full text

A comparative study of differences in the referral behaviour patterns of men and women who have experienced cardiac-related chest pain

Social Science Medicine

Social Science Medicine

Heart and Lung

Social Science Medicine

Journal of Women's Health

Circulation

Heart and Lung

Heart and Lung

The New England Journal of Medicine

Acute illness behaviour: a conceptual exploration and specification

Social Science Medicine

Content Analysis in Communication Research

Trials of Life — the evolution of thrombolytic therapy

Women and Heart Disease

Factfile Newsletter

Descriptive Research

Do women with acute myocardial infarction receive the same treatment as men?

British Medical Journal

Acute myocardial infarction in women

Critical Care Nursing Clinics of North America

Somatic awareness and coronary artery disease in women with chest pain

Heart and Lung

Women's decision to seek care for symptoms of acute myocardial infarction

Heart and Lung

Treatment seeking behaviour among those with signs and symptoms of acute myocardial infarction

Heart and Lung

Impact of a public health campaign on pre-hospital delay, patients reporting chest pain

Heart

Gruppo Italiano per lo Studio deila Stretochinasi nell Infarto

Intravenous thrombolytic therapy in acute myocardial infarction

Lancet