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Coronary Heart Disease and Early Decision Making, from Symptoms to Seeking Care: Studies with Focus on Pre-hospital Delay in Acute Myocardial Infarction Patients
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Despite several investigations and interventions aimed at decreasing the time from symptom onset to medical care seeking in acute myocardial infarction patients, the delay time is still too long for best treatment outcomes. In this thesis, investigations aimed at improving our understanding of the factors influencing delay time are evaluated, as well as attitudes to medical care seeking in patients, relatives and the general public. Additionally, an evaluation was performed to examine whether health-related quality of life had any influence on delay time and re-admissions.

Participating patients, relatives and representatives of the general public were generally knowledgeable about acute myocardial infarction (AMI) and its symptomatology. The majority of participants knew about the importance of receiving fast treatment when an AMI occurs. Despite people’s knowledge, several patients and relatives felt uncertain of symptom origin and how to act at symptom onset. Patients commonly consulted an additional person when symptoms did not disappear. However, people appeared to act more appropriately if someone else had chest pain compared to self-experienced symptoms.

In patients who had suffered from more than one AMI, poor total health status increased the risk of delaying for more than two hours, but no independent association was found between total health status and re-admissions within the first year post-AMI.

Place, publisher, year, edition, pages
Uppsala: Acta Universitetis Upsaliensis , 2011. , 71 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 685
Keyword [en]
Acute Myocardial Infarction, Pre-Hospital Delay, Knowledge, Attitudes, Decision Making, Quality of Life, Re-admission
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-156636ISBN: 978-91-554-8114-8 (print)OAI: oai:DiVA.org:uu-156636DiVA: diva2:432646
Public defence
2011-09-16, Enghoffsalen, Akademiska sjukhuset, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-08-25 Created: 2011-08-04 Last updated: 2011-09-08
List of papers
1. Patients' and relatives' thoughts and actions during and after symptom presentation for an acute myocardial infarction
Open this publication in new window or tab >>Patients' and relatives' thoughts and actions during and after symptom presentation for an acute myocardial infarction
2007 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 6, no 4, 280-286 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Relatives play an important role in deciding to seek medical care after the onset of symptoms of an acute myocardial infarction (AMI). OBJECTIVE: The aim of this study was to gain deeper understanding of how AMI patients and their relatives think and act during and after onset of symptoms. METHODS: Six focus group interviews were conducted with AMI patients (N=13) and relatives (N=14). Manifest content analysis was used to analyse the transcribed data. RESULTS: The AMI patients experienced a variety of symptoms and both patients and relatives often felt uncertain about the origin of the symptoms, interpreted them as less serious conditions and tried to alleviate the discomfort in various ways. When symptoms continued the patients consulted a relative, who often decided to seek care. Many considered waiting for an ambulance was too long and the relative often drove the patients to the hospital. CONCLUSION: Patients as well as relatives were insecure about AMI symptoms and how to act. All patients contacted a relative, who was more eager than the patient to seek help. Many preferred to go in their own car to the hospital, believing it to be faster than an ambulance. Information about AMI symptoms and recommended action should be given to the public and to AMI patients and their relatives.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-129810 (URN)10.1016/j.ejcnurse.2007.02.001 (DOI)17478122 (PubMedID)
Available from: 2010-08-24 Created: 2010-08-24 Last updated: 2017-12-12Bibliographically approved
2. Knowledge and attitudes toward seeking medical care for AMI-symptoms
Open this publication in new window or tab >>Knowledge and attitudes toward seeking medical care for AMI-symptoms
Show others...
2011 (English)In: International Journal of Cardiology, ISSN 0167-5273, E-ISSN 1874-1754, Vol. 147, no 2, 224-227 p.Article in journal (Refereed) Published
Abstract [en]

Background: Time is crucial when an acute myocardial infarction (AMI) occurs, but patients often wait before seeking medical care. Aim: To investigate and compare patients' and relatives' knowledge of AMI, attitudes toward seeking medical care, and intended behaviour if AMI-symptoms occur. Methods: The present study was a descriptive, multicentre study. Participants were AMI-patients <= 75 years (n = 364) and relatives to AMI-patients (n = 319). Questionnaires were used to explore the participants' knowledge of AMI and attitudes toward seeking medical care. Results: Both patients and relatives appeared to act more appropriate to someone else's chest pain than to their own. Patients did not have better knowledge of AMI-symptoms than relatives. Women would more often contact someone else before seeking medical care. A greater percentage of elderly (65-75 years), compared to younger individuals, reported that they would call for an ambulance if chest pain occurred. Conclusions: There were only minor differences between patients and relatives, regarding both knowledge and attitudes. It seems easier to act correctly as a bystander than as a patient. Therefore, in order to decrease patients' delay time it is important to educate relatives as well as patients on how to respond to symptoms of an AMI.

Keyword
Myocardial infarction, Knowledge, Attitude, Decision making, Patient, Family
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-149720 (URN)10.1016/j.ijcard.2009.08.019 (DOI)000287480200014 ()19853936 (PubMedID)
Available from: 2011-03-22 Created: 2011-03-22 Last updated: 2017-12-11Bibliographically approved
3. Knowledge about Acute Myocardial Infarction (AMI) and attitudes to medical care seeking: a comparison between patients and the general public
Open this publication in new window or tab >>Knowledge about Acute Myocardial Infarction (AMI) and attitudes to medical care seeking: a comparison between patients and the general public
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Patients with acute myocardial infarction often have long decision times beforeseeking medical care. The decision time is influenced by knowledge of AMI-symptoms,psychological factors and the response of people near the patient to the symptoms.Aim: To investigate and compare the knowledge of AMI, intended actions in response to AMIsymptomsand attitudes toward seeking medical care of patients and the general public.Method: This was a multi-centre study with descriptive and comparative design, usingquestionnaires as an instrument. The population consisted of AMI-patients and representatives ofthe general public.Results: There was good knowledge about typical AMI-symptoms among the participants. Themajority thought an AMI always starts suddenly. Patients did not know more about the timedependencyof treatment outcome than the general public. A greater proportion of the generalpublic would contact an additional person before consulting medical professionals.Conclusions: Patients had no better knowledge about AMI than the general public, but wouldmore commonly act appropriately in case of AMI-symptoms.

Keyword
Acute myocardial infarction, decision making, patient, general public, knowledge and attitudes
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-156574 (URN)
Available from: 2011-08-04 Created: 2011-08-04 Last updated: 2011-08-26Bibliographically approved
4. Influence of health-related quality of life in myocardial infarction with regard to the time from symptom onset to hospital arrival, and the risk of re-admission
Open this publication in new window or tab >>Influence of health-related quality of life in myocardial infarction with regard to the time from symptom onset to hospital arrival, and the risk of re-admission
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: Despite increased awareness of the importance of early treatment in acutemyocardial infarction (AMI), the delay from symptom onset until hospital arrival is still too longand re-hospitalisations are frequent. Little is known about how health-related quality of life(HRQL) affects delay time and the frequency of re-admissions.Method: We used quality registers to investigate whether patients’ HRQL has any impact ondelay time with a new AMI, and on the rate of re-admissions during the first year. AMI-patients<75 years, with HRQL assessed with EQ-5D at one-year follow-up, and who thereafter had anew AMI registered, were evaluated for the correlation between HRQL and delay time (n=454).The association between HRQL and re-admissions was evaluated among those who had anadditional one-year follow-up registration after the new AMI (n=216).Results: Patients who reported poor total health status (EQ-VAS ≤50), compared to those whoreported EQ-VAS 81-100, had tripled risk to delay ≥2 hours from symptom onset to hospitalarrival (adjusted OR 3.01, 95% CI: 1.43-6.34). Patients scoring EQ-VAS ≤50 had a higher riskof re-admissions in the univariate analysis (OR 3.08, 95% CI: 1.71-5.53). However, thecorrelation did not remain significant after adjustment (OR 1.99, 95% CI: 0.90-4.38). EQ-indexwas not independently associated with delay time or re-admissions.Conclusion: Aspects of total health status post-AMI were independently associated with delaytime to hospital arrival in case of a new AMI. However, the influence of total health status on therisk of re-admissions was less clear.

Keyword
AMI, quality of life, delay time, re-admission, depression, anxiety
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-156575 (URN)
Available from: 2011-08-04 Created: 2011-08-04 Last updated: 2011-08-26Bibliographically approved

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