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Heart 2000;83:388-393 ( April )

Cardiovascular medicine

Patients' interpretation of symptoms as a cause of delay in reaching hospital during acute myocardial infarction R Hornea, D Jamesb, K Petriec, J Weinmand, R Vincente

a Centre for Health Care Research, University of Brighton, Falmer Campus, Brighton BN1 9PH, UK, b School of Pharmacy and Biomolecular Sciences, University of Brighton, Brighton, UK, c Department of Behavioural Medicine, University of Auckland, Auckland, New Zealand, d Division of Psychiatry and Psychology, Guy's, King's and St Thomas' Medical Schools (Guy's Campus), London SE1, UK, e Cardiology, Brighton Health Care NHS Trust, Royal Sussex County Hospital, Brighton, UK

Correspondence to: Dr Horne email: r.horne{at}brighton.ac.uk

Accepted 23 November 1999

OBJECTIVE---To examine whether the association between expected symptoms of acute myocardial infarction and actual symptoms predicted delay in reaching hospital and help seeking behaviour.
DESIGN---During hospital convalescence, participants completed a structured interview designed to measure symptom experience and help seeking behaviour following the onset of symptoms of acute myocardial infarction.
PATIENTS---88 patients admitted to hospital with their first myocardial infarction
MAIN OUTCOME MEASURES---Delay in reaching hospital from onset of worst symptoms, obtained from ambulance and hospital records.
RESULTS---The most common symptoms expected by patients with myocardial infarction were central chest pain (76%), radiating arm or shoulder pain (34%), and collapse (26%). The most common symptoms experienced were sweats or feeling feverish (78%), chest pain (64%), and arm, shoulder, or radiating pain (66%). A mismatch between symptoms experienced and those expected occurred in 58% of patients, and was associated with delay. Patients who experienced a mismatch between expectation and actual symptoms also were more likely to have a third party decide to call for help.
CONCLUSIONS---The experience and interpretation of symptoms is an important source of delay and help seeking following onset of myocardial infarction symptoms.


Keywords: myocardial infarction; symptoms; delayed diagnosis

© 2000 by Heart


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