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 Horne^a, D James^b, K Petrie^c, J Weinman^d, R Vincent^e

^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

OBJECTIVETo examine whether the association between expected symptoms of acute myocardial infarction and actual symptoms predicted delay in reaching hospital and help seeking behaviour.
DESIGNDuring 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.
PATIENTS88 patients admitted to hospital with their first myocardial infarction
MAIN OUTCOME MEASURESDelay in reaching hospital from onset of worst symptoms, obtained from ambulance and hospital records.
RESULTSThe 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.
CONCLUSIONSThe 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

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© 2000 by Heart
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