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A qualitative study of the experiences of myocardial infarction patients who represent post-primary percutaneous coronary intervention
  1. HM Iles-Smith1,
  2. L McGowan2,
  3. C Rogers1,
  4. F Fath-Ordoubadi1,
  5. C Dickens3,
  6. C Deaton2
  1. 1Manchester Heart Centre, Central Manchester and Manchester Children’s University Hospital, Manchester, UK
  2. 2School of Nursing, Midwifery and Social Work, The University of Manchester, Manchester, UK
  3. 3School of Community Based Medicine, The University of Manchester, Manchester, UK

Abstract

Introduction The current gold standard treatment for ST elevation myocardial infarction (STEMI) is primary percutaneous coronary intervention (PCI). Representation due to potential ischaemic cardiac events post-primary PCI may occur in up to 30% patients. Anecdotally, following STEMI patients often report difficulty with symptom attribution, which leads to help-seeking via acute healthcare services for both non-cardiac and cardiac origin chest pain. At present little is known about the personal experiences and possible trigger factors involved in representation following STEMI and primary PCI. The purpose of this study was to explore the experiences and factors involved in the representation of STEMI patients within 12 months post-primary PCI. The patients’ perception of symptoms, including the causal attributions they attach to these symptoms, will be described.

Methods A qualitative methodology involving in-depth semistructured interviews was conducted. Seventeen purposively selected patients, who represented within 12 months post-primary PCI, were interviewed regarding their perception of symptom causes, their reasons for seeking help and their emotional experiences. Data collection and analysis were conducted concurrently. Emergent themes and topics were used as a basis for future interviews with subsequent patients. The interviews were transcribed verbatim and stored and managed in a qualitative software package (NVivo 8). “Framework” analysis was used to analyse and interpret the data.

Results Interim qualitative data analysis is available for 17 patients (15 male, mean age 57 years (31–79 years)); post-representation one patient received coronary artery bypass grafting, two PCI, and the remaining patients received a diagnosis of angina (n  =  1), heart failure (n  =  1), anxiety (n  =  6) and indeterminate diagnosis (n  =  6). Preliminary analysis revealed that a great deal of uncertainty, anger and anxiety exits in relation to symptom recognition. Loss of confidence and inability to determine or make sense of symptoms were all themes that featured highly. Patients also attempted to construct illness events and reported receiving insufficient information or follow-up post-primary PCI.

Conclusion The introduction of a region-wide primary PCI service introduces new challenges in developing rehabilitation services to fit the individual needs of service users. Representation is both distressing for the patient and a burden on limited healthcare services. The information gained through this study will be of value to service providers involved in planning aftercare services. The identification of possible trigger factors will aid the development of a targeted intervention with the potential of reducing representation and hospitalisation.

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