A Qualitative Study of Symptom Experiences of Women With Acute Coronary Syndrome

Abstract

Background Most studies show that women with symptoms of acute coronary syndrome (ACS) delay seeking care longer than men. Contributing factors include that women are more likely to experience diverse symptoms, to experience symptoms that do not match pre-existing symptom expectations, to interpret symptoms as non-cardiac, and to minimize symptoms until they become incapacitating. Objective The aim of the study was to identify factors influencing women’s ability to recognize and accurately interpret symptoms of suspected ACS. Methods This qualitative study used in-depth interviews with 18 women diagnosed with ACS to determine how they recognized, interpreted, and acted on symptoms. An interview guide developed from the author’s initial research was used to provide structure for the process. Results All of the women went through a process of recognizing and interpreting their symptoms. Eight women had symptoms arise abruptly. Most of these women recognized a change immediately, “knew” to go for treatment, and did so quickly. Three women had vague symptoms which started slowly, converting unexpectedly to intense symptoms prompting them to seek care urgently. The remaining seven women had evolving symptoms, were more likely to interpret symptoms as unrelated to their heart, and avoided disclosing symptoms to others. Despite recognizing the situation may be serious, women with evolving symptoms adopted a wait-and-see approach. Conclusion Women with less severe, intermittent, or evolving symptoms are at an increased risk of delayed presentation, diagnosis, and treatment for ACS. These women should be targeted for educational and behavioral interventions.

Nurse Practitioner Knowledge of Symptoms of Acute Coronary Syndrome

“…In two of the cases (cases one and four), similar characteristics included an abrupt onset of symptoms, featuring “classic” symptoms of a heart attack (chest pain or pressure) with moderate to severe pain intensity referred to in the literature as immediately recognizable MI cases. 7,14–15 In case one, the 75-year-old female awoke from sleep with chest pressure rated as a “5–6” on a 0–10 pain intensity scale. While most NPs ( n =11) diagnosed the patient correctly and said the situation was serious, only nine (75%) selected all the correct actions (wake spouse, call 9–1-1, take aspirin).…”

Patient’s Transition Experiences from Hospital to Home after an Acute Cardiac Event

“…The gender factor also influences the interpretation of symptoms. Women who have less severe, intermittent, and gradual heart attack symptoms are at increased risk of delayed presentation, diagnosis, and treatment for ACS [28]. The increasing knowledge about the transition phase requires modification of the strategies that have been used to deal with situations and events before the transition that needs to be modified [14].…”

From Bodily Sensations to Symptoms: Health Care–Seeking Practices Among People Affected by Acute Coronary Syndrome

“…Some studies express the ambition to explore the process of interpretation and decision in greater depth, but these seem to be hampered by unchallenged basic assumptions similar to those from the cardiology field embedded in the research designs. For example, Davis (2017) recently conducted an interesting interview study aiming to identify factors influencing women's ability to recognize and accurately interpret symptoms of suspected ACS. According to this study, the women underwent a process of recognizing and interpreting their symptoms.…”

“…Much research has, therefore, focused on investigating whether the reasons why patients do not seek health care in a timely manner are due to difficulties in recognizing symptoms (Moser et al, 2006; O’Donnell, McKee, Mooney, O’Brien, & Moser, 2014; O’Donnell & Moser, 2012; Roffi et al, 2015), or to issues related to race and gender (Al-Hassan, 2015; Banks & Dracup, 2007; Davis, 2017; Galick, D’Arrigo-Patrick, & Knudson-Martin, 2015; McSweeney, Lefler, Fischer, Naylor, & Evans, 2007; Ratner et al, 2006); age (Ryan & Zerwic, 2003); beliefs; knowledge and interpretation of symptoms (Cytryn, Yoskowitz, Cimino, & Patel, 2009; O’Brien, O’Donnell, McKee, Mooney, & Moser, 2013; Perkins-Porras, Whitehead, Strike, & Steptoe, 2009; Thuresson et al, 2007); cognitive, affective, and behavioral responses (Finnegan et al, 2000; Gallagher, Marshall, & Fisher, 2010; Rosenfeld, Lindauer, & Darney, 2005; Sjöström-Strand & Fridlund, 2008); or patients’ and relatives’ thoughts and actions (Henriksson, Lindahl, & Larsson, 2007) or emotions (Nymark, Mattiasson, Henriksson, & Kiessling, 2014).…”