When every minute counts: From symptoms to admission for acute myocardial infarction with special emphasis on gender differences
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Background Acute myocardial infarction is a major cause of death and morbidity worldwide, both in women and in men. Up to the age of 70 the incidence of acute myocardial infarction is higher in men than in women. Although the incidence is lower in young women than in young men, young women are particularly vulnerable due to higher fatality rates. The lower incidence in women compared to men might underestimate women’s risk. Women might also be less likely to identify themselves as possible sufferers and to take cardio-protective actions. The treatment of acute myocardial infarction has changed dramatically the last decades and reperfusion therapy has great impact on myocardial damage. The most critical time of an acute myocardial infarction is the very early phase, as rapid treatment is significantly associated with reduced mortality. Time has therefore become an important issue regarding the patients’ prognosis. These patients often delay in seeking medical assistance, and this “patient delay” accounts for most of the total prehospital delay. Several aspects are reported to influence prehospital delay but knowledge about gender specific aspects is limited. Aims The overall aim was to generate knowledge about gender- specific aspects that might contribute to an early diagnosis of women and men with ischaemic heart disease and to decrease prehospital delay in patients with acute myocardial infarction. Material and methods This is a multicentre cross- sectional study including 149 women and 384 men with a first acute myocardial infarction. Respondents were consecutively recruited from the coronary units in 5 Norwegian hospitals. A self- administered questionnaire was mailed to eligible patients after hospital discharge. The respondents were asked about symptom experience, symptom assessment and illness behaviour. A pilot study including 82 patients with a first acute myocardial infarction was conducted prior to the main study. Results There were no statistically significant gender differences in patient delay or total prehospital delay. More than half of both women and men waited more than an hour before they called for medical assistance and a total prehospital delay exceeding two hours was reported by half the study population. How symptoms were experienced and interpreted had a greater impact on men’s delay compared to women’s. Consulting a partner increased patient delay in both genders; however, having a partner with low education level increased patient delay in men and not in women. More than half of both women and men reported that their acute symptoms were not in accordance with their expectations and this increased delay in both genders. Illness behaviour had a vital influence on prehospital delay in both women and men. Women were less likely than men to experience chest symptoms and more likely to report atypical symptoms in the acute phase. Hypertensive women were also less likely than women who were not hypertensive to experience acute chest symptoms, but this association was not found in men. Though gender differences were found in the frequency of symptoms the top four reported acute symptoms (symptoms from chest, left arm, sweating and dyspnoea) were the same in women and men. Symptom experience more likely influenced a cardiac attribution in women than in men, while medical history had a greater impact in men than in women. Younger men (<55 years) were more likely than older men to report musculoskeletal symptoms in the acute phase, to report a higher number of acute symptoms and to attribute their symptoms as noncardiac. These associations were not found in women. During the year before the acute myocardial infarction women were more likely than men to report symptoms that might be related to a cardiac disease, and these early warning symptoms were associated with symptoms experienced in the acute phase. Women experiencing chest symptoms the year before had five times higher risk of experiencing acute chest symptoms, and this risk was nearly tripled in men. One in three women and one in four men had consulted a physician for their chest symptoms the year before the acute myocardial infarction. Younger men (<66 years) were less likely than older men to contact a physician for these chest symptoms. Conclusions There were no statistically significant gender differences in prehospital delay; however, factors associated with delay differed between women and men. Women and men differed in symptom presentation and how these influenced the interpretation of the situation. Early warning symptoms might be a tool to early diagnoses of coronary heart disease, and a greater awareness of these symptoms might be vital. Younger men differed from older men regarding acute symptoms and cardiac attribution. Keywords Ischaemic heart disease, acute coronary syndrome, acute myocardial infarction, prodromal symptoms, gender (sex) differences, prehospital delay, decision-making.
Består avLøvlien, Mona; Schei, Berit; Gjengedal, Eva. Are there gender differences related to symptoms of acute myocardial infarction? A Norwegian perspective.. Progress in Cardiovascular Nursing. (ISSN 0889-7204). 21(1): 14-9, 2006. 16522964.
Løvlien, Mona; Schei, Berit; Hole, Torstein. Women with myocardial infarction are less likely than men to experience chest symptoms.. Scandinavian Cardiovascular Journal. (ISSN 1401-7431). 40(6): 342-7, 2006. 10.1080/14017430600913199. 17118824.
Løvlien, M; Schei, B; Hole, T. Prehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction.. European Journal of Cardiovascular Nursing. (ISSN 1474-5151). 6(4): 308-13, 2007. 10.1016/j.ejcnurse.2007.03.002. 17452019.
Løvlien, Mona; Schei, Berit; Hole, Torstein. Myocardial infarction. Journal of Advanced Nursing. (ISSN 0309-2402). 63(2): 148-54, 2008. 10.1111/j.1365-2648.2008.04654.x. 18547371.
Løvlien, Mona; Johansson, Ingela; Hole, Torstein; Schei, Berit. Early warning signs of an acute myocardial infarction and their influence on symptoms during the acute phase, with comparisons by gender.. Gender medicine : official journal of the Partnership for Gender-Specific Medicine at Columbia University. (ISSN 1878-7398). 6(3): 444-53, 2009. 10.1016/j.genm.2009.09.009. 19850240.
UtgiverNorges teknisk-naturvitenskapelige universitet, Det medisinske fakultet, Institutt for samfunnsmedisin
SerieDoktoravhandlinger ved NTNU, 1503-8181; 2010:144
Dissertations at the Faculty of Medicine, 0805-7680; 444