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

The reduction of prehospital delay for patients with acute coronary syndrome (ACS) is widely discussed within cardiac research. Medically informed literature generally considers patient hesitancy in seeking treatment a significant barrier to accessing timely treatment. With this starting point, we conducted an interview study with people previously hospitalized for ACS and with the bystanders involved in their decision to contact the health care system. The analysis was conducted in two stages: first, a systematic extraction of key information; second, an in-depth analysis informed by medical anthropology. This led us to understand the prehospital period as an interpretation process where bodily sensations appeared as symptoms. Informants vacillated between sensations, knowledge, interpretations, and emotions as they struggled to preserve everyday ordinariness. They were led to contact the health care system by bodily discomfort rather than a rational decision to reduce risk. The paradigmatic implications from medical anthropology proved an important alternative to the medical paradigm.

Association between the reported intensity of an acute symptom at first prehospital assessment and the subsequent outcome: a study on patients with acute chest pain and presumed acute coronary syndrome

BACKGROUND

To decrease the morbidity burden of cardiovascular disease and to avoid the development of potentially preventable complications, early assessment and treatment of acute coronary syndrome (ACS) are important. The aim of this study has therefore been to explore the possible association between patients' estimated intensity of chest pain when first seen by the ambulance crew in suspected ACS, and the subsequent outcome before and after arrival in hospital.

METHODS

Data was collected both prospectively and retrospectively. The inclusion criteria were chest pain raising suspicion of ACS and a reported intensity of pain ≥4 on the visual analogue scale.

RESULTS

All in all, 1603 patients were included in the study. Increased intensity of chest pain was related to: 1) more heart-related complications before hospital admission; 2) a higher proportion of heart failure, anxiety and chest pain after hospital admission; 3) a higher proportion of acute myocardial infarction and 4) a prolonged hospitalisation. However, there was no significant association with mortality neither in 30 days nor in three years. Adjustment for possible confounders including age, a history of smoking and heart failure showed similar results.

CONCLUSION

The estimated intensity of chest pain reported by the patients on admission by the ambulance team was associated with the risk of complications prior to hospital admission, heart failure, anxiety and chest pain after hospital admission, the final diagnosis and the number of days in hospital.

TRIAL REGISTRATION

ClinicalTrials.gov 151:2008/4564 Identifier: NCT00792181. Registred 17 November 2008 'retrospectively registered'.

Biopsychosocial predictors of coping strategies of patients postmyocardial infarction

Data from the Patients and Families Psychological Response to the Home Automated External Defibrillator Trial were used to examine the relationship between biopsychosocial variables and patients' coping strategies postmyocardial infarction. This study is the secondary data analysis of longitudinal observational study. A total of 460 patient-spouse pairs were recruited in January 2003 to October 2005. Hierarchical linear regression analysis examined biological/demographic, psychological and social variables regarding patients' coping scores using the Family Crisis Oriented Personal Evaluation Scale. Lower social support and social support satisfaction predicted lower total coping scores. Being younger, male gender and time since the myocardial infarction predicted lower positive coping strategy use. Higher anxiety and lower social support were related to fewer positive coping methods. Lower educational levels were related to increased use of negative coping strategies. Reduced social support predicted lower total coping scores and positive coping strategy use and greater passive coping style use. Social support from a broad network assisted with better coping; those living alone may need additional support. Social support and coping strategies should be taken into consideration for patients who have experienced a cardiac event.