11 research outputs found
Gender Differences in Symptoms of Myocardial Ischaemia
Aims
Better understanding of symptoms of myocardial ischaemia is needed to improve timeliness of treatment for acute coronary syndromes (ACS). Although researchers have suggested sex differences exist in ischaemic symptoms, methodological issues prevent conclusions. Using percutaneous coronary intervention (PCI) balloon inflation as a model of myocardial ischaemia, we explored sex differences in reported symptoms of ischaemia.
Methods and results
Patients having non-emergent PCI, but not haemodynamic instability or left bundle branch block or non-acute coronary occlusion, were prospectively recruited. Pre-procedure, descriptions of pre-existing symptoms were obtained using open-ended questioning. Inflation was maintained for 2 min or until moderate discomfort or clinical instability occurred. During inflation, subjects were exhaustively questioned about their symptoms. Concurrent ECG data were collected. The final sample was 305 [39.7% women; mean age 63.9 (±10.6)]. No sex differences were found in rates of chest or typical ischaemic discomfort, regardless of ischaemic status. Women were significantly more likely to report throat/jaw discomfort [odds ratio: 2.91; 95% confidence interval: 1.58–5.37] even after statistical adjustment for clinical and demographic variables.
Conclusion
This prospective study with ECG-affirmed ischaemia found no statistically significant differences in women\u27s and men\u27s rates of chest and other typical symptoms during ischaemia, although women were more likely to experience throat and jaw discomfort. Currently both popular press and some patient education materials suggest women experience myocardial ischaemia differently from men. Steps to ensure women and health professionals are alert for the classic symptoms of myocardial ischaemia in women, as well as men, may be warranted
Reducing the time-lag between onset of chest pain and seeking professional medical help: a theory-based review
Background: Research suggests that there are a number of factors which can be associated with delay in a patient
seeking professional help following chest pain, including demographic and social factors. These factors may have
an adverse impact on the efficacy of interventions which to date have had limited success in improving patient
action times. Theory-based methods of review are becoming increasingly recognised as important additions to
conventional systematic review methods. They can be useful to gain additional insights into the characteristics of
effective interventions by uncovering complex underlying mechanisms.
Methods: This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies
exploring the issue of why people having a heart attack delay seeking professional medical help. The study used
standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data
relating to theoretical underpinnings.
Results: Thirty six papers from the 53 in the original systematic review referred to a particular theoretical
perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory
was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this
model including different coping mechanisms, strategies of denial and varying models of treatment seeking.
Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and
referred to models of maintaining integrity, ways of knowing, and the influence of gender.
Conclusions: The review highlights the need to examine an individual’s subjective experience of and response to
health threats, and confirms the gap between knowledge and changed behaviour. Interventions face key challenges if they are to influence patient perceptions regarding seriousness of symptoms; varying processes of coping; and obstacles created by patient perceptions of their role and responsibilities. A theoretical approach to review of these papers provides additional insight into the assumptions underpinning interventions, and illuminates factors which may impact on their efficacy. The method thus offers a useful supplement to conventional systematic review methods
Longer pre-hospital delay in first myocardial infarction among patients with diabetes : an analysis of 4266 patients in the Northern Sweden MONICA Study
Background: Reperfusion therapy reduces both morbidity and mortality in myocardial infarction, but the effectiveness depends on how fast the patient receives treatment. Despite the time-dependent effectiveness of reperfusion therapy, many patients with myocardial infarction have delays in seeking medical care. The aim of this study was to describe pre-hospital delay in a first myocardial infarction among men and women with and without diabetes and to describe the association between pre-hospital delay time and diabetes, sex, age, symptoms and size of residential area as a proxy for distance to hospital. Methods: This population based study was based on data from 4266 people aged 25-74 years, with a first myocardial infarction registered in the Northern Sweden MONICA myocardial infarction registry between 2000 and 2008. Results: The proportion of patients with delay times >= 2 h was 64% for patients with diabetes and 58% for patients without diabetes. There was no difference in delay time >= 2 h between men and women with diabetes. Diabetes, older age and living in a town or rural areas were factors associated with pre-hospital delay times >= 2 h. Atypical symptoms were not a predictor for pre-hospital delay times >= 2 h, OR 0.59 (0.47; 0.75). Conclusions: A higher proportion of patients with diabetes have longer pre-hospital delay in myocardial infarction than patients without diabetes. There are no differences in pre-hospital delay between men and women with diabetes. The largest risk difference for pre-hospital delay >= 2 h is between women with and without diabetes. Diabetes, older age and living in a town or rural area are predictors for pre-hospital delay >= 2 h