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The Process of Care-seeking for Myocardial Infarction Among Patients With Diabetes
Umeå University, Faculty of Medicine, Department of Nursing.ORCID iD: 0000-0002-7918-6121
Umeå University, Faculty of Medicine, Department of Nursing.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Cardiology.
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2015 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 30, no 5, E1-E8 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: People with diabetes have a higher risk for myocardial infarction (MI) than do people without diabetes. It is extremely important that patients with MI seek medical care as soon as possible after symptom onset because the shorter the time from symptom onset to treatment, the better the prognosis.

OBJECTIVE: The aim of this study was to explore how people with diabetes experience the onset of MI and how they decide to seek care.

METHODS: We interviewed 15 patients with diabetes, 7 men and 8 women, seeking care for MI. They were interviewed 1 to 5 days after their admission to hospital. Five of the participants had had a previous MI; 5 were being treated with insulin; 5, with a combination of insulin and oral antidiabetic agents; and 5, with oral agents only. Data were analyzed according to grounded theory.

RESULTS: The core category that emerged, "becoming ready to act," incorporated the related categories of perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Our results suggest that responses in each of the categories affect the care-seeking process and could be barriers or facilitators in timely care-seeking. Many participants did not see themselves as susceptible to MI and MI was not expressed as a complication of diabetes.

CONCLUSIONS: Patients with diabetes engaged in a complex care-seeking process, including several delaying barriers, when they experienced symptoms of an MI. Education for patients with diabetes should include discussions about their increased risk of MI, the range of individual variation in symptoms and onset of MI, and the best course of action when possible symptoms of MI occur.

Place, publisher, year, edition, pages
Wolters Kluwer, 2015. Vol. 30, no 5, E1-E8 p.
Keyword [en]
decision making, diabetes mellitus, experiences, grounded theory, myocardial infarction
National Category
URN: urn:nbn:se:umu:diva-98138DOI: 10.1097/JCN.0000000000000195ISI: 000360497200001PubMedID: 25325370OAI: diva2:782747
Available from: 2015-01-22 Created: 2015-01-20 Last updated: 2015-10-09Bibliographically approved
In thesis
1. Symptoms and care seeking behaviour during myocardial infarction in patients with diabetes
Open this publication in new window or tab >>Symptoms and care seeking behaviour during myocardial infarction in patients with diabetes
2015 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Symtom, fördröjning och beslut att söka vård vid hjärtinfarkt hos patienter med diabetes
Abstract [en]

Background: In Myocardial infarction (MI) it is well established that timely diagnosis and treatment may reduce mortality and improve the prognosis. Therefore it is important that patients with MI seek medical care as soon as possible. Patients with diabetes have a higher risk for MI and worse prognosis compared to patients without diabetes. Previous research is inconclusive regarding symptoms and pre-hospital delay times in MI among patients with diabetes and there is lack of research in how patients with diabetes perceive, interpret and respond to MI symptoms. 

Aim: The overall aim of this thesis was to explore symptoms and care seeking behaviour during MI in patients with diabetes. 

Methods: This thesis comprises four studies. Studies I and II were based on data from the Northern Sweden MONICA myocardial infarction registry to describe symptoms in 4028 patients (I) and pre-hospital delay and factors associated with pre-hospital delay of ≥ 2 h in 4266 patients (II). Study III included 694 patients, at five hospitals in Sweden. The patients answered a questionnaire about symptoms, response to symptoms and delay times in MI. In study IV data were collected through interviews about experiences of getting MI and the decision to seek medical care. 

Results: Study I showed that typical MI symptoms according to MONICA criteria were common in both men and women, both with and without diabetes, and no differences between the groups were found. Study II showed that more patients with diabetes had pre-hospital delay times of ≥ 2 h compared to patients without diabetes. In Study III, chest pain was the most common self-reported MI symptom in patients with and without diabetes and there were no differences between the groups. Shoulder pain/discomfort, shortness of breath and tiredness were more common in patients with diabetes whereas cold sweat was less common compared to patients without diabetes. Less than 40 % of patients with diabetes called the emergency medical services (EMS) as their first medical contact (FMC) and about 60 % initially contacted a spouse after symptom onset. Patients with diabetes reported longer patient delay than patients without diabetes, but after age and gender adjustments the results were not significant. Pain, pressure or discomfort in the stomach, anxiety, symptoms that come and go and thoughts that the symptoms would disappear were associated with longer patient delay in patients with diabetes. In study IV, the analysis revealed the core category “Becoming ready to act” and the categories perceiving symptoms, becoming aware of illness, feeling endangered, and acting on illness experience. Patients with diabetes described a variety of different MI symptoms, the onsets of MI varied and it was sometimes difficult to interpret symptoms as related to MI. The decision to seek medical care for MI was complex with several barriers for timely care seeking. 

Conclusion: Chest pain was common in patients with diabetes and in contrast to our hypothesis chest pain was equally common in both patients with and without diabetes. There were more similarities than differences in MI symptoms between patients with and without diabetes. However, patients with diabetes were more likely to have pre-hospital delay for 2 hours or more compared to those without diabetes and there seems to be an underutilization of the use of emergency medical services as first medical contact. The process to seek care for MI was complex, initiated by perceiving symptoms, followed by illness awareness, feelings of being endangered and finally acting on the illness experience.

Abstract [sv]

Bakgrund: Vid hjärtinfarkt är det sedan tidigare väl känt att snabb vård och behandling är viktigt för att förbättra prognosen. Det är därför av stor vikt att patienter med hjärtinfarkt söker vård så snart som möjligt efter att symtomen startat. Patienter med diabetes löper större risk att drabbas av hjärtinfarkt och prognosen efter en hjärtinfarkt är sämre än för patienter utan diabetes. Tidigare forskning har varit ofullständig när det gäller symtom och fördröjning att söka sjukvård vid hjärtinfarkt hos patienter med diabetes. Det saknas också forskning om hur patienter med diabetes uppfattar, tolkar och agerar vid symtom på hjärtinfarkt. 

Syfte: Det övergripande syftet med föreliggande avhandling var att utforska symtom och hur man agerar vid hjärtinfarkt hos patienter med diabetes. 

Metod: Avhandlingen består av fyra delstudier. Studie I och II baseras på data från norra Sveriges MONICA-hjärtinfarktregister för att beskriva symtom hos 4028 patienter samt pre-hospital fördröjning och faktorer som har samband med fördröjning hos 4266 patienter. Studie III inkluderade 694 patienter från 5 sjukhus i Sverige som alla besvarade en enkät om symtom, agerande och fördröjningstider vid hjärtinfarkt. I studie IV samlades data in via intervjuer som handlade om upplevelsen av att drabbas av hjärtinfarkt och beslutet att söka medicinsk vård. 

Resultat: Studie I visade att typiska hjärtinfarktsymtom enligt MONICA kriterier var vanliga hos både män och kvinnor, med och utan diabetes och ingen skillnad mellan grupperna kunde påvisas. Studie II visade att en större andel av patienter med diabetes jämfört med patienter utan diabetes hade pre–hospital fördröjning ≥2 timmar. I studie III var bröstsmärta det vanligaste hjärtinfarktsymtomet hos patienter med diabetes och det var ingen skillnad jämfört med patienter utan diabetes. Smärta/obehag i skulderpartiet, andningsbesvär och trötthet var vanligare hos patienter med diabetes medan kallsvett var mindre vanligt i jämförelse med patienter utan diabetes. Mindre än 40 % av patienterna med diabetes kontaktade SOS alarm som första kontakt med sjukvården och ungefär 60 % kontaktade initialt en partner efter symtomdebut. Patienter med diabetes rapporterade längre fördröjningstider jämfört med patienter utan diabetes, men efter justeringar för ålder och kön var skillnaden inte signifikant. Smärta obehag eller tryck i magen, ångest, intermittenta symtom samt att man trodde att symtomen skulle gå över hade samband med längre patientfördröjning hos patienter med diabetes. I studie IV resulterade analysen i kärnkategorin ”Att bli redo att agera” och kategorierna att uppleva symtom, inse att man är sjuk, känna ett hot och agera utifrån upplevelsen. Patienter med diabetes beskrev en mängd olika hjärtinfarktssymtom, debuten av symtom varierade och det var ibland svårt att tolka symtomen som hjärtinfarkt. Beslutet att söka vård vid hjärtinfarkt var komplext och beslutet fördröjdes på grund av flera barriärer. 

Slutsats: Sammanfattningsvis var bröstsmärta vid hjärtinfarkt vanligt och i motsats till vår hypotes lika vanligt hos patienter med som utan diabetes. Det fanns fler likheter än skillnader i hjärtinfarktsymtom mellan grupperna, Patienter med diabetes hade dock längre pre-hospital fördröjning jämfört med patienter utan diabetes. Trots betydelsen av snabb medicinsk vård vid hjärtinfarkt underutnyttjades SOS alarm som första medicinska kontakt. Processen att söka vård för hjärtinfarkt var komplex. Den började med upplevelsen av symtom, följt av insikten att man är sjuk, att man känner ett hot och slutligen agerar utifrån upplevelsen av sjukdom.

Place, publisher, year, edition, pages
Umeå: Umeå universitet, 2015. 53 p.
Umeå University medical dissertations, ISSN 0346-6612 ; 1700
myocardial infarction, diabetes mellitus, symptoms, symptom interpretation, pre-hospital delay, patient delay, decision making, care seeking behaviour
National Category
Research subject
Caring Sciences
urn:nbn:se:umu:diva-99983 (URN)978-91-7601-222-2 (ISBN)
Public defence
2015-03-13, Aulan, vårdvetarhuset, Umeå universitet, Umeå, 09:00 (Swedish)
Available from: 2015-02-20 Created: 2015-02-17 Last updated: 2015-02-20Bibliographically approved

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