International Journal of Cardiology 116 (2007) 120 www.elsevier.com/locate/ijcard Letter to the Editor Poor recognition of symptoms and access to medical care in women with myocardial infarction☆ Fernanda Carneiro Mussi a , Luiz Carlos Santana Passos b , Angélica Araújo de Menezes 1 , Bruno Caramelli c,⁎ a c Nursing School of the Federal University of Bahia (UFBA), Brazil b School of Medicine of the Federal University of Bahia, Brazil Heart Institute, University of São Paulo Medical School, São Paulo, Brazil Received 21 November 2005; received in revised form 22 January 2006; accepted 11 March 2006 Available online 3 July 2006 Two-thirds of the deaths related to acute myocardial infarction (AMI) occurs out-of-hospital. Despite the evidence that the factor time is crucial, many AMI patients still delay to get medical care [1,2] or have their risk underestimated by physicians . In order to investigate this situation, we evaluated how 43 AMI women interpret the symptoms and what were their immediate actions. Demographic data, pain characteristics, and immediate actions were evaluated. The association between the decision times to seek medical care and the arrival times was analyzed. The analysis of the association between the decision time and pain interpretation was performed using the chi-square test. The methodological approach from the Grounded Theory  was used to analyze the interviews in order to qualify the decision for seeking care and the arrival times. This method identifies the basic social processes in the context in which they occur and develops theoretical models of empiric reality phenomena . Patients aged 61.5 years old in average, 88.4% had not had a previous AMI, and 72% of these happened at home. The medians for decision to seek medical care and arrival times were respectively 45 and 105 min. The third quartile shows that for up to 75% of them, these times were respectively 2 ☆ This study was performed in the Federal University of Bahia (UFBA)University Hospital Edgar Santos and was supported by the Fundação de Amparo a Pesquisa (Research Support Foundation) of the State of Bahia/ Ministry of Health/Decit/Secretary of the State of Bahia and PIBIC-CNPqUFBA. ⁎ Corresponding author. Unidade de Medicina Interdisciplinar em Cardiologia. Av. Dr. Enéas de Carvalho Aguiar, 44 Cep:05403-000Cerqueira César-SP, Brazil. E-mail address: [email protected] (B. Caramelli). 1 Undergraduate nursing student. 0167-5273/$ - see front matter © 2006 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2006.03.042 and 3 h, evidencing that a group of women is delaying to decide and get to medical care. Pearson's Linear Correlation analysis between decision times up to 24 h and arrival times up to 24 h was highly significant (r = 0.992, p = 0.00). Regarding pain interpretation, only 18.6% of the women associated the symptom with a heart problem. Pain interpretation was not associated with decision time to seek medical care and arrival at a care facility. Only 7.0% of the women used ambulances and 81.4% went by car and public transportation means. Regarding the first health care facility, 62.8% of them went to a Hospital, 6.9% to outpatient clinics, 16.9% went to a primary care health service and 7% called a physician to be seen at home or at his office. These findings highlight the importance of health education programs in order to improve outcome for AMI patients and suggest that the targets should be patients and the family members. References  Bahr RD. Access to early cardiac care: chest pain as a risk factor for heart attacks, and the emergence of early cardiac care centers. Md Med J 1992;42(2):133–8.  Bahr RD. Reawakening awareness of the importance of prodromal symptoms in the shifting paradigm to early heart attack care. Clinician 1996;14(4):7–9.  Ottesen MM, Dixen U, Torp-Pedersen C, Kober L. Prehospital delay in acute coronary syndrome—an analysis of the components of delay. Int J Cardiol Jul 2004;96(1):97–103.  Glaser BG, Strauss AL. The discovery of grounded theory: strategies for qualitative research. New York: Aldine de Gruyter; 1967.  Chenitz WC, Swanson JM. From practice to grounded theory. Qualitative using grounded theory. Menlo Park: Addison-Wesley Publishing; 1986. p. 3–15.