International Journal of Cardiology 116 (2007) 120
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,⁎
Nursing School of the Federal University of Bahia (UFBA), Brazil
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 [3]. 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 [4] 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 [5].
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).
Undergraduate nursing student.
0167-5273/$ - see front matter © 2006 Elsevier Ireland Ltd. All rights reserved.
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.
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[3] 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.
[4] Glaser BG, Strauss AL. The discovery of grounded theory: strategies for
qualitative research. New York: Aldine de Gruyter; 1967.
[5] Chenitz WC, Swanson JM. From practice to grounded theory.
Qualitative using grounded theory. Menlo Park: Addison-Wesley
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Poor recognition of symptoms and access to medical care in women