Women's Interpretation of Cardiac Symptoms at the Time of Their Cardiac Event: The Effect of Co-Occurring Illness

BACKGROUND: Women tend to access medical help for a myocardial infarction later than men and are at a disproportionate risk of dying or of suffering disability as a consequence. Co-morbidity is associated with delay but little is known how this affects decision making. AIM: To examine the effect of co-occurring chronic illness or infections on women's interpretation of their symptoms and action at the time of their cardiac event. METHODS: Semi-structured interviews with 44 women admitted to 3 district hospitals following a cardiac event. For the purposes of analysis they were divided into those who arrived at the hospital within 12 h of onset of symptoms (<12 hour group) and those who took more than 12 h (>12 hour group). FINDINGS: Women utilised their mental records of knowledge and experiences to make sense of their cardiac symptoms. The mental records of the <12 hour group contained knowledge of symptoms and previous experiences relevant to cardiac problems. Those of the >12 hour group contained knowledge and experience of recent and co-occurring chronic illnesses, this provided persuasive 'evidence' to suggest that their symptoms were normal or typical for their current state of health and resulted in delay. CONCLUSION: Women's decision making and timely access to medical help at the time of a cardiac event is influenced by their repertoire of knowledge and experience. Interventions need to be designed to capture the process of symptom recognition and the influence of co-morbidity.