Uncertainty as a precursor to delay in seeking care for women experiencing symptoms of acute coronary syndromes

Purpose: The majority of studies have found that women take longer than men to seek care for acute coronary syndromes (ACS) symptoms. Women are more likely to have atypical symptoms, perceive themselves as invulnerable to heart disease, and keep their symptoms to themselves. The purpose of this study was to explore the sociocontextual experience of how women with ACS recognize and interpret their symptoms while simultaneously managing everyday responsibilities and deciding whether to seek treatment. Methods: In this grounded theory, qualitative study, in-depth, semistructured interviews were conducted with 9 women diagnosed with an ACS event. Results: The mean age was 60.7 years (SD = 9.0). Four participants were African American; five were Caucasian. All participants went through a process of recognizing and interpreting their symptoms as they tried to make sense of the experience. This search was embedded in a larger social context because they had to manage ongoing relationships and obligations in their lives while discerning what was happening to them. Participants fell into 2 groups based on the noticeability of symptoms and their abilities to recognize a symptom pattern. Group A (n = 5) experienced uncertainty related to their bodily cues and were unable to recognize a coherent symptom pattern. All had variable symptoms that were drawn out over time. They could not make sense of them, despite trying various strategies to label them. When unable to recognize a symptom pattern, they returned to their usual lives while continuing to monitor their symptoms. Eventually, they sought treatment because someone else encouraged them to. Group B (n = 4) had more prominent symptoms, recognized a coherent symptom pattern quickly, labeled their condition, and moved toward care sooner. While they spent less time trying to make sense of their symptoms, they spent more time preparing themselves and others for their departure. Conclusions: The importance of recognizing a coherent symptom pattern prior to seeking care has not been previously studied in women with cardiac symptoms. This study offers a theoretical understanding of how and why women come to their symptom interpretations and manage the uncertainties of an ACS event.