Influence of expectations about symptoms on delay in seeking treatment during myocardial infarction

BACKGROUND: Patients having cardiac symptoms often delay for hours before seeking treatment. Educational programs have had little impact on reducing this delay time. OBJECTIVES: To identify symptoms expected by a patient during a myocardial infarction and to examine whether a discrepancy between expectations and experience influenced delay in seeking treatment. METHODS: A retrospective, descriptive design was used. The setting was a large northeastern medical center. The convenience sample included 65 patients (mean age, 57; 74% men) after their first myocardial infarction. Data were collected with the Symptom Representation Questionnaire, a semi-structured interview guide that identified subjects' expectations about heart disease, actual symptom experience, and strategies used to manage the experience. RESULTS: The majority of subjects reported that they had expectations about the symptoms of heart disease that focused on location, intensity, associated symptoms, and quality. Expectations did not match the symptom experience of 74% of subjects. Subjects whose expectations did not match their experience delayed significantly longer before seeking treatment than subjects whose expectations did match their experience. CONCLUSIONS: Our results indicated that patients have expectations about symptoms of heart disease that may influence their behavior during a myocardial infarction.