J Korean Acad Nurs.  2009 Dec;39(6):888-898. 10.4040/jkan.2009.39.6.888.

Comparison of Clinical Manifestations and Treatment-Seeking Behavior in Younger and Older Patients with First-time Acute Coronary Syndrome

• Hwang SY

• KMID: 1718163
• DOI: http://doi.org/10.4040/jkan.2009.39.6.888

Abstract

PURPOSE
This study was conducted to examine and compare clinical manifestations and predicting factors for treatment-seeking delay among patients <65 and > or =65 yr with first-time acute coronary syndrome (ACS). METHODS: A total of 288 patients who were diagnosed with ACS were individually interviewed at C university hospital in G-city from November 2007 to December 2008. RESULTS: Median pre-hospital delays for younger and older patients were 5 and 12 hr, respectively. Younger patients were more likely to be current smokers, heavy drinkers, obese, stressed, and have an unhealthy diet and family history, and to complain of chest pain, left shoulder and arm pain, perspiration, and nausea. Older patients were more likely to have hypertension and diabetes, and to complain syncope and dyspnea. Logistic regression analyses showed that after adjustment for age, gender and education, progressive onset of symptom and no attribution to cardiac problem significantly predicted pre-hospital delay >3 hr in both younger and older patients. Low perceived health status was a significant independent predictor in older patients only. CONCLUSION: Health care providers should be concerned with different manifestations between younger and older adults, and educate people at risk for heart attack about symptoms and actions to get immediate help.

Keyword

Acute coronary syndrome; Acute myocardial infarction; Health care seeking behavior

MeSH Terms

Acute Coronary Syndrome/complications/diagnosis/*psychology
Adult
Age Factors
Aged
Aged, 80 and over
Attitude to Health
Chest Pain/complications
Diabetes Complications/complications
Dyspnea/complications
Female
*Health Behavior
Humans
Hypertension/complications
Interviews as Topic
Male
Middle Aged
Nausea/complications
Questionnaires
Risk Factors
Syncope/complications
Time Factors

Figure

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  Figure 1 Comparison of associated symptoms in younger and older subjects. *p<.05.

Reference

1. An KE, Koh BG. Pre- and in-hospital delay in treatment and in-hospital mortality after acute myocardial infarction. Journal of Korean Academy of Nursing. 2003. 33:1153–1160.

2. Antman EM, Anbe DT, Armstrong PW, Bates ER, Green LA, Hand M, et al. ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (Committee to revise the 1999 guidelines for the management of patients with acute myocardial infarction). Circulation. 2005. 111:2013–2014.

3. Arslanian-Engoren C, Patel A, Fang J, Armstrong D, Kline-Rogers E, Duvernoy CS, et al. Symptoms of men and women presenting with acute coronary syndromes. American Journal of Cardiology. 2006. 98:1177–1181.

4. Berger PB, Ellis SG, Holmes DR Jr, Criger DA, Granger CB, Betriu A, et al. Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: Results from the global use of strategies to open occluded arteries in acute coronary syndromes (GUSTO-IIb) trial. Circulation. 1999. 100:14–20.

5. Brieger D, Eagle KA, Goodman SG, Steg PG, Budaj A, White K, et al. Acute coronary syndromes without chest pain, an underdiagnosed and under treated high-risk group: Insights from the global registry of acute coronary events. Chest. 2004. 126:461–469.

6. Canto JG, Shlipak MG, Rogers WJ, Malmgren JA, Frederick PD, Lambrew CT, et al. Prevalence, clinical characteristics, and mortality among patients with myocardialinfarction presenting without chest pain. JAMA. 2000. 283:3223–3229.

7. Dracup K, Moser DK. Beyond sociodemographics: Factors influencing the decision to seek treatment for symptoms of acute myocardial infarction. Heart & Lung. 1997. 26:253–262.

8. Dracup K, Moser DK, McKinley S, Ball C, Yamasaki K, Kim CJ, et al. An international perspective on the time to treatment for acute myocardial infarction. Journal of Nursing Scholarship. 2003. 35:317–323.

9. Eom WS, Kim DK, Kim YJ, Ryu JS, Cho JH, Joo SB, et al. The first symptoms and diagnosis of acute coronary syndrome in elderly patients of Korea. Geriatric Disease. 2003. 7:313–320.

10. Franklin K, Goldberg RJ, Spencer F, Klein W, Budaj A, Brieger D, et al. Implications of diabetes in patients with acute coronary syndromes. Archives of Internal Medicine. 2004. 164:1457–1463.

11. Goldberg RJ, Mooradd M, Gurwitz JH, Rogers WJ, French WJ, Barron HV, et al. Impact of time to treatment with tissue plasminogen activator on morbidity and mortality following acute myocardial infarction (the second National Registry of Myocardial Infarction). American Journal of Cardiology. 1998. 82:259–264.

12. Goldberg RJ, Steg PG, Sadiq I, Granger CB, Jackson EA, Budaj A, et al. Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). American Journal of Cardiology. 2002. 89:791–796.

13. Gregoratos G. Clinical manifestations of acute myocardial infarction in older patients. American Journal of Geriatric Cardiology. 2001. 10:345–347.

14. Hwang SY, Park EH, Shin ES, Jeong MH. Comparison of factors associated with atypical symptoms among older and younger patients with acute coronary syndromes. Journal of Korean Medical Science. 2009. 24:789–794.

15. Jeong MH, Kim YJ, Kim CJ, Cho MC, An YK, Na SW, et al. Korean acute myocardial infarction registry. Korean Circulation Journal. 2007. 37(10):Supplement. 3–18.

16. Korea National Health Insurance Corporation. National health insurance statistical yearbook 2006. 2007. 12. Seoul: Author.

17. Classification of disease and causes of death 2007. Korea National Statistical Office. 2007. 12. 01. Retrieved October 8, 2008. from http://Kosis.kr.

18. Løvlien M, Schei B, Hole T. Prehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction. European Journal of Cardiovascular Nursing. 2007. 6:308–313.

19. Milner KA, Funk M, Richards S, Vacarrino V, Krumholz HM. Symptom predictors of acute coronary syndromes in younger and older patients. Nursing Research. 2001. 50:233–241.

20. Moser DK, An KA. Responses to symptoms of acute myocardial infarction: Reasons for delay and bystanders' role. Journal of Korean Academy of Nursing. 2002. 32:1063–1071.

21. Moser DK, Kimble LP, Alberts MJ, Alonzo A, Croft JB, Dracup K, et al. Reducing delay in seeking treatment by patients with acute coronary syndrome and stroke: A scientific statement from the American Heart Association Council on cardiovascular nursing and stroke council. Circulation. 2006. 114:168–182.

22. Oh HS, Jang KS, Jeong MH. Decision tree model of treatment-seeking delay among patients with acute coronary syndrome. Korean Journal of Health Promotion and Disease Prevention. 2008. 8:235–244.

23. Ottesen MM, Kober L, Jorgensen S, Torp-Pedersen C. Determinants of delay between symptoms and hospital admission in 5,978 patients with acute myocardial infarction. European Heart Journal. 1996. 17:429–437.

24. Schuler J, Meier B, Behrens S, Thimme W. Present treatment of acute myocardial infarction in patients over 75 years, data from the Berlin myocardial infarction registry. Clinical Research in Cardiology. 2006. 95:360–367.

25. Song YB, Hahn JY, Gwon HC, Kim JH, Lee SH, Jeong MH, et al. The impact of initial treatment delay using primary angioplasty on mortality among patients with acute myocardial infarction: From the Korea acute myocardial infarction registry. Journal of Korean Medical Science. 2008. 23:357–364.

26. Tespili M, Guagliumi G, Valsecchi O, Musumeci G, Vassileva A, Saino A, et al. In-hospital clinical outcome in elderly patients with acute myocardial infarction treated with primary angioplasty. Italian Heart Journal. 2003. 4:193–198.

27. Thuresson M, Berglin M, Lindahl B, Svensson L, Zedigh C, Herlitz J. Thoughts, actions, and factors associated with prehospital delay in patients with acute coronary syndrome. Heart & Lung. 2007. 36:398–409.

28. Zerwic JJ. Patient delay in seeking treatment for acute myocardial infarction symptoms. Journal of Cardiovascular Nursing. 1999. 13:21–32.