title: Symptom recognition and healthcare experiences of young women with acute myocardial infarction.
abstract: BACKGROUND
  Prompt recognition of acute myocardial infarction symptoms and timely care-seeking behavior are critical to optimize acute medical therapies. Relatively little is known about the symptom presentation and care-seeking experiences of women aged ≤55 years with acute myocardial infarction, a group shown to have increased mortality risk as compared with similarly aged men. Understanding symptom recognition and experiences engaging the healthcare system may provide opportunities to reduce delays and improve acute care for this population.
  
  
  RESULTS
  We conducted a qualitative study using in-depth interviews with 30 women (aged 30-55 years) hospitalized with acute myocardial infarction to explore their experiences with prodromal symptoms and their decision-making process to seek medical care. Five themes characterized their experiences: (1) prodromal symptoms varied substantially in both nature and duration; (2) they inaccurately assessed personal risk of heart disease and commonly attributed symptoms to noncardiac causes; (3) competing and conflicting priorities influenced decisions about seeking acute care; (4) the healthcare system was not consistently responsive to them, resulting in delays in workup and diagnosis; and (5) they did not routinely access primary care, including preventive care for heart disease.
  
  
  CONCLUSIONS
  Participants did not accurately assess their cardiovascular risk, reported poor preventive health behaviors, and delayed seeking care for symptoms, suggesting that differences in both prevention and acute care may be contributing to young women's elevated acute myocardial infarction mortality relative to men. Identifying factors that promote better cardiovascular knowledge, improved preventive health care, and prompt care-seeking behaviors represent important target for this population.
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.). Judith.Lichtman@yale.edu.
authors.forename: Judith H
authors.initials: JH
authors.lastname: Lichtman
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
authors.forename: Erica C
authors.initials: EC
authors.lastname: Leifheit-Limson
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
authors.forename: Emi
authors.initials: E
authors.lastname: Watanabe
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
authors.forename: Norrina B
authors.initials: NB
authors.lastname: Allen
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
authors.forename: Brian
authors.initials: B
authors.lastname: Garavalia
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
authors.forename: Linda S
authors.initials: LS
authors.lastname: Garavalia
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
authors.forename: Harlan M
authors.initials: HM
authors.lastname: Krumholz
authors.affiliation: From the Department of Chronic Disease Epidemiology (J.H.L., E.C.L.-L., E.W.) and Department of Health Policy and Management (H.M.K., L.A.C.), Yale School of Public Health, New Haven, CT; Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL (N.B.A.); Cardiovascular Outcomes Research, Saint Luke's Mid America Heart Institute, Kansas City, MO (B.G., J.A.S.); School of Medicine (B.G., J.A.S.) and School of Pharmacy (L.S.G.), University of Missouri-Kansas City; Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, CT (H.M.K.); Section of Cardiovascular Medicine, Department of Internal Medicine (H.M.K.) and Robert Wood Johnson Clinical Scholars Program, Department of Internal Medicine (H.M.K., L.A.C.), Yale School of Medicine, New Haven, CT; and Global Health Leadership Institute, Yale University, New Haven, CT (L.A.C.).
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Curry
mesh_terms: D000328:Adult; D000367:Age Factors; D003220:Conflict, Psychological; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D054624:Health Status Disparities; D054625:Healthcare Disparities; D006760:Hospitalization; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000523:psychology* / Q000628:therapy; D010342:Patient Acceptance of Health Care; D011314:Preventive Health Services; D036301:Qualitative Research; D021641:Recognition, Psychology; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D061665:Time-to-Treatment
keywords: diagnosis; myocardial infarction; qualitative research; women