title: The experiences of myocardial infarction patients readmitted within six months of primary percutaneous coronary intervention.
abstract: OBJECTIVE
  To explore the experiences of patients readmitted due to potential ischaemic heart disease symptoms within six months of primary percutaneous coronary intervention.
  
  
  BACKGROUND
  Following myocardial infarction and primary percutaneous coronary intervention, some patients experience potential ischaemic heart disease symptoms that may lead to readmission. Symptoms may be related to cardiac ischaemia, reduced psychological health or a comorbid condition.
  
  
  METHODS
  A qualitative study involving semistructured, in-depth interviews conducted once, mean 196 (50-384) days following readmission (at least six months following original ST-elevation myocardial infarction and primary percutaneous coronary intervention). This is the qualitative part of a mixed methods study.
  
  
  METHODS
  Participants were purposefully selected, and concurrent sampling, data collection and data analysis were performed. Data were organised using framework analysis; constant comparative analysis involving deduction and induction led to identification of cogent themes and subthemes.
  
  
  RESULTS
  Twenty-five participants (14 men, 27-79 years) experienced 1-4 readmissions; discharge diagnoses were cardiac, psychological, indeterminate, pulmonary and gastric. Three main themes emerged: (1) anxiety, uncertainty and inability to determine cause of symptoms, (2) fear of experiencing further myocardial infarction and (3) insufficient opportunity to validate self-construction of illness.
  
  
  CONCLUSIONS
  Fear of dying or experiencing a further myocardial infarction led to patients seeking help at the time of potential ischaemic heart disease symptoms. Participants were anxious and lacked understanding regarding symptom attribution at the time of readmission and generally following their heart attack. Additionally, original heart attack symptoms were used as a comparator for future symptoms. Participants reported feeling well immediately after primary percutaneous coronary intervention but later experiencing fatigue and debilitation often linked to potential ischaemic heart disease symptoms.
  
  
  CONCLUSIONS
  Increased education and information related to symptom attribution post-primary percutaneous coronary intervention and postreadmission are worthy of exploration and may lead to increased understanding and reassurance for this patient group.
authors.affiliation: Leeds Teaching Hospitals NHS Trust, Trust Headquarters, St James Hospital, Leeds, UK.
authors.forename: Heather
authors.initials: H
authors.lastname: Iles-Smith
authors.affiliation: Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
authors.forename: Christi
authors.initials: C
authors.lastname: Deaton
authors.affiliation: School of Nursing, Midwifery and Social Work, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK.
authors.forename: Malcolm
authors.initials: M
authors.lastname: Campbell
authors.affiliation: Lancashire Care NHS Foundation Trust, Preston, UK.|School of Healthcare, Faculty of Medical and Health, University of Leeds, Leeds, UK.
authors.forename: Catherine
authors.initials: C
authors.lastname: Mercer
authors.affiliation: School of Healthcare, Faculty of Medical and Health, University of Leeds, Leeds, UK.
authors.forename: Linda
authors.initials: L
authors.lastname: McGowan
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology; D001294:Attitude to Health; D003324:Coronary Artery Disease / Q000523:psychology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000523:psychology*; D010359:Patient Readmission; D062645:Percutaneous Coronary Intervention / Q000523:psychology*; D036301:Qualitative Research; D063189:Symptom Assessment; D013997:Time Factors
keywords: anxiety; cardiovascular; qualitative study; symptom perception