Symptom Recognition and Healthcare Experiences of Young Women With Acute Myocardial Infarction

Abstract

Background Prompt recognition of acute myocardial infarction (AMI) 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 AMI, 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. Methods and Results We conducted a qualitative study using in-depth interviews with 30 women (aged 30-55 years) hospitalized with AMI 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 non-cardiac 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 AMI mortality relative to men. Identifying factors that promote better cardiovascular knowledge, improved preventive health care, and prompt care-seeking behaviors represent important targets for this population.

Coronary Artery Disease in Premenopausal and Postmenopausal Women

“…10,11) A previous study also indicated that young women were more likely to have CAD without chest pain. 12) Another study in a Canadian cohort of patients whose age was under 55 years with acute coronary syndrome supported this pattern. 13) Our study showed that 48.88% of postmenopausal cases were identified as ACS, compared to 82.46% of premenopausal patients identified as ACS.…”

“…19) There were relatively few narrowed segments of coronary arteries in younger women compared with women over 50 years of age. 12) This was probably because young women were more likely to have inflammation, coronary spasm, plaque erosion, or rupture. The clinical manifestations of postmenopausal patients were more complex, and collateral circulation was easily formed as they had a longer disease duration and long-term progress of the disease course.…”

Outcomes of Women and Men With Acute Coronary Syndrome Treated With and Without Percutaneous Coronary Revascularization

“…Extensive evaluations have suggested that these discrepancies are multifactorial 5. They are partly explained by clinical differences where women with ACS are older at presentation, have a higher burden of comorbidities, and tend to present later and with more atypical symptoms compared with men 3, 6, 7, 8, 9, 10. In addition, there are sex‐based differences in the primary and secondary treatment of coronary disease 11, 12, 13.…”

Clinical and Gender Differences in Heart Transplant Recipients in the New Heart Study

“…9,10 Researchers have also shown that gender differences exist in regards to acute myocardial infarction and heart failure symptom recognition among women, and reperfusion and preventive therapies remain underutilized in women, which may also account for their increased mortality. [11][12][13][14][15][16] Yet, the fact remains that women are transplanted less frequently than men, making it critical for researchers to examine why such gender differences continue to exist. Since men and women who have already undergone an OHT should theoretically have similar cardiac illness profiles, examining clinical characteristics and outcomes in those who have undergone OHT may shed light on this continued gender disparity.…”