Slow-onset myocardial infarction and its influence on help-seeking behaviors

Patient decision delay continues to be a major factor of delay along the pathway of care for patients with myocardial infarction (MI). Although potentially modifiable, efforts to reduce these delays through educational and media interventions have been relatively unsuccessful. This failure has been due, in part, to the lack of understanding about the complex sociopsychological and clinical dimensions associated with the phenomenon of help-seeking behavior.

The aims of this study were to (1) perform an in-depth analysis of patients' MI symptom experiences and (2) describe their help-seeking behavior in response to these symptom experiences.

In-depth interviews were used to examine the symptom experiences and help-seeking behavior of men and women with MI. Participants (n = 42) were interviewed 2 to 4 days after their admission to 1 of 2 hospitals in Dublin, Ireland.

Two new discrete MI categories emerged from the findings-slow-onset MI and fast-onset MI. Slow-onset MI is characterized by the gradual onset of mild symptoms, whereas fast-onset MI describes the sudden onset of severe chest pain. Most participants (n = 27) experienced slow-onset MI but expected the symptom presentation associated with fast-onset MI. The mismatch of expected and experienced symptoms for participants with slow-onset MI led to the mislabeling of symptoms to a noncardiac cause and protracted help-seeking delays. Participants with fast-onset MI (n = 15) quickly attributed their symptoms to a cardiac cause, which expedited appropriate help-seeking behaviors.

Definitions of MI and the educational information provided to the public need to be reviewed. Slow-onset MI and fast-onset MI provide plausible definition alternatives and, possibly, a more authentic version of real MI events than what is currently used. They also provide a unique "delay" perspective, which may inform future educational initiatives targeted at decision delay reduction.