The experiences of myocardial infarction patients readmitted within six months of primary percutaneous coronary
Heather Iles-Smith1, Christi Deaton2, Malcolm Campbell3
1Leeds Teaching Hospitals NHS Trust, Trust Headquarters, St James Hospital, Leeds, UK.
Insights
Patients readmitted after heart attack treatment experienced anxiety and fear of further myocardial infarction due to unclear symptoms. Enhanced patient education on symptom attribution post-primary percutaneous coronary intervention is recommended.
Area of Science:
- Cardiology
- Patient Experience
- Health Psychology
Background:
- Patients undergoing primary percutaneous coronary intervention (PCI) for myocardial infarction (MI) may experience recurrent symptoms leading to readmission.
- These symptoms can stem from cardiac ischemia, psychological distress, or comorbidities, necessitating further investigation.
Purpose of the Study:
- To explore the lived experiences of patients readmitted within six months of primary PCI due to potential ischemic heart disease (IHD) symptoms.
- To understand the factors influencing patient decisions to seek medical help and their perceptions of symptom attribution.
Main Methods:
- A qualitative study employing semistructured, in-depth interviews with 25 patients readmitted after primary PCI for ST-elevation MI.
- Data were collected and analyzed concurrently using framework and constant comparative analysis to identify key themes.
Main Results:
- Three primary themes emerged: anxiety and uncertainty regarding symptom cause, fear of recurrent MI, and a lack of validation for self-perceived illness.
- Participants frequently compared new symptoms to their original MI, often experiencing fatigue and debilitation post-PCI.
Conclusions:
- Fear of mortality and recurrent MI drive help-seeking behavior, often accompanied by significant anxiety and a poor understanding of symptom attribution.
- Improved patient education on symptom interpretation following primary PCI and readmission is crucial for enhancing patient understanding and reassurance.
Aims And Objectives:
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.
Design:
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.
Conclusion:
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.
Relevance To Clinical Practice:
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.
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