Women´s Experience of a myocardial infarction

Abstract: Background: Coronary heart disease (CHD) is the sleading cause of mortality in men and women in Western society. Few studies of CHD have been performed on women or with a focus on cardiac risk factors in women’s lives. Results from studies of men have been generalized to women, which may be inappropriate or even dangerous. Aim: The overall aim of this thesis was to describe women’s experience of a myocardial infarction and to explore and describe important factors associated with this. Furthermore, to describe women’s daily life five years later and the long-term follow-up resources in primary care. Method: The first study (I) described women’s (n=19) symptoms and reasons for delay in seeking medical care at the time of a first myocardial infarction. A content Sanalysis method was used. The second study (II) looked at how women perceive stress in their daily lives at the time of (n=20) and after (n=14) the MI. The third study (III) examines how women cope with stress at the time of (n=20) and after (n=14) an MI. In study four (IV) the women (n=12) were interviewed five years after the MI. Studies II, III and IV used a phenomenographic method with contextual analysis. Study five (V) describes the results of a questionnaire sent to primary health care centres in Skåne, elucidating resources and cardiac rehabilitation possibilities. Findings: The women had difficulties interpreting the symptoms or did not recognize the symptoms at all until they experienced their first MI (I). They had problems making the final decision to seek medical care. The women wanted support and help from a family member or a friend. Some women found it difficult to call for ambulance transportation and often first consulted the PHCC (I). Study II resulted in two description categories: the women conceived the stress as a personal trait and as a response to their immediate surroundings. The women had experienced being under enormous pressure at the time of the MI, which they found stressful. Furthermore, they had to assume a great deal of responsibility for their family and work. After the MI the stress continued to increase. Study III resulted in three description categories regarding the women’s coping strategies with stress at the time of and after the MI: cogitative actions, social belonging and emotional diversion. The women became aware that they needed to make plans for their needs and it was essential for them to be confirmed. By talking to someone they trusted they received emotional support. Avoidance was used because they did not take their cardiac events seriously and tried just to resume their lives as if nothing had happened. Study IV showed that the women changed their lifestyle immediately and some needed time for reflection before they could make the prescribed lifestyle changes. The women found it difficult to continue with all the changes. Even five years after the MI they still needed support from health care professionals. A minority of the PHCCs (V) had nurses with special education in coronary heart disease and cardiac rehabilitation, and 5% of the PHCCs had nurses with a special position to take care of these patients. Of all centres 76% had access to a physiotherapist whereas there were significantly more 8 public PHCCs compared to private centres that had access to a physiotherapist. The same relation was found regarding access to a dietician. Conclusions and implications: The women had difficulties interpreting the symptoms or did not recognize the symptoms at all until they experienced their first MI. For women it is important to recognize the role of stress as an essential risk factor for MI. The women described how they felt stress over a long period and how it affected them. They mentioned different strategies to cope with stress in their personal and professional lives related to MI. Even five years after the MI, that event had a significant impact on the women An understanding of this phenomenon can assist primary healthcare, coronary care and rehabilitation nurses in supporting women, as well as their partners, to adapt their daily lives both before and after an MI. This thesis points out that patients suffering an MI need long-term support. Well-educated staff with adequate resources in primary health care can be of great importance.