Sociodemographic and clinical factors associated with
					the decision time for seeking care in acute myocardial infarction

Mussi, Fernanda Carneiro; Gibaut, Mariana de Almeida Moraes; Damasceno, Carla Almeida; Mendes, Andreia Santos; Guimarães, Armênio Costa; Santos, Carlos Antonio de Souza Teles

doi:10.1590/0104-1169.3178.2361

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Revista Latino-Americana de Enfermagem

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Original Articles • Rev. Latino-Am. Enfermagem 21 (06) • Nov-Dec 2013 • https://doi.org/10.1590/0104-1169.3178.2361 copy

Sociodemographic and clinical factors associated with the decision time for seeking care in acute myocardial infarction ¹ 1 Paper extracted from masters thesis “Factors influencing the decision time for men and women with myocardial infarction to the demand for health services”, presented to Universidade Federal da Bahia, Salvador, BA, Brazil. Supported by Fundação de Amparo à Pesquisa do Estado da Bahia (FAPESB) process # APP0121/2009.

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVE:

this study aimed to analyze the interaction of gender in the association between decision time for seeking healthcare services and the sociodemographic and clinical variables.

METHOD:

this exploratory, cross-sectional study was performed with 100 individuals interviewed in hospitals in Salvador, Bahia. The chi-square test or Fisher's exact test and the robust linear regression model were used in the analysis. A statistical significance of 5% was adopted.

RESULTS:

men and women presented long decision times. The decision time was less for smokers and those with constant and/or severe pain. There was an interaction between gender and smoking and between gender and pain radiating to the neck or jaw for the decision time outcome.

CONCLUSION:

decision times were long and were influenced by clinical and gender variables. The study provides support for nursing care practices focused on the specificity of these factors and of the genders aiming to reduce the decision time.

Myocardial Infarction; Gender Identity; Nursing Care

Variables			Sample (N=100)		Men (n=71)		Women (n=29)		p value*
Variables			n	%	n	%	n	%	p value*
Report of cardiovascular risk factors
	Arterial hypertension		66	66.0	43	60.6	23	79.3	0.186
	Family history of coronary artery disease		50	50.0	34	47.9	16	55.2	0.696
	Dyslipidemia		31	31.0	19	26.8	12	41.4	0.239
	Diabetes mellitus		23	23.0	13	18.3	10	34.5	0.153
	Smoker		19	19.0	15	21.1	4	13.8	0.290
Coronary artery disease
	Previous angina		52	52.0	35	49.3	17	58.6	0.397
	Previous acute myocardial infarction		16	16.0	10	14.1	6	20.7	0.595
Type of acute myocardial infarction
	With ST elevation		65	65.0	51	71.8	14	48.3	0.025
	Without ST elevation		35	35.0	20	28.2	15	51.7	0.025
Judgment of the symptoms
	Regarding the nature
		Associated with cardiac problem	44	44.0	33	46.5	11	37.9	0,440
		Did not associate with cardiac problem	41	41.0	26	36.6	15	51.7	0,760
		Did not know what it was	15	15.0	12	16.9	3	10.3	0,309
	Regarding the severity
		Severe	64	64.0	45	63.4	19	65.5	0,840
		Not severe	36	36.0	26	36.6	10	34.5	0,840

Variables			Sample (N=100)		Men (n=71)		Women (n=29)		P value*
Variables			N	%	N	%	n	%	P value*
Acute myocardial infarction symptoms
		Chest pain	81	81.0	57	80.3	24	82.8	0.774
		Sweating	67	67.0	52	73.2	15	51.7	0.054
		Dyspnea	47	47.0	32	45.1	15	51.7	0.545
		Pain radiating to the arms	43	43.0	31	43.7	12	41.4	0.834
		Pain radiating to the back	35	35.0	23	32.4	12	41.4	0.393
		Nausea	32	32.0	23	32.4	9	31.0	0.895
		Vomiting	31	31.0	20	28.2	11	37.9	0.338
		Dizziness	20	20.0	17	23.9	3	10.3	0.123
		Pain radiating to the neck	17	17.0	13	18.3	4	13.8	0.711
		Radiating epigastric pain	18	18.0	11	15.5	7	24.1	0.307
		Palpitation	14	14.0	10	14.1	4	13.8	1.000
		Syncope	10	10.0	7	9.9	3	10.3	1.000
		Headache	6	6.0	3	4.2	3	10.3	0.352
		Tremors	2	2.0	2	2.8	-	-	1.000
		Pain radiating to the jaw	7	7.0	2	2.8	5	17.2	0.021
Characteristics of the pain
	Constancy (n=99)
		Constant	66	66.0	49	69.0	17	58.6	0.319
		Inconstant	23	23.0	15	21.1	8	27.6	0.326
	Type of pain
		Squeezing	45	45.0	33	46.5	12	41.4	0.642
		Burning	36	36.0	29	40.8	7	24.1	0.114
		Cutting	14	14.0	9	12.7	5	17.2	0.540
		Stabbing	13	13.0	7	9.9	6	20.7	0.144
		Heavy	6	6.0	2	2.8	4	13.8	0.057
	Pain intensity at onset of symptoms
		Mild	4	4.0	3	4.2	1	3.4	0.578
		Moderate	33	33.0	26	36.6	7	24.1
		Severe	63	63.0	42	59.2	21	72.4
	Pain intensity at the decision for care
		Moderate	17	17.0	10	14.1	7	24.1	0.359
		Severe	83	83.0	61	85.9	22	75.9

Variables			Geometric Mean, in hours, of the decision time
Variables			Sample (N=100)	P value*	Men (n=71)	Women (n=29)	P value
Report of cardiovascular risk factors
	Arterial hypertension
		Yes (66)	1.1	0.990	1.0	1.2	0.278
		No (34)	1.1	0.990	0.9	2.9	0.278
	Smoker
		Yes (18)	0.5	0.052	0.3	2.4	0.017
		No (82)	1.3		1.3	1.3
	Diabetes mellitus
		Yes (23)	1.0	0.405	1.1	0.9	0.510
		No (77)	1.1		0.9	1.8
Judgment of the symptoms
	Associated with cardiac problem (44)		0,8	0.289	0.7	1.2	0.764
	Not associated with cardiac problem (56)		1,3		1.2	1.5
Severity of the symptoms
	Severe (64)		0,8	0.007	0.6	1.1	0.470
	Not severe (36)		2,0		1.9	2.1

Variables			Geometric Mean of the decision time, in hours
Variables			Sample (N=100)	P value*	Men (n=71)	Women (n=29)	P value
Type of symptoms
	Chest pain
		Yes (81)	1.0	0.848	0.9	1.5	0.339
		No (19)	1.2		1.3	0.9
	Sweating
		Yes (66)	0.9	0.286	0.8	1.5	0.366
		No (34)	1.4		1.5	1.3
	Dyspnea
		Yes (47)	1.0	0.580	1.0	0.9	0.179
		No (53)	1.2		0.9	2.4
	Nausea
		Yes (32)	1.0	0.715	0.9	1.1	0.774
		No (68)	1.1		1.0	1.6
	Dizziness
		Yes (20)	1.0	0.929	1.1	0.8	0.600
		No (80)	1.1		0.9	1.5
	Pain radiating to neck
		Yes (17)	2.4	0.015	3.3	0.9	0.011
		No (83)	0.9		0.7	1.5
	Epigastric pain
		Yes (18)	0.9	0.538	0.9	0.8	0.407
		No (82)	1.1		0.9	1.7
	Palpitations
		Yes (14)	1.0	0.964	1.5	0.4	0.154
		No (86)	1.1		0.9	1.7
	Pain radiating to jaw
		Yes (7)	4.2	0.018	26.6	2.0	<0.001
		No (93)	1.0		0.9	1.3
Characteristics of the pain
	Constancy
		Constant (66)	0.7	0.000	0.6	1.1	0.244
		Inconstant (34)	2.7		3.0	2.2
Type of pain
	Squeezing
		Yes (45)	1.4	0.215	1.1	2.4	0.471
		No (55)	0.9		0.8	1.0
	Burning
		Yes (36)	0.7	0.141	0.7	0.9	0.945
		No (64)	1.3		1.2	1.6
	Tearing
		Yes (14)	1.7	0.348	2.3	0.9	0.127
		No (86)	1.0		0.8	1.6
	Stabbing
		Yes (13)	2.1	0.145	1.7	2.7	0.897
		No (87)	1.0		0.9	1.2
	Heavy
		Yes (6)	0.7	0.499	0.4	1.0	0.653
		No (94)	1.1		1.0	1.5
Pain intensity at onset of symptoms
	Mild (4)		6.6	0.000	4.5	20.0	0.351
	Moderate (35)		2.1		1.7	3.9
	Severe (61)		0.6		0.6	0.8

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E-mail: rlae@eerp.usp.br

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[1] Corresponding Author: Fernanda Carneiro Mussi Rua Professor Clementino Fraga, 220, Apto. 1901 Bairro: Ondina CEP: 40170-050, Salvador, BA, Brasil E-mail: femussi@uol.com.br