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Hwang: Comparison of Clinical Manifestations and Treatment-Seeking Behavior in Younger and Older Patients with First-time Acute Coronary Syndrome
Original Article
Journal of Korean Academy of Nursing

Journal of Korean Academy of Nursing 2009; 39(6): 888-898.

Published online: 31 December 2009

DOI: https://doi.org/10.4040/jkan.2009.39.6.888

Comparison of Clinical Manifestations and Treatment-Seeking Behavior in Younger and Older Patients with First-time Acute Coronary Syndrome

Seon Young Hwang

Assistant Professor, Department of Nursing, Chosun University, Gwangju, Korea.

Address reprint requests to: Hwang, Seon Young. Department of Nursing, Chosun University, 375 Seoseok-dong, Dong-gu, Gwangju 501-759, Korea. Tel: 82-62-230-7637, Fax: 82-62-230-6329, seon9772@chosun.ac.kr

Received 21 June 2009       Accepted 2 December 2009

Copyright © 2009 Korean Society of Nursing Science

Abstract

Purpose

This study was conducted to examine and compare clinical manifestations and predicting factors for treatment-seeking delay among patients <65 and ≥65 yr with first-time acute coronary syndrome (ACS).

Methods

A total of 288 patients who were diagnosed with ACS were individually interviewed at C university hospital in G-city from November 2007 to December 2008.

Results

Median pre-hospital delays for younger and older patients were 5 and 12 hr, respectively. Younger patients were more likely to be current smokers, heavy drinkers, obese, stressed, and have an unhealthy diet and family history, and to complain of chest pain, left shoulder and arm pain, perspiration, and nausea. Older patients were more likely to have hypertension and diabetes, and to complain syncope and dyspnea. Logistic regression analyses showed that after adjustment for age, gender and education, progressive onset of symptom and no attribution to cardiac problem significantly predicted pre-hospital delay >3 hr in both younger and older patients. Low perceived health status was a significant independent predictor in older patients only.

Conclusion

Health care providers should be concerned with different manifestations between younger and older adults, and educate people at risk for heart attack about symptoms and actions to get immediate help.

Keywords: Acute coronary syndrome, Acute myocardial infarction, Health care seeking behavior

Figures and Tables

Figure 1
Comparison of associated symptoms in younger and older subjects. *p<.05.
jkan-39-888-g001
Table 1
General Characteristics of the Subjects (N=288)
jkan-39-888-i001
Table 2
Clinical Characteristics and Risk Factors of the Subjects (N=288)
jkan-39-888-i002

*Family history included the histories of hypertension, heart disease or stroke in their parents or siblings.

ED=emergency department; OPD=out patient department; STEMI=ST-elevation myocardial infarction; NSTEMI=non-ST-elevation myocardial infarction; UA=unstable angina; PCI=percutaneous coronary intervention; LVEF=left ventricular ejection fraction; CABG=coronary artery bypass graft; hs-CRP=high sensitivity-C reactive protein; CCU=coronary care unit; BMI=body mass index; TC=total cholesterol.

Table 3
Cognitive and Behavioral Responses to Symptoms of the Subjects
jkan-39-888-i003
Table 4
Predictors of Pre-hospital Delay >3 hr in Younger and Older Subjects by Multiple Logistic Regression Analyses
jkan-39-888-i004

*Adjusted variables: age, gender and education level.

CI=confidence interval; NSTEMI=non-ST-elevation myocardial infarction; UA=unstable angina.

Notes

This work was supported by Korea Research Foundation grant (KRF-2007-331-E00276).

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