Health professionals' knowledge of initial presentation of acute myocardial infarction

Abstract: McSpurren, F., Smith, L. (2006) Health professionals' knowledge of initial presentation of acute myocardial infarction. www.nursingtimes.net

Abstract:McSpurren, F., Smith, L. (2006) Health professionals' knowledge of initial presentation of acute myocardial infarction. www.nursingtimes.net

Aim:To determine doctors' and nurses' knowledge of the initial presentation of acute myocardial infarction (AMI) who work in A&E, emergency receiving units (ERU) and coronary care units (CCU).

Background:Heart disease is the major killer of men and women. The accurate diagnosis of acute myocardial infarction (AMI) is inherently difficult to ascertain due in part to atypical symptom presentation in some patients. This is reflected in the mortality and morbidity rates of patients who may be misdiagnosed and subsequently mismanaged. Many of these patients are women.

Design and methods:This was a descriptive, non-experimental survey of 155 doctors and nurses working in A&E, ERU and CCU in three district general hospitals in one acute hospital trust.

Results:The majority of the sample identified the classic symptoms of AMI - chest pain, arm pain, jaw pain and nausea - but fatigue, dizziness and pain between the shoulder blades were less well recognised. The symptoms of dyspnoea and pain between the shoulder blades reached statistical significance when doctors' and nurses' replies were compared. Prodromal symptoms associated with AMI were poorly recognised by both doctors and nurses and in particular, intermittent chest pain (&#61539; ^{2 =}14.43 df=1 p=<0001) and abdominal pain (&#61539; ²⁼5.44 df=1 p=0.02) when the two professions were compared. Significantly, less than half of the respondents (44%) considered there were sex-based differences in the initial presentation of AMI (&#61539; ²=9.93 df=4 p=0.04).

Conclusion:The surveyed health professionals indicated that they were aware of the listed typical symptom presentation of AMI but this trend was not evident with the listed atypical symptoms. It is also clear that AMI prodromal symptom recognition in both professional groups in the sample is lacking. More respondents disagree or don't know if there are sex-based differences in the initial presentation of AMI than agree.

In the UK someone sustains an acute myocardial infarction (AMI) every two minutes, of whom 30% will die before reaching hospital (British Heart Foundation, 2005). Approximately 20-25% of patients admitted to hospital with the eventual diagnosis of AMI will not receive appropriate, av