Iles-Smith Heather, Deaton Christi, Campbell Malcolm, Mercer Catherine, McGowan Linda
Leeds Teaching Hospitals NHS Trust, Trust Headquarters, St James Hospital, Leeds, UK.
Cambridge Institute of Public Health, School of Clinical Medicine, University of Cambridge, Cambridge Biomedical Campus, Cambridge, UK.
J Clin Nurs. 2017 Nov;26(21-22):3511-3518. doi: 10.1111/jocn.13715. Epub 2017 Apr 20.
To explore the experiences of patients readmitted due to potential ischaemic heart disease symptoms within six months of primary percutaneous coronary intervention.
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.
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.
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.
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.
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.
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.
探讨在初次经皮冠状动脉介入治疗后六个月内因潜在缺血性心脏病症状再次入院的患者的经历。
在心肌梗死和初次经皮冠状动脉介入治疗后，一些患者会出现可能导致再次入院的潜在缺血性心脏病症状。症状可能与心脏缺血、心理健康下降或合并症有关。
一项定性研究，在再次入院后平均196（50 - 384）天（距最初的ST段抬高型心肌梗死和初次经皮冠状动脉介入治疗至少六个月）进行一次半结构化深度访谈。这是一项混合方法研究的定性部分。
有目的地选择参与者，并同时进行抽样、数据收集和数据分析。数据使用框架分析进行整理；涉及演绎和归纳的持续比较分析导致确定有说服力的主题和子主题。
25名参与者（14名男性，年龄27 - 79岁）经历了1 - 4次再次入院；出院诊断为心脏、心理、不明、肺部和胃部疾病。出现了三个主要主题：（1）焦虑、不确定性和无法确定症状原因，（2）害怕再次发生心肌梗死，（3）验证自我疾病认知的机会不足。
对死亡或再次发生心肌梗死的恐惧导致患者在出现潜在缺血性心脏病症状时寻求帮助。参与者在再次入院时以及心脏病发作后普遍对症状归因感到焦虑且缺乏理解。此外，最初的心脏病发作症状被用作未来症状的比较标准。参与者报告在初次经皮冠状动脉介入治疗后立即感觉良好，但后来经常出现与潜在缺血性心脏病症状相关的疲劳和虚弱。
增加与初次经皮冠状动脉介入治疗后和再次入院后症状归因相关的教育和信息值得探索，这可能会增加该患者群体的理解和安心程度。
