[Context and background after infarction. GISSI nursing].

INTRODUCTION

While the clinical course of myocardial infarction (AMI) from symptoms to outcome has been investigated in great detail, only a few data are available from the patients' side on their subjective feelings, their experience and their awareness of risk before the occurrence of AMI.

METHODS

A sample population of 3863 AMI patients, randomized for the GISSI-3 study, was interviewed by nurses an average of four days after the AMI. The questions explored the activities performed at the time the AMI occurred, the patients' perceptions and the preventive practices that were adopted.

RESULTS

AMI occurs in "normal" life situations: only 10.3% patients reported heavy exertion immediately before the onset of AMI and 5.6% reported emotional involvement as a possible acute trigger. A large majority of patients would associate the AMI with something wrong or unusual occurring before the event. On average, > 60% patients associated the AMI with cardiac symptoms (chest pain, shortness of breath) or with psychological symptoms, such as anxiety; an important minority (30%) associated it with joint pain or a fever, suggesting inflammation as a possible trigger event. Preventive practices were declared by 25% of patients, but the number drops to 6% if at-risk patients (those with a history of AMI or angina) are excluded. Diet and drugs are the most widely adopted practices. Male sex and a history of AMI are linked with a more widespread use of preventive practices. Younger patients and patients with a higher education modified their lifestyle (exercise, smoke) to a greater extent, while there are no major differences between patients with or without a history of hypertension and angina.

CONCLUSIONS

Large-scale use of preventive practices is very unlikely, and this is true not only for the general population, but also for AMI "at-risk" groups. These patients (elderly, less-educated people) should be the target of specific educational interventions aimed at increasing the awareness of risk and promoting safer and more health-oriented lifestyles.