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Impact of Prodromal Symptoms on Prehospital Delay in Patients With First-Time Acute Myocardial Infarction in Korea

Hwang, Seon Young PhD, RN; Zerwic, Julie J. PhD, RN; Jeong, Myung Ho PhD, MD

The Journal of Cardiovascular Nursing: May-June 2011 - Volume 26 - Issue 3 - p 194-201
doi: 10.1097/JCN.0b013e3181f3e2e0
ARTICLES: Patient Prehospital Delay

Background: Information is limited concerning how affected individuals respond to early warning signs before their acute coronary event and how the presence of prodromal symptoms impacts prehospital delay.

Objectives: This study's aim was to identify the characteristics and interpretation of prodromal symptoms in patients with a first-time acute myocardial infarction (AMI) and to determine whether the presence of prodromal symptoms was predictive of prehospital delay.

Subjects and Methods: This was a descriptive study using semistructured interview. A total of 271 hospitalized patients diagnosed as having AMI were interviewed from November 2007 to December 2008 at a university hospital in Korea. Patients were queried regarding whether they noticed a most troubling prodromal symptom prior to their acute cardiac event and how they responded to the symptom.

Results: Men (53.0%) and women (54.2%) experienced prodromal symptoms. Patients who reported prodromal symptoms were more likely to be older and to have no chest pain upon hospitalization than those with no prodromes. Many patients did not generally recognize the importance of their warning symptoms; only about 40% visited a clinic in response to any prodromal symptom. Logistic regression analyses revealed that the presence of prodromal symptoms was an independent predictor affecting prehospital delay of more than 3 hours and more than 12 hours.

Conclusions: Recognizing prodromal symptoms as needing attention could be a trigger for patients to seek medical help earlier. Educational strategies should focus on improving awareness of prodromal symptoms of AMI, particularly in those with a family history or at high risk for cardiovascular disease.

Seon Young Hwang, PhD, RN Assistant Professor, Department of Nursing, College of Medicine, Chosun University, Gwangju, Korea.

Julie J. Zerwic, PhD, RN Associate Professor, Department of Biobehavioral Health Sciences, College of Nursing, University of Illinois at Chicago.

Myung Ho Jeong, PhD, MD Professor and Director of Heart Research Center, Chonnam National University Hospital, Gwangju, Korea.

This study was supported by research funds from Korea Research Foundation # KRF-2007-331-E00276.

Correspondence Seon Young Hwang, PhD, RN, Department of Nursing, College of Medicine, Chosun University, 375 Seoseok-Dong, Dong-Gu, Gwangju, South Korea (

© 2011 Lippincott Williams & Wilkins, Inc.