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The second myocardial infarction: Higher risk factor burden and earlier second myocardial infarction in women compared with men. The Northern Sweden MONICA study
Luleå University of Technology, Department of Health Sciences, Medical Science.ORCID iD: 0000-0002-8842-7759
Luleå University of Technology, Department of Health Sciences, Health and Rehabilitation.ORCID iD: 0000-0002-1682-8326
Sunderby Research Unit, Department of Public Health and Clinical Medicine, Umeå University.
Department of Research, Norrbotten County Council, Luleå.
Show others and affiliations
2017 (English)In: European Journal of Cardiovascular Nursing, ISSN 1474-5151, E-ISSN 1873-1953, Vol. 16, no 5, p. 418-424Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Several studies have examined various parameters and experiences when patients suffer their first myocardial infarction (MI), but knowledge about when they suffer their second MI is limited.

AIM: To compare risk factors for MI, that is, diabetes, hypertension and smoking, for the first and second MI events in men and women affected by two MIs and to analyse the time intervals between the first and second MIs.

METHODS: A retrospective cohort study of 1017 patients aged 25-74 years with first and second MIs from 1990 through 2009 registered in the Northern Sweden MONICA registry.

RESULTS: More women than men have diabetes and hypertension and are smokers at the first MI. Similar differences between the genders remain at the time of the second MI for diabetes and hypertension, although both risk factors have increased. Smoking decreased at the second MI without any remaining difference between genders. Women suffer their second MI within a shorter time interval than men do. Within 16 months of their first MI, 50% of women had a second MI. The corresponding time interval for men was 33 months.

CONCLUSION: Patients affected by an MI should be made aware of their risk of recurrent MI and that the risk of recurrence is highest during the first few years after an MI. In patients affected by two MIs, women have a higher risk factor burden and suffer their second MI earlier than men do and thus may need more aggressive and more prompt secondary prevention.

Place, publisher, year, edition, pages
Sage Publications, 2017. Vol. 16, no 5, p. 418-424
Keywords [en]
Modifiable risk factors, retrospective cohort study, second myocardial infarction, self-management, time interval
National Category
Other Health Sciences Physiotherapy Nursing
Research subject
Health Science; Physiotherapy; Nursing
Identifiers
URN: urn:nbn:se:ltu:diva-61085DOI: 10.1177/1474515116686229ISI: 000402662800008PubMedID: 28029268Scopus ID: 2-s2.0-85020204387OAI: oai:DiVA.org:ltu-61085DiVA, id: diva2:1056606
Note

Validerad;2017;Nivå 2;2017-06-05 (andbra)

Available from: 2016-12-15 Created: 2016-12-15 Last updated: 2022-07-05Bibliographically approved
In thesis
1. The second myocardial infarction: A known but different experience
Open this publication in new window or tab >>The second myocardial infarction: A known but different experience
2018 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aim of this thesis was to explore the second myocardial infarction (MI) and describe experiences of the second myocardial infarction from the perspectives of patients and personnel in cardiac rehabilitation (CR).

This thesis includes four studies. Studies using quantitative method (I, II) and qualitative method (III, IV) were performed. Studies I and II were retrospective cohort studies based on data from the Northern Sweden’s MONICA myocardial infarction registry. A paired design was used. Study I included 1017 participants, and the corresponding figure for Study II was 820 participants. The participants had at least two MI events recorded in the MONICA MI registry from 1990 – 2009 (I) and 1986 – 2009 (II). The two MI events studied were the first and second events. Study III included eight patients who suffered two MIs. The data were collected through interviews about the experience of suffering a second MI. In Study IV, personnel working with CR were interviewed about the experience of working with patients suffering from a second MI and data from study III were used for describing the patients expressed needs during CR. Data were analysed by descriptive and analytic statistics (I, II) and by qualitative content analysis (III, IV).

Both men and women had higher risk factor burdens when suffering the second MI compared when they suffered the first MI. Women had a higher risk factor burden at both first and second MI compared with men. Women also suffered the second MI with a shorter time interval than men did (I). The most common symptom reported in men and women at both MI events were typical symptoms. In men, 10.6 % reported different types of symptoms at first and second MI, and the corresponding figure for women was 16.2 % (II). The number of patients with a prehospital delay < 2 hours increased at the second MI. Furthermore, the results showed that patients with a prehospital delay ≥ 2 hours at the first MI were more likely to have a prehospital delay ≥ 2 hours at the second MI (II). Suffering a second MI is a known but different event compared to the first MI, it makes afflicted people realise the seriousness and the importance of making lifestyle changes (III). People express they are more affected after having the second MI, both physically and psychologically (III). In the analysis of congruence between the needs patients expressed linked to CR and personnel’s description of how they worked, a theme emerged: “Be seen as a unique person” 2(IV). The patients expressed a need of customised care, and the personnel described that it was important for them to individualise the care given to these patients.

Suffering a second MI is experienced as a different and more serious event that the first one. The patients had gained valuable knowledge due to their previous experience and the second MI was a wake-up call for life style changes. A majority of the patients had typical symptoms at both MI events and an increased number of patients had a prehospital delay < 2 hours at the second MI. We suggest that the personnel in CR pay attention to first-time MI patients’ illness representation to enhance the patient’s awareness of the seriousness of the illness and the fact that they suffer from a chronic illness. The care given after an MI, including cardiac rehabilitation should be person-centred to involve the patient as an active participator in the care and were the patient’s resources and needs are in focus.

Place, publisher, year, edition, pages
Luleå: Luleå University of Technology, 2018
Series
Doctoral thesis / Luleå University of Technology 1 jan 1997 → …, ISSN 1402-1544
National Category
Nursing
Research subject
Nursing
Identifiers
urn:nbn:se:ltu:diva-71447 (URN)978-91-7790-254-6 (ISBN)978-91-7790-255-3 (ISBN)
Public defence
2018-12-07, D770, Luleå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2018-11-06 Created: 2018-11-05 Last updated: 2021-10-15Bibliographically approved

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Strömbäck, UlricaVikman, IreneEngström, Åsa

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