Intended for healthcare professionals


Decision making processes in people with symptoms of acute myocardial infarction: qualitative study

BMJ 2002; 324 doi: (Published 27 April 2002) Cite this as: BMJ 2002;324:1006
  1. Jill Pattenden (jp30{at}, research fellow,
  2. Ian Watt, professor of primary care,
  3. Robert J P Lewin, professor of rehabilitation,
  4. Neil Stanford, research fellow
  1. Department of Health Sciences, University of York, Heslington, York YO10 5DQ
  1. Correspondence to: Pattenden
  • Accepted 29 November 2002


Objective: To identify the themes that influence decision making processes used by patients with symptoms of acute myocardial infarction.

Design: Qualitative study using semistructured interviews.

Setting: Two district hospitals in North Yorkshire.

Participants: 22 patients admitted to hospital with confirmed second, third, or fourth acute myocardial infarction.

Main outcome measure: Patients' perceptions of their experience between the onset of symptoms and the decision to seek medical help.

Results: Six main themes that influence the decision making process were identified: appraisal of symptoms, perceived risk, previous experience, psychological and emotional factors, use of the NHS, and context of the event.

Conclusions: Knowledge of symptoms may not be enough to promote prompt action in the event of an acute myocardial infarction. Cognitive and emotional processes, individual beliefs and values, and the influence of the context of the event should also be considered in individual interventions designed to reduce delay in the event of symptoms of acute myocardial infarction.

What is already known on this topic

What is already known on this topic Individual sociodemographic and clinical characteristics affect the time to seeking medical care in patients with symptoms of acute myocardial infarction

Appraisal of symptoms is difficult; people with classic and severe symptoms are more likely to take prompt action

What this study adds

What this study adds The decision to seek medical help in patients who have had one or more previous myocardial infarctions is a complex process

Simply providing patients with information on symptoms of acute myocardial infarction, and what to do in the event of these symptoms, may not be sufficient to promote prompt action


  • Funding North Yorkshire Health Authority. The British Heart Foundation funded the original “HeartSave” scheme that prompted this research

  • Competing interests None declared

  • Accepted 29 November 2002
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