Abstract 2089: Symptoms Preceding Out-of-Hospital Presumed Myocardial Infarction Deaths: Atypical is Typical
Purpose: Efforts to prevent sudden death in victims of out-of-hospital myocardial infarction (MI) include teaching victims and bystanders to recognize MI symptoms and access emergency services, thus reducing treatment-seeking delay and mortality. The purposes of this study were to identify the frequency of typical and atypical acute symptoms in victims of out-of-hospital presumed MI death and to describe the role of attribution of symptoms to non-cardiac causes by victims.
Method: 72 decedents were identified through Oregon death certificates and included deaths with MI listed as the first cause of death (ICD-10 code I21) aged 18 or older from April to November 2004. Decedents died at home, in the community, or in the emergency department (ED)/DOA. Inpatient and nursing home deaths as well as deaths during sleep without prior symptoms or alone and found were excluded. Semistructured interviews with family members or bystander witnesses were conducted to elicit data about symptoms, decisions, and actions from the onset of symptoms to collapse and death. Typical symptoms were defined as chest pain, pressure, or discomfort. Atypical symptoms were defined as non-chest pain symptoms.
Results: Decedents had a mean age of 75, were 83% male, and died at home (78%), community setting (8%), or ED/DOA (14%). Seventeen (24%) collapsed without symptoms. Witnesses reported a mean of 3.5 symptoms reported by 55 victims with symptoms. Significantly more victims had atypical symptoms [n = 41 (75%)] than typical ones [n = 14 (25%)] [χ2 (1, N = 55) = 13.2, p < .01]. Differences by age or gender were not significant. The most frequent atypical symptoms were fatigue (n = 32) and shortness of breath (n = 27). Attribution to non-cardiac causes occurred in 21 (38%) victims, but did not differ between atypical and typical cases (χ2 (1, N = 55)= .05, p= .82). Victims with atypical symptoms were more likely to seek care for prodromal symptoms in the 2 weeks prior to death than those with typical symptoms (χ2 (1, N = 55) = 4.2, p= .04).
Conclusion: Victims of out-of-hospital MI death are more likely to experience atypical than typical symptoms. Chest pain may be more easily recognized and acted upon than atypical symptoms. Attribution to non-cardiac causes may contribute to out-of-hospital MI death.