Delaying the decision to seek emergency medical treatment for the symptoms of an acute ischemic event (i.e., acute myocardial infarction, unstable angina) can mean the difference between life and death. Research has shown that women, African Americans, and older persons tend to delay seeking treatment for the symptoms of an acute myocardial infarction (AMI) longer than middle-aged white men. Delays can lead to the destruction of heart muscle and may lead to poorer recovery, greater disability, and premature death. The purpose of this pilot study is to examine barriers to seeking prompt emergency care for acute ischemic symptoms and to see how these barriers impede sustained cardiovascular care over 6 month period after an acute event. This study will focus on an urban, predominantly older African American population who are admitted for the symptoms for AMI or unstable angina. Participants will be referred by hospital staff and will be interviewed within 5 days of hospitalization for the acute event. Follow-up interviews will take place 3- months and 6-months post-event. Baseline interviews will include questions pertaining to psychosocial factors, perceived and practical barriers to medical care, acute cardiac symptoms, medical comorbidity, knowledge of the warning signs of a heart attack and of personal cardiovascular risk factors, depressive symptomatology, and health cognitions and somatic complaints associated with cardiovascular disease. Follow-up interviews will focus on barriers that impede sustained cardiac care (i.e., treatment and medication compliance, lifestyle changes, and improved well-being). Many patients who experience symptoms of acute ischemia die before they reach the hospital or expire in the emergency room. In an effort to understand the barriers to delay in all acute ischemia patients, a retrospective proxy interview will be conducted among next of kin based on the in-hospital patient interview. The results of this study could play a key role in disentangling cardiovascular disparities among women and African Americans, and lead to the development of an intervention that would focus on lowering practical and perceived barriers to emergency cardiac care and recovery. ? ?
