Presentation of Signs and Symptoms of Acute Myocardial Infarction in Men and Women - Research Paper Example

? Presentation of Signs/Symptoms of Acute Myocardial Infarction in Men and Women. Georgia College and Objective To access the influence, impact and effect of gender in the diagnosis of acute myocardial infarction among the general population and to determine whether any notable presenting symptoms or signs are associated more weakly or strongly with acute myocardial infarction in men than in women. Design A combination of both quantitative and qualitative approaches using analysis of synthesized primary and secondary data from clinical trials and cardiac/coronary research. Setting The setting of the study will be health institutions emergency departments. The number of health institutions is limited to 15.The health institutions will be of varying types and sizes within the United States. Sample 15 men and an equal number of women of varied age groups who will appear in emergency department exhibiting symptoms and signs that are normally associated with AMI. Common symptoms associated with AMI include chest pains and chest congestions, nausea, shortness of breath, sweating, palpitations and indigestion in women. A minimum follow up of six months for first subjects experiencing AMI for the first time and eight months for participants who have had a history of AMI. Tests and Measurements The study constructs can be measured through observation. Structured questionnaires will be administered to the patients and the health specialists who are attending to the patients to help and obtain data to support the study. A multivariable model that makes use of logistic regression will be applied to both clinical characteristics and patients demographics. Statement of the problem It is a widely acceptable fact that AMI is the number one killer condition in the USA. Despite ones disease, the eventual cause of death is usually heart failure as a result of AMI. Commonly known as heart attack, AMI is a result of blood supply interaction to a part of the heart the result of which is the death of heart cells. However, due to the confusion that larks within the symptoms of AMI and the symptoms of other chest health conditions, misdiagnosis has been a common occurrence. Patients suffering from basic chest complication exhibit similar symptoms to those suffering from AMI. Some of the similarities include chest pains, shortness in breath, congested chests, sweating and palpitations. This has made it easier for pharmacists, physicians and other care givers to give patients the wrong treatment leading to recurring conditions or eventual death of the affected patient. Previous research has shown that about 47% of deaths due to AMI occur outside the precincts of a hospital. This suggests inaction to early warning signs from people with heart conditions. If the symptoms can be separated among the two gender groups, it would make diagnosis of AMI simple and fast hence reducing the overall cost of treatment and eventually saving lives. Previous studies have found the signs and symptoms that are associated with AMI. The current evidence has been largely on co relational designs and quasi experiments using self report data. However, up to date, no study has conclusively assigned the signs and symptoms of AMI to a specific demographic group according to gender. A 2007 research report by the National Health Institute, (NIH), points out at women experiencing different physical symptoms or new symptoms all together for as long as three weeks or more before experiencing a case of AMI. The study involved over 500 women. However the symptoms reported were still similar to those of the men. 42.1% reported to experience shortness of breath, 47.8% complained of sleep disturbance and 70.6% experienced unusual fatigue (NIH,2007). However, similar symptoms are also common in men who have experienced AMI. I propose to study the signs and symptoms prevalence in people suffering from AMI and proceed to assign their popularity of occurrence to a particular gender group. The study will be conducted through observations, questionnaires and later opinions from cardiac experts who have extensively dealt with AMI cases. The study however is limited and does not touch on cases of “silent” myocardial infarctions. The study leaves room for further studies on “silent” AMI that can lead to an easy identification according to gender type and treatment of the condition. Research Question Can the presentation of signs/symptoms of acute myocardial infarction be wholly or partly split between the male and female patients? Research question evaluation using finer model Feasibility Information to show that the study will have access to adequate number of research subjects includes the fact that AMI is a common medical condition among the world population. In 2008, cardiovascular diseases accounted for one in three deaths in the United States. The leading cause of death for both women and men in the United States is heart disease. In 2008, more than half of the deaths attributable to heart disease were in men. Cases of AMI are spread across geographical area with the lowest prevalence in Minnesota and its highest occurrence in Mississippi. It also cuts across social and ethnic boundaries. According to the CDC, Alaska natives and American Indians have the lowest prevalence at 17.9%. They are followed by Hispanics, the pacific or Asian Islanders, the African Americans and finally the whites at 25.1%. Considering this spread, research subjects will be available by the numbers and gender. There are more than 600 cardiovascular hospitals in the USA according to the American Heart Association. The research subjects have been limited to 30. 15 men and an equal number of women. With such a spread in prevalence such a number manageable. Information to show that I have sufficient technical expertise to implement the proposed study includes the fact that currently, I am taking a medical related degree program in nursing specializing in heart surgery and cardiology. I believe through the degree course I have gained sufficient technical expertise to handle the matter under study. Regarding the research aspect, one of the modules that I have studied in medical school includes research studies and statistics. The topic was covered broadly in the module. Issues in medical research ethics, sampling techniques, research study design and measurements were discussed extensively. It is my honest view that the module gave the would be medical researchers the necessary expertise to conduct a viable study research. Issue of study funding is always challenging for any researcher who is just starting out. Proper research funding is normally a reserve for established researchers. However, the topic under research intends to make a breakthrough in the diagnosis of AMI and its related conditions. I believe it is relevant to the current times and if marketed aggressively it would receive some level of funding. Probable financiers of the study include leading cardiovascular and heart institutions, both hospitals and schools and non-governmental organizations like the American Heart Foundation who conduct awareness campaigns on heart diseases. The study could be used to further their knowledge. The study can also be incubated under established research facilities such as the CDC who can in turn meet the financial costs of the study. The most obvious funding option remains self-funding. I can personally solicit funds from personal savings, family, and friends to finance the study. The study is convenient and can be undertaken within the specified time frame of three academic semesters. This would be ensured by limiting the extent that the study would cover geographically. Myocardial Infarction is a nationwide occurrence as earlier explained. Similar results can be obtained from studying its symptoms and signs presentation in varied geographic areas. Limiting the geographic area of study will thus make sure the study is conducted within the specified time. Taking a smaller representative sample of subjects for the study will also ensure the study is undertaken within a shorter period. The study is of my personal interest as the investigator.AMI is a leading cause of death in the country and limiting its impact as a result of understanding its signs and symptoms would be a noble cause. Never before have the signs and symptoms of AMI been conclusively attributed to men and women. However, this is what the study aims to achieve. My medical specialization is on heart and cardiovascular diseases so the interest has always been in me. I have always found the functioning of the heart very fascinating. The opportunity to save lives that the study presents also makes it even more interesting. The study question aims to extend previous findings on AMI prevalence among the gender groups. Different studies have already been undertaken to analyze the signs and symptoms of AMI on a particular gender. However, these studies have been biased towards the male gender. The studies are normally undertaken on male athletes especially marathon runners. In the current year, already more than five studies have been undertaken on heart failure whose focus has been exclusively on men. By bringing in women under the study and attempting to separate the symptoms and signs presentation of AMI among the genders, this study will be extending on the previous studies. Previous studies have focused on either pre or post AMI symptoms, this study will focus on both pre and post AMI presentation of signs and symptoms Ethical Ethics issues in the studies will always arise. Some of the ethical issues that will be addressed by the study include benefit, privacy issues and consent. The study deliberately left out clinical trials because of the ethical issues associated with clinical trials. In clinical trials it would have been deemed unethical if the study did not promise any form of direct benefit to the participants. The study as it is can promise future benefits at best. Whenever a direct contact is made with a study subject, ethics will demand that the researcher informs the respondents of the study benefits. The researcher should however be very careful to neither understate or overstate the benefits. The study would also aim at securing informed consent from the subjects under research. Before requesting permission to proceed with the study, the subjects will be informed of the procedures of the study and other research design. Rights to privacy is a crucial ethical concern in the medical practice. All patients have a right to privacy which must be respected by the researcher. This privacy protects the subjects and the validity of the research. The study will restrict access to information that reveals indentifying features like names, addresses and telephone numbers. Relevance to future research directions as stated in the research problem, the study will open up “silent” AMI for further research. The Future research on AMI will also be based on the symptoms and how they are applicable to either gender. Review of Literature Research question: Can the presentation of signs/symptoms of acute myocardial infarction be wholly or partly split between the male and female patients? Type of question/ treatment intervention: Diagnosis/ assessment. Type of studies to be included in the literature search: Systematic review, clinical trials, Cohort study case study, case series or case report, evaluation research, secondary data analysis and qualitative research. Search terms and Boolean connectors used for database searching: Acute Myocardial Infarction, Gender and Presentation Signs Symptoms AMI, AMI male female or AMI Research Signs Symptoms and Gender. An exclusion criterion for the search was the year of publication of both the primary and secondary data sources. Language of the publication was also used as an exclusion criterion. Sources that were more than five years old were inadmissible. Databases used: Medline, Pub med, and the New England Journal of medicine database. Literature Search 10 publications were retrieved from the various databases, one publication was excluded based on review of conditions and the abstract, 9 articles reviewed and none was excluded. A total of nine articles were included in the literature review. Language of literature was a permissible criterion for exclusion. Review articles on an almost similar topic was conducted and their reference lists were searched to find other studies that were potentially eligible. Methods Sampling Target population for the study is males and females who are at a greater risk of suffering from AMI. AMI cuts across the entire population spectrum. Everyone is at risk. However risk groups may vary according to lifestyle choices. Risk factors among the population vary according to obesity, high blood pressure, cigarette smoking, high cholesterol, inactivity and diabetes. Inactivity increases the risk factor for AMI to 53%. The most affected demographic group is that of men. Men are more at risk than women at any given age particularly before menopause. However, AMI causes slightly more deaths in women than in men given the fact that women have a much longer lifespan. Accessible population The risk factors of AMI are normally associated with the urban population and thus the population under study will be 15 men and women from urban areas. An additional reason why the study would focus on the urban population would be availability and accessibility of health facilities. Most health facilities are located within urban areas and they are the setting of the study. A 95% confidence interval will be applicable for both continuous and dichotomous data. Inclusion criteria Inclusion criteria refer to definitive pre set conditions that the subjects must meet before they are approached to participate in the study. Besides sex, other inclusion criterion for the study is urban dwellers because they are at a higher risk of suffering from AMI. This is because their lifestyles are characterized by inactivity and eating disorders associated with increasing the risk factors for AMI. Treatment history of the subjects and repeat occurrences of the condition under study will also be applicable inclusion criteria. Exclusion criteria give reasons why a subject is not admissible to participate in the clinical trial. Exclusion criteria Exclusion criteria for the study will include the underlying medical conditions that the subject could be suffering from and the stage of the condition under research. AMI symptoms could easily resemble symptoms presentations from other conditions. For example, subjects with previous history of breathing and chest problems could have similar symptoms as those of AMI thus making it time consuming to isolate the particular condition that they are experiencing at the time of diagnosis. Inclusion of such subject will stretch the time allocated for the study and the subjects will increase the studies error estimate due to increased bias. Sample size The study aims to target 15 women and an equal number of men who have experienced AMI incidences. Sampling method The sampling method that will be applicable to the study. A non-probability purposive sampling method will be applicable for this study. The two main types of purposive sampling, quota sampling and judgment sampling will be applicable. The study will select the study subjects to fit the quotas that had been previously identified, social economic and gender. Judgmental sampling occurs when the investigator conducts a study that conforms to some pre set criterion. It allows the investigator to make use of only the population that could yield the required information as it relates to the study objectives. In this particular study, the subjects will be limited to only those who have experienced AMI in the recent past, not exceeding six months. A limited application of snowball sampling will be put in use since the subjects under study can be best located through extensive referral networks. Potential study subjects are identified through referrals networks, which are cyclically put in use to identify other subjects. Setting The research will occur under a field setting. The investigator will map out target hospitals within the closest urban area that deals with patients that have undergone AMI. The hospital could be an exclusive cardiac unit or a general hospital that attends to multiple health conditions. The emergency department of the hospitals will be used to initially identify the subjects. The setting of the study can eventually be extended to the subject’s home depending on their consent and need. Type of study design, their strengths and weaknesses The study will utilize both descriptive and exploratory studies. Descriptive design is mostly used when the investigator is interested in the current status of the subject under study and hence collects data to justify the status. It mainly reports and determines the way things are. It tries to study and describe possible characteristics and behavior. In this particular study, a descriptive approach will seek to determine which signs and symptoms regarding AMI are more prevalent in either gender. Exploratory study design is applicable because the investigator is not yet clear on the problems to be encountered during the study. Descriptive studies allows comparison of the subjects under study without giving the need to manipulate the independent variable. The independent variable is normally fixed. Gender in this particular study cannot be manipulated. Both exploratory and descriptive studies are less costly. Exploratory studies are very efficient in enabling the investigator to know and thoroughly define the variables. Exploratory studies are linked to old biases related to qualitative research namely non systematic design, non representativeness and are feared to be subjective. Descriptive studies give limited interpretations because the investigator is not really sure whether a particular variable is as a result or cause of the behavior being studied. Operational definitions Operational definitions refers to processes through which a concepts characteristic is defined including classification and identification. It’s a process that is used to ascertain the validity of the information that has been gathered for the study. For this study the operational definition of AMI is heart attack resulting from the death of heart cells as a result of interruption of the flow of blood to any part of the heart. The operational definition of the presentation of its signs and symptoms is those that have been generally agreed on by practicing cardiologists and the American Heart Foundation. Classical symptoms have been described earlier in the study proposal. Measurements Measurements refer to methods by which distinguishing values are assigned to variables. The two types of variables in the study are dependent variables and independent variables. Direct measurement methods are applicable. The presenting symptoms in men and women can be physically tallied and counted. Both ordinal and nominal levels of measurements will be used in the study. Validity and reliability of this measurements will depend on the subjects response in the data collection instrument. For example the subject’s age can be obtained from adding years to the year of birth. Nominal level of measurement will be used where common characteristics are used to classify the observations. Ordinal measurements can also be used in this regard. Reliability and validity of this measurement will depend on the investigators own observation and the subjects response Institutional review board This proposal has been submitted to the instructor for review under the title “Presentation of Signs/Symptoms of Acute Myocardial Infarction in Men and Women.” References CDC. (n.d.). Fact Sheets: American Heart Association.Retrieved April 20, 2012, from heart.org: http://www.heart.org Chan, P., SV, A., & Drecker, C. (2011). Translationa Research Investigating Underlying Disparities in AMI Patients Health Status. Cardivascular Quality and Outcomes, 4 , 467-76. Jonathan, H. K., Rajeev, M., George, C., Chris, T., & John, C. (2012). Cardiac Arrest in Male and Female Long Distance Running Athletes. New England Journal of Medicine , 130-140. Nabel, E., & E, B. (2012). A Tale of Myocardial Infarction and Coronary Heart Disease. New England Journal of Medicine , 55-64. National Institute of Health. (2007).Women's Early Warning Symptoms of AMI. National Institute of Health , 67-89. Roger, V., & Lloyd-Jones, D. (2012). Heart Disease and Stroke Statistics, 2012 Update. Epub: American Heart Association. Rumsfeld, J., Schelbert, E., Krumholz, H., Reid, K., & Masoudi, M. (2008). Mortality, Quality of Care and Ischaemic Symptoms During Myocardial Infarction. Heart , 7-12. Soman, A., Brigier, D., Astley, C., & Chew, D. (2009). Potential Survival Gains in the Treatment of Myocardial Infarction. Heart , 1844-1850. Tarone, R., & McLaughin, J. (2012). Coronary Arteries, Myocardia Infarction and History.New England Journal Of Medicine, 369 , 1259-1260. Table 1: Study Methods of Selected Publications Author (Year) N (Study design) Population Setting Variables Instrumentation Jonathan, H. K., Rajeev, M., George, C., Chris, T., & John, C. (2012) Case control and cohort study 51 male runners and 8 female athletes The study population consisted of full and half marathon athletes. Clinical setting with a review of medical records. Independent variables: demographics Dependent variable: cardiac arrest incidences, race distance Internet search engines, surveys and questionnaires Soman, A., Brigier, D., Astley, C., & Chew, D. (2009). Descriptive studies. 1630 patients in the nationwide registry The study population consisted of patients under hospital based care Hospitals in South Australia. Independent variables: MI Dependent variables: Recurrence of MI GRACE score and literature based surveys. Rumsfeld, J., Schelbert, E., Krumholz, H., Reid, K., & Masoudi, M. (2008). Case studies of 1859 patients with MI. 10,911 patients with MI were screened. 19 hospitals in the US. Independent variables: demographics. Dependent variables: electrocardiograph changes and symptoms. Interviews and chart documentation. Chan, P., SV, A., & Drecker, C. (2011). Translational research involving 4340 patients. 31566 patients were screened. 24 health centers in the US. Independent variables: demographics. Dependent variables: biomarker, metabolic and genetic characteristics. Chart abstractions and baseline interviews. National Institute of Health. (2007). Case study 515 women. The study population consisted of women around the United States. Hospital setting and the patients homes. Independent variables: race and ethnicity of the subjects. Dependent variables: symptoms Questionnaires and surveys. Table 3: Statistical results of selected studies Results by variable of interest. Author (Year) Dependent Variable 1 Dependent Variable 2 Dependent Variable3 Other Dependent Variable Jonathan, H. K., Rajeev, M., George, C., Chris, T., & John, C. (2012) Race distance. Level of physical training. Participation history in races. Soman, A., Brigier, D., Astley, C., & Chew, D. (2009). Mortality. Recurrent MI. Rumsfeld, J., Schelbert, E., Krumholz, H., Reid, K., & Masoudi, M. (2008). Electrocardiograph changes. General AMI symptoms. Chan, P., SV, A., & Drecker, C. (2011). Biomarkers. Genetic characteristics. Metabolic characteristics. National Institute of Health. (2007). Anxiety. Indigestion. Chest pains. Fatigue and shortness of breath. Read More