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American Journal of Critical Care. 2010;19: 63-73 doi:10.4037/ajcc2010372
Copyright © 2010 by the American Association of Critical-Care Nurses.
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Racial Differences in Women’s Prodromal and Acute Symptoms of Myocardial Infarction

By Jean C. McSweeney, RN, PhD, Patricia O’Sullivan, EdD, Mario A. Cleves, PhD, Leanne L. Lefler, PhD, APN, Marisue Cody, PhD, Debra K. Moser, RN, DNSc, Kelly Dunn, RN, PhD, PHCNS-BC, Margaret Kovacs, EdD, ARNP-BC, Patricia B. Crane, RN, PhD, Lois Ramer, DNSc, FNP-BC, Patricia R. Messmer, PhD, RN-BC, Bonnie J. Garvin, RN, PhD and Weizhi Zhao, MS. Jean C. McSweeney is a professor and Leanne L. Lefler is an assistant professor in the College of Nursing, University of Arkansas for Medical Sciences, Little Rock, Arkansas. Patricia O’Sullivan is a professor in the School of Medicine, University of California, San Francisco, California. Mario A. Cleves is a professor and Weizhi Zhao is a biostatistician in the College of Medicine, Arkansas Children’s Hospital, Little Rock, Arkansas. Marisue Cody is with the Veterans Affairs, Office of Research and Development, Department of Veterans Affairs, Washington, DC. Debra K. Moser is a professor and the Gill Endowed Chair, College of Nursing, University of Kentucky, Lexington, Kentucky. Kelly Dunn is an associate professor in the School of Nursing, University of Texas Health Science Center, San Antonio, Texas. Margaret Kovacs is a manager in the Division of Clinical Research and Outcomes, Baptist Cardiac and Vascular Institute, Miami, Florida. Patricia B. Crane is an associate professor in the School of Nursing, University of North Carolina, Greensboro, North Carolina. Lois Ramer is the director of Clinical Resource Management, Los Angeles County and University of Southern California Medical Center, Los Angeles, California. Patricia R. Messmer is the director of Patient Care Services Research, Children’s Mercy Hospitals and Clinics, Kansas City, Missouri. Bonnie J. Garvin is professor emeritus, College of Nursing, Ohio State University, Columbus, Ohio.

Corresponding author: Jean C. McSweeney, College of Nursing, University of Arkansas for Medical Sciences, 4301 W Markham St, Slot 529, Little Rock, AR 72205 (e-mail: mcsweeneyjeanc{at}uams.edu).

Background Minority women, especially black and Hispanic women, have higher rates of coronary heart disease and resulting disability and death than do white women. A lack of knowledge of minority women’s symptoms of coronary heart disease may contribute to these disparities.

Objective To compare black, Hispanic, and white women’s prodromal and acute symptoms of myocardial infarction.

Methods In total, 545 black, 539 white, and 186 Hispanic women without cognitive impairment at 15 sites were retrospectively surveyed by telephone after myocardial infarction. With general linear models and controls for cardiovascular risk factors, symptom severity and frequency were compared among racial groups. Logistic regression models were used to examine individual prodromal or acute symptoms by race, with adjustments for cardiovascular risk factors.

Results Among the women, 96% reported prodromal symptoms. Unusual fatigue (73%) and sleep disturbance (50%) were the most frequent. Eighteen symptoms differed significantly by race (P<.01); blacks reported higher frequencies of 10 symptoms than did Hispanics or whites. Thirty-six percent reported prodromal chest discomfort; Hispanics reported more pain/discomfort symptoms than did black or white women. Minority women reported more acute symptoms (P < .01). The most frequent symptom, regardless of race, was shortness of breath (63%); 22 symptoms differed by race (P <.01). In total, 28% of Hispanic, 38% of black, and 42% of white women reported no chest pain/discomfort.

Conclusions Prodromal and acute symptoms of myocardial infarction differed significantly according to race. Racial descriptions of women’s prodromal and acute symptoms should assist providers in interpreting women’s symptoms.


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Copyright © 2010 by the American Association of Critical-Care Nurses.