The Acute Coronary Syndrome Experience among Native American Adults in Northern Arizona

Abstract

Diseases of the heart have been the number one cause of death in the Native American population for decades and is an adverse health disparity for this population. Heart disease mortality rates are higher in Native Americans than in the U.S. population (American Heart Association, 2015; Veazie et al., 2014). The purpose of this Doctor of Nursing Practice (DNP) project is to describe the acute coronary syndrome (ACS) experience among Native American adults who reside in northern Arizona and diagnosed with an acute myocardial infarction .A qualitative dominant mixed methods design (QUAL→quan) was used to describe the ACS symptom experience among this population. Data was collected from a convenience sample of nine Native American men residing on the Navajo and Hopi reservations in northern Arizona diagnosed with an acute myocardial infarction. The qualitative portion of this study consisted of a semi-structured interview and the quantitative portion consisted of the completion of a demographic questionnaire and the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey. Qualitative description were used to analyze the data and develop codes, subcategories, categories and themes. Descriptive statistics were used to analyze the data from the demographic questionnaire and MAPMISS results. The findings in this study revealed the average age of the first heart attack for these participants was 58 years. The average time from symptom onset to hospital presentation was 7.4 hours. A common prodromal symptom was very tired/unusual fatigue. Common acute symptoms were chest pain, shortness of breath, gastrointestinal symptoms and diaphoresis. Neck/throat, generalized chest, and top of shoulders were most frequently reported areas of acute pain or discomfort. Influences to not seeking treatment included ignoring symptoms or thinking symptoms would go away. Influences to seeking treatment included worsening or non-resolution of symptoms. Accessing health care was difficult for almost all participants and contributed to treatment delay. Findings from this study gave new insight on ACS symptoms and the ACS experience of Native American men, reinforced current knowledge of the health disparities that exist in this population, and will assist in the development of culturally-sensitive, community-based education programs directed toward the Native American population.