Transcript College Emergency Medicine conference 2007

Feeling fixed: a qualitative study of patients following
primary angioplasty.
Fiona Sampson (Research Fellow), Alicia O’Cathain (Senior Research Fellow),
Steve Goodacre (Professor of Emergency Medicine).
Background
Randomised controlled trials have shown that primary angioplasty appears to
produce better outcomes than intravenous thrombolysis for ST-elevation acute
myocardial infarction (STEMI). The National Infarct Angioplasty Project was set
up to test the feasibility and cost-effectiveness of implementing a countrywide
primary angioplasty service for STEMI patients. As part of the project evaluation,
we used qualitative methods to explore the perspectives of patients and carers
who have experienced primary angioplasty at two hospitals involved in this
project.
Methods
We undertook face-to-face semi-structured interviews with a purposive sample of ten
primary angioplasty patients (selected based on age, sex, time and admission route)
and six of their carers. Interviews took place around 2 weeks after discharge. We used a
critical incident technique to identify positive and negative views of the patient and carer
experience. We used Framework analysis to analyse data, identifying a thematic
framework and then coding transcripts systematically according to the framework.
Results
Interviewees remembered little of the decision to undergo primary angioplasty and felt that
it was a life-saving decision undertaken on their behalf. Patients and carers were amazed at
the speed with which the patient felt better following their angioplasty and struggled to come
to terms with their condition. Some did not believe they had had a heart attack, either
because symptoms were not what they considered ‘classic’ symptoms, or because
resolution of their symptoms was so fast they felt it could not have been a heart attack.
Patients expressed their confidence in the procedure, with some believing their problem
to have been ‘fixed’. Two issues appeared to contribute to this: the speed of recovery from
an extreme of feeling near death to feeling healthy, and physically seeing the arteries
opened during the angioplasty procedure; literally 'seeing the fixing in process'.
Conclusions
Patients and carers spoke very positively of their experience of primary angioplasty for
STEMI and felt confident in the procedure. However, the potential implications of
patients feeling ‘fixed’ needs further investigation, particularly with regard to attitudes
towards cardiac rehabilitation.
For further details please contact Fiona Sampson, Health Services Research, School of Health and
Related Research, University of Sheffield, 30 Regent Street, Sheffield S1 4DA. Telephone: 0114 2220687.
E-mail: [email protected]