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myocardial infarction, narrative analysis, out-of-hospital death, sudden cardiac death, symptoms



  1. Rosenfeld, Anne PhD, RN, CNS
  2. Christensen, Vivian PhD
  3. Daya, Mohamud MD, MS


Background: Sudden cardiac death is a major cause of death in the United States. Most cases occur outside the hospital, yet little is known about the symptoms and actions of individuals who die before reaching the hospital.


Objective: The purpose of this study was to describe the symptoms, symptom management, and care-seeking patterns in sudden cardiac death victims.


Methods: This cross-sectional study used qualitative and quantitative data collection methods to obtain descriptions of symptoms and treatment-seeking delay from family members and bystanders (respondents) in 140 cases of sudden cardiac death due to presumed myocardial infarction. Decedents were identified from death certificate data from the state of Oregon in the United States. Respondents completed a survey of demographics and myocardial infarction symptoms and an in-depth interview. Narrative analysis was used to analyze qualitative data.


Results: Three behavior patterns or trajectory types were developed focusing on key characteristics of the symptom patterns, the meanings attributed to those symptoms, the actions taken by the decedents and their family members or bystanders, and the time course of events. Each case was categorized as 1 trajectory type. The trajectory types are Normal Day (n = 49), Something Not Right (n = 62), and Thought It Was Something Else (n = 29). The key distinction across the trajectory types is the perception and interpretation of symptoms and the resulting actions between symptom perception and death.


Conclusions: This study is 1 of the first to describe what victims of sudden cardiac death are doing and thinking during the period between symptom onset and collapse. The trajectory types identified in this study suggest that misinterpretation of symptoms (the Something Not Right and Thought It Was Something Else groups) is common among victims and bystanders.