| Learning Objective #1: Identify symptoms of acute coronary syndromes which vary in individuals with diabetes. | |||
| Learning Objective #2: Describe the implications for differences in symptoms of acute coronary syndromes due to comorbid conditions such as diabetes. |
Background: The global burden of diabetes is significant and increasing at epidemic rates in developed nations. The number afflicted has risen from 30 to 171 million in the past 20 years alone. Diabetes imparts a four-fold increased risk of cardiovascular disease and is associated with more complications and poorer outcomes following acute coronary syndromes (ACS). Patients with diabetes often experience cardiac autonomic neuropathy (CAN) manifested by painless myocardial ischemia. CAN may also impact the way patients perceive other symptoms of ACS.
Purpose: The purpose of this study was to examine ACS symptom differences in patients with diabetes compared to those without diabetes.
Methods: A descriptive cross-sectional design was utilized. A convenience sample of 112 women and 144 men from two large, urban, regional medical centers in the Midwest participated in the study. The Symptoms of Acute Coronary Syndromes Inventory was used to measure symptom type, location, quality, and severity of pain. Interviews were conducted in the patient’s room a minimum of 12 hours after admission.
Results: Patients with diabetes comprised 33.2% of the sample and were more likely to have a history of heart disease (X2=11.62, p<.01) and coronary interventions (X2=8.16, p<.01) compared to those without diabetes. Patients with diabetes had significantly more risk factors including hypertension (X2=9.9, p<.01) and obesity (X2=6.0, p<.02). Patients with diabetes reported significantly less chest pain (X2=4.21, p=.04), less heat sensations (X2=4.33, p=.04), and more unusual fatigue (X2=6.9, p<.01).
Discussion: Lack of chest pain in patients with diabetes is a serious concern since this is the hallmark symptom of ACS and is well known to the public. This could contribute to a delay in accessing emergency medical services or a decision to forgo care altogether if patients erroneously believe that their symptoms are caused by minor illness.
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