Does Diabetes Mellitus Make a Difference in Symptom Presentation of Patients with Acute Myocardial Infarction?

Friday, 25 July 2014: 3:50 PM

Polly W. C. Li, MSc (Cardiology), BNurs, RN
Diana T. F. Lee, PhD, MSc, PRD (HCE), RM, RN, RTN
Doris S. F. Yu, PhD, BSc (Nursing Studies), RN
The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, Hong Kong


The study aimed to compare the differences in symptom presentation between diabetic and non-diabetic patients with acute myocardial infarction (AMI), and to examine the impact of diabetes on symptom presentation in AMI patients.


A consecutive sample of patients with a confirmed diagnosis of AMI was recruited from the cardiac units of three regional hospitals in Hong Kong. Data collection was conducted through face-to-face interview. The validated Chinese version of the Symptoms of Acute Coronary Syndromes Inventory (SACSI-C) was used for symptom assessment.


A total sample of 397 patients was recruited, with the mean age of 63.3 ± 12.7 years. Diabetes (32%) was the second most prevalent comorbidity in the sample. Diabetic patients were less likely to present with chest pain (p<0.0001) and sweating (p=0.001). Conversely, they were more likely to present with shortness of breath (p=0.001) and difficulty in breathing (p=0.003) than the non-diabetic patients. Overall, the diabetic patients were more likely to present with atypical AMI symptoms (p<0.0001). The result of multivariable logistic regression analysis showed that diabetes was an independent predictor of atypical symptom presentation in AMI patients, with an odds ratio of 2.37 (95% confidence interval: 1.36–4.12; p=0.002).


In summary, diabetic patients have a 2.4-fold increased risk for atypical symptom presentation than that of non-diabetic patients. Health professionals should remain vigilant at recognizing atypical AMI presentation in diabetic patients. A tailor-made educative intervention should be directed to them.