Women’s Decision Making Patterns During Heart Attack Symptoms


Reluctance to call 911 was a major theme in many stories regardless of the patterns of decision making.

Educating women and their physicians about interpreting the symptoms of myocardial infarction remains a significant obstacle in reducing decision time.



Understanding Treatment-Seeking Delay in Women with Acute Myocardial Infarction:

Descriptions of Decision-Making Patterns


In this qualitative study, 52 women were asked in semi-structured interviews to describe the symptoms and related thoughts, decisions, and actions from the onset of symptoms of myocardial infarction to arrival at the hospital.

Study participants were 38 to 87 years old , had a mean of 13.1 years of education, and were predominantly white, insured, married, and unemployed, retired, or housewives.

Narrative analysis was used to examine the stories and to identify patterns of decision-making behavior.


“Knowing” Group

The knowing group encompassed women who knew that they would seek care for their symptoms or who knew that they needed help, although this classification does not mean that women knew that they were having a heart attack.

Knowing and Going

The 14 women with stories of knowing and going knew almost immediately that something was wrong; sometimes, but not always, they knew or suspected they were having a heart attack.

Knowing and Letting Someone Take Over

The stories of the 4 women with the pattern of knowing and letting someone take over suggested that women did not always know or say that their symptoms were heart related or even explain their symptoms

Knowing and Going on the Patient’s Own Terms

The 3 women classified as knowing and going on the patient’s own terms recognized symptoms, but their stories were different. Even when these women described seeking advice, they did not always follow the advice, choosing to reach medical care in other ways. These other ways involved driving to the hospital rather than calling 911 and calling a primary care provider rather than going to the hospital, all of which added time.

Knowing and Waiting

The 4 women in the knowing-and-waiting group decided that they needed help but did not call during the night or on the weekend. Usually they delayed seeking treatment because they did not want to disturb others; so they waited until the morning or Monday to seek help.

“Managing” Group

Women in the managing group had a steady or smooth pattern of decision making. Women with managing stories decided on a course and followed it until a trigger prompted action

Managing an Alternative Hypothesis

A total of 11 women had stories that fit into the pattern described as managing an alternative hypothesis; 7 of the 11 attributed the cause of their symptoms to gastrointestinal problems. Many started their story by saying, “I thought I had…”


A total of 12 women had stories that were categorized as minimizing. Women with these stories tried to ignore their symptoms or hoped the symptoms would go away.


American Journal of Clinical Care

July 2005

Dr. Parker’s Commentary

Although this is not the usual “scientific” study,  I found this to be more interesting than the usual medical research approach.

It is a small study , but it captures the personality and psychological differences  involved in decision making.

Clearly, one is going to be able to make better decision if  one is aware of the possible symptoms of having a heart attack; minimizing and denial are the least effective strategies.



If you can keep your head when all about you are losing theirs, it’s just possible you haven’t grasped the situation.”

Jean Kerr


Dr. Parker is a 68 year old heart attack survivor and cardiac psychologist. He is an Honors graduate of Stanford University with forty years of clinical experience. Dr. Parker is available for consultation on heart matters. Contact him at heartcurrents(at)gmail.com.


  1. Hello Dr. Steve – this Oregon study is one of my favourites. I quote this one a lot. When I go through the categories one by one during my presentations, the women in my audience always nod knowingly when they recognize which category best fits their own likely responses!

    There have been a number of researchers who have also studied women’s puzzling treatment-seeking delay behaviour in mid-MI since this study was published over a decade ago, and not surprisingly, the reasons for this delay are remarkably similar to the Oregon findings.

    Now we just need to go from more studies to actually figuring out how to convince women to seek timely help during a heart attack!

    • Carolyn:

      I also found myself nodding as I was reading this study; it stands out from other, allegedly more rigorous studies, in capturing the humans behind the process. I think men also have similar decision making styles that get them into trouble, and I would like to come across some research like this for men. As I psychologist, I would have liked to have seen some psychological testing go along with this that might might have sorted out the variables even further, but I think the “narrative analysis” was brilliant. Someone had their thinking hat on.

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