Background

1. 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. 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. 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). 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'. • 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: f.c.sampson@sheffield.ac.uk