Clinical Research in Cardiology

, Volume 101, Issue 11, pp 909–916 | Cite as

The patient’s interpretation of myocardial infarction symptoms and its role in the decision process to seek treatment: the MONICA/KORA Myocardial Infarction Registry

  • Inge Kirchberger
  • Margit Heier
  • Rupert Wende
  • Wolfgang von Scheidt
  • Christa Meisinger
Original Paper



The patients’ misinterpretation of symptoms of an evolving acute myocardial infarction (AMI) is a major cause for prolonged pre-hospital delays. The objective of this study was to identify factors associated with an attribution of the symptoms to the heart and to investigate the association between symptom misinterpretation and time until first medical contact (delay time).


The study population comprised 1,684 men and 559 women, aged 25–74 years, hospitalized with a first-time AMI recruited from a population-based AMI Registry.


A total of 50.3 % of the patients attributed their experienced symptoms to the heart. Logistic regression modeling revealed that symptoms like chest pain, pain in the left upper extremity, and fear of death facilitated a correct attribution to the heart, whereas symptoms like vomiting or pain in the right upper extremity made a correct labeling difficult. Female sex, low educational status, migration background, and current smoking were associated with a higher risk of misinterpretation of symptoms. A family history of AMI or a history of angina pectoris, hypertension, and hyperlipidemia were shown to facilitate a correct interpretation of symptoms. Variables associated with a misinterpretation of symptoms did not significantly differ between men and women. People with misinterpretation of symptoms had a 1.59-fold risk (95 % confidence interval 1.33–1.90) to have a delay time of at least 2 h, compared with persons who correctly attributed their symptoms.


Symptom misinterpretation is common among patients with AMI, significantly related to symptoms, sociodemographic characteristics and individual risk factors, and associated with a prolonged delay time.


Myocardial infarction Pre-hospital delay Symptom misinterpretation 



The KORA research platform and the MONICA Augsburg studies were initiated and financed by the Helmholtz Zentrum München, German Research Center for Environmental Health, which is funded by the German Federal Ministry of Education, Science, Research and Technology and by the State of Bavaria. Since the year 2000, the collection of AMI data has been co-financed by the German Federal Ministry of Health to provide population-based AMI morbidity data for the official German Health Report (see Steering partners of the MONICA/KORA Infarction Registry, Augsburg, include the KORA research platform, Helmholtz Zentrum München and the Department of Internal Medicine I, Cardiology, Central Hospital of Augsburg. We thank all members of the Helmholtz Zentrum München, Institute of Epidemiology II and the field staff in Augsburg who were involved in the planning and conduct of the study. We wish to thank the local health departments, the office-based physicians, and the clinicians of the hospitals within the study area for their support. Finally, we express our appreciation to all study participants.

Conflict of interest

The authors declare that they have no conflict of interest.


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Copyright information

© Springer-Verlag 2012

Authors and Affiliations

  • Inge Kirchberger
    • 1
    • 2
  • Margit Heier
    • 1
    • 2
  • Rupert Wende
    • 3
  • Wolfgang von Scheidt
    • 3
  • Christa Meisinger
    • 1
    • 2
  1. 1.MONICA/KORA Myocardial Infarction RegistryCentral Hospital of AugsburgAugsburgGermany
  2. 2.Institute of Epidemiology II, Helmholtz Zentrum MünchenGerman Research Center for Environmental Health (GmbH)NeuherbergGermany
  3. 3.Department of Internal Medicine I-CardiologyCentral Hospital of AugsburgAugsburgGermany

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