A Study Of Symptom Experience In Patients With Aortic Dissection Before Hospitalization

Objectives This study aims to investigate the symptom expernence in patients with aortic dissection(AD)before the admission to hospital to identify the clinical characteristics of its initial incidence,paving the way for better outcomes through health education and symptom management.Methods Cardiovascular and emergency departments in three tertiary general hospitals at the capital city were accessed to recruited AD patients from June 2017 to February 2018 upon approval.The general information sheet,35-item adapted Memorial Symptom Assessment Scale(MSAS)including three AD symptoms(i.e.loss of consciousness,hemorrhage and paralysis)was used to collect background data,AD knowledge,self-care ability,smoking/drinking habit as well as experience of symptoms in terms of frequency,severity and bothering impact.Patients withhypertension also answered the 8-item Morisky Medication Adherence Scale(MMAS)to inform the compliance with pharmaceutical treatments.The content validity of adapted MSAS was determined through the 3-expert panel,while its reliability was examined using the pilot test which also examined the feasibility of study protocols.The SPSS 22.0 was used to perform frequency and descriptive analysis,while the overall and dimensional scores of adapted MSAS between groups were compared with Independent t-test,Mann-Whitney U test and one-way Analysis of Variance(ANOVA).Results A total of 88 eligible AD inpatients were recruited with 100%100%of administered questionnaires being returned back and 96.59%of which being valid.Patients aged from 25-81(Mean ± Standard Deviation,51.2±2.1)years old,and the ratio of male to female was 2.7:1(62:23).Slightly more than half(57.6%)patients lived in cities,and approximately one third(31.8%)reached the middle/secondary level of education.The number of patients classified as Stanford B was nearly twice that of type A patients.The content validity index for the adapted MMAS is 0.771,while the internal reliability(Cronbach's alpha,?)is 0.832,suggesting that the adapted MMAS have satisfactory validity and reliability.Using this scale a total of 22 symptoms were identified to be experienced within 7days after patients'medical consultation or before hospitalization,including those experienced during the onset.With this scale a total of 22 symptoms were reported to be experienced within seven days before the medical consultation or inhospitalization,including those experienced during the initial onset.That is,pain(92.9%),shortness of breath(76.1%),vomiting(71.2%),dizziness(65.8%)and worrying(64.0%).In particular the pain was mainly reaping chest pain(79.7%)reaching the score of 2.87(standard deviation,SD 0.05)for the frequency of occurrence(occasionally=2,frequently=3),3.54(SD 0.12)for the severity(severe=3,very severe=4),and 2.45(SD 0.04)for the degree of distressfulness or bothering(somewhat=2,quite a bit=3),respectively.The statistical analysis shows that the scoring difference of symptom experience between groups by age,sex and Stanford type was significant with all p values smaller than 0.05.The scoring of symptom experience between groups were significantly different between groups by the level of knowledge about AD disease(knowledgeable or not,p<0.05),self-care ability(good or not,p<0.05)and Stanford type(A or B,p<0.05),respectively.For AD patients reporting to have hypertension 63.6%,their MMAS reached the average score of 2.8(SD 1.1)which was classified as poor compliance within the score range of one to four.Conclusion Symptoms experienced by patients upon the disease onset,before the medical consultation or the admission to hospital were diversified,complicated and characterized by the reaping chest pain.Patients' age,sex,Stanford type,smoking habit,AD knowledge and self-care ability had an influence over their symptom experience in terms of the frequency of occurrence,the severity of symptoms,and the degree of distress.To have a deep understanding of symptom experience among AD patients will contribute great to the reduction of misdiagnosis,timely medical support and monitor of high risk population.