The purpose of this study is to conduct focus groups with people like you to discover what symptoms you want to be addressed to manage your pain. Possible interventions might include some education, distractions, games, music as examples, which would be all accessible on a SMART phone. We need your expert advice on how to build your intervention for your heart-related pain and anxiety.

This study targets ACS patients (individuals who have chest pain (unstable angina) and or have had a heart attack)

• Adult ACS participants (all ages) who have (a) had ACS-related pain and/or anxiety, (b) confirmed heart disease by nuclear imaging or chemical /exercise stress test, (c) Canadian Cardiovascular Society Angina Score documented class I, II or III angina, and d) are able to read, speak and understand English will be eligible to participate.

You will be asked to do the following:

• Answer some questions about your employment status, income, marital status, previous health history, and medications that you are currently taking, questionnaires about your level of heart disease. This should take about 2-4 minutes, maximum.
• Grant permission to access your medical files in order to collect information regarding your:  Date of birth, age, medical diagnosis and related medical history, the details of your treatments that diagnosed your heart disease (for example electrocardiograms, cardiac catherizations, stress treadmill test results).

You have the choice of either to participate in a focus group interview of about 5-10 people with heart disease or an individual interview that will be conducted using a semi-structured, open-ended interview guide and will be tape recorded. Broad introductory questions will be asked about your experiences of heart disease and the kinds of symptoms you had with your chest pain.

We will ask you to help design the intervention in terms of the symptoms to be monitored (i.e. pain and anxiety) and the interactive components (i.e. distraction-music, gaming, relaxation breathing techniques) and preferred interface features of the app to include in the intervention.

Focus groups and interviews will be conducted in a meeting room at the Centre for Health and Wellness (the Heart Strong Program) at Brock University.

Secondarily, we will be conducting individual interviews to determine the acceptability of the proposed design of the intervention. You have the option of choosing either the first or second set of interviews.

There is no direct benefit for participants participating in phase 1 of this project.  However, for ACS patients and HCPs it may provide the ability to inform development and design a digital health care intervention for use in contemporary emergency departments. With sequential usability and feasibility testing of the proposed intervention, the HE♥RT-PAiN-SMART-ACS may have the potential to change the way in which heart attack related pain and associated symptoms are assessed and treated in emergency room settings and at home.

Secondarily, this intervention may assist our scientific community in particular, nurses and doctors with access to patients’ ongoing cardiac pain severity and anxiety levels with downloadable real time data capture.

Thirdly, overall the HE♥RT-PAiN-SMART-ACS intervention project has the potential to reduce unnecessary health and economic care burden and improve cardiovascular outcomes for those suffering with debilitating ACS.

Prodromal Symptoms are those vague, short-lived, infrequent, troublesome symptoms that can occur before a severe heart attack of angina attack that are definite warning signs that a person has or is developing heart disease.  Some people have described unusual symptoms such as, night sweats, dizziness, shortness of breath, sleep disturbances, increasing fatigue, anxiety or headaches as example happening days, weeks, months before they ended up in the hospital with a heart attack or angina attack.

Adult men and women (all ages) will be recruited if they have heart disease and are able to read, speak and understand English.

You will be asked to do the following:

• Answer some questions about your employment status, income, marital status, previous health history, and medications that you are currently taking, questionnaires about your level of heart disease. This should take about 2-4 minutes, maximum.
• Grant permission to access your medical files in order to collect information regarding your:
  • Date of birth
  • Age
  • Medical diagnosis and related medical history
  • The details of your treatments that diagnosed your heart disease (for example electrocardiograms, cardiac catheterizations, stress treadmill test results).
• Participate in a focus group interview of about 6 to 8 people with heart disease, that will be conducted using a semi-structured, open-ended interview guide and will be tape recorded. Broad introductory questions will be asked about your experiences of the warning signs of your heart disease. (1 to 1½ hours)
• We will ask you to help us look at the existing tool and verify that the symptoms contained in the original tool that are still worth including, to make sure no PS are left out of the revised PS-SS.
• Each focus group will be conducted in a meeting room at the Health and Wellness Centre at Brock University and the Niagara Health System – St. Catharines site.

• This study will help change the way in which heart attack related prodromal warning signs and symptoms are screened and assessed in the hospital
• Assist nurses and doctors to screen people at high risk for development of heart disease, possible early diagnosis, individualize risk profile modification plans and allow timely cardiac treatment interventions.
• Help decrease disability and death associated with heart disease.