Study Explores Gendered Experiences of Post-Heart-Attack Recovery

Men and women recovering from acute myocardial infarction in a nine-person Spanish study initially became more motivated to change their lifestyles, but their capacity to sustain those changes differed according to work, family responsibilities, health limitations and social expectations. Women more frequently described fatigue, mobility-limiting conditions, employment insecurity and a rapid return to household duties, while men more often described finding time to walk and resuming work with limited changes. The qualitative findings do not establish biological differences between the sexes or prove that gender caused these outcomes. Instead, they show how the social roles attached to men and women may shape the practical experience of recovery after hospital discharge.

Researchers used an interpretative phenomenological design to examine how nine adults described the changes they believed were necessary after a myocardial infarction. Participants were recruited through post-infarction follow-up at two urban primary healthcare centres in Spain. Four identified as women and five as men; none identified as non-binary. Their ages ranged from 44 to 78 years. Although both centres served neighbourhoods with relatively high socioeconomic indicators, the final group also included people with limited economic resources. Interviews were conducted between March 2022 and December 2023, usually at participants’ homes or in private rooms, and lasted approximately one hour. The researchers audio-recorded and transcribed the interviews verbatim before applying deductive and inductive thematic analysis in ATLAS.ti.

Recruitment continued until the investigators judged that no new themes or insights were emerging. They considered nine participants sufficient for the study’s specific objectives and relatively homogeneous group, a sample size described as consistent with thematic saturation in focused qualitative research. Two researchers conducted the interviews, while the wider team refined the coding through comparison and consensus discussions. Credibility was supported through participant validation and reflective dialogue, and transferability through purposive sampling with maximum variation and detailed descriptions of the setting. The design explored lived experience rather than clinical endpoints, so it did not measure whether any intervention improved survival, symptoms or cardiovascular risk.

The analysis produced three themes: mobilizing personal and behavioural resources, engaging with emotions, and experiencing follow-up from the healthcare team. Participants commonly reflected on habits preceding the infarction, including diet, alcohol consumption, smoking, stress and work. Several treated the event as a turning point that required new priorities, healthier routines and a degree of self-protection. Walking was the most frequently described form of physical activity, and smoking cessation appeared among the more persistent changes. Yet participants also described returning to familiar routines over time. Their accounts therefore showed that initial motivation did not automatically translate into sustained adherence, particularly when recommended activities competed with fatigue, work, caregiving or limited mobility.

Women in this sample described more difficulties maintaining physical activity than men. Post-infarction tiredness was a recurrent concern: one woman said she became breathless after tasks that had once been manageable, while an older participant reported greater difficulty climbing stairs. Preexisting illnesses, including joint problems, also restricted movement for some participants. One 61-year-old woman distinguished between incidental walking and a deliberate exercise routine, attributing her limitations to a knee problem. By contrast, men more often described walking as something they could fit into an existing daily structure, and one man said that having more time during sick leave allowed him to walk more. These observations describe patterns within the sample; they do not establish that women generally exercise less after myocardial infarction.

Employment was another major source of contrast. Men in the study generally described returning to work without substantial adjustment. Women reported job loss, insecure conditions and concern that prospective employers would view them as unreliable because of their cardiac history. One woman said, “They sacked me and now I cope as best I can.” Another explained that employers did not see her as being “100%” and expected that she might take more sick leave, which she said made new employment difficult. The study’s analysis linked these experiences to gendered economic and employment circumstances rather than treating job loss as a direct physiological effect of the infarction. Whether the same patterns occur in larger or more diverse populations remains unknown.

Household responsibilities also changed only temporarily for several participants. Partners and children initially helped women with cooking and domestic work, encouraged them to rest and allowed them to resume activities gradually. One participant described how the routine quickly returned to normal. Men reported little change in their household roles, with spouses continuing to carry most domestic tasks. Within this sample, therefore, recovery unfolded around established expectations about paid work, caregiving and the distribution of household labor. The authors interpret this as evidence that pre-existing social roles can reassert themselves after discharge, but they caution that the findings should not be generalized automatically to every woman or man. Gender was examined as a framework for social roles, expectations and power relations, not as a replacement for individual assessment.

Recovery also involved conflicting emotions. Participants expressed guilt about what they regarded as poor choices before the infarction, including smoking, diet or insufficient attention to their health. A 44-year-old woman said she wondered whether behaving differently might have prevented her condition. Fear of another event or sudden death was widespread. One 51-year-old man described the death of a friend during a padel match and the resulting question of whether the same might happen to him. A 58-year-old woman recalled being afraid to fall asleep because she might not wake again. Relatives sometimes shared this vigilance. These accounts identify fear, guilt and vulnerability as part of participants’ recovery experience, but the small qualitative sample did not quantify their prevalence or establish effects on clinical outcomes.

Participants were generally positive about emergency care but described post-discharge information and follow-up as sparse, vague or inconsistent. Advice about diet, smoking and exercise was sometimes basic, and one participant said she had received no recommendations before leaving hospital. Instructions concerning driving and returning to work were not always explained, leaving some participants uncertain. Many expected early contact with a cardiologist but instead encountered delays, an unclear plan or primary-care follow-up focused on other chronic conditions. One man said, “I even don’t know who the cardiologist is.” Most participants had not taken part in a cardiac rehabilitation programme, and the investigators suggested that limited availability in the study area may have contributed. Sexual changes, including reduced libido among some men, were rarely discussed with clinicians despite medication and age potentially being considered by participants.

Based on these experiences, the authors proposed a broader nursing assessment after myocardial infarction. They recommended evaluating functional capacity, fatigue, comorbidities, emotional wellbeing, household and caregiving duties, employment conditions, family support and the practical feasibility of lifestyle recommendations, rather than assuming needs from sex or gender categories. They also described potential roles for individualized goals, motivational interviewing, medication and symptom education, brief emotional support, scheduled follow-up and coordination among hospital care, primary care and cardiac rehabilitation. With a patient’s agreement, relatives could participate in education and goal setting, although the study participants said little about how families actively shaped healthy habits. The authors further proposed that mobile applications and connected devices might complement these services where structured rehabilitation is limited, while stressing affordability, accessibility, digital literacy and equity. The study did not test a digital intervention or the effectiveness of any nursing approach, so these remain proposed implications rather than demonstrated benefits.

Subject of Research: Gendered experiences of lifestyle change, employment, emotional responses and healthcare follow-up during recovery after acute myocardial infarction.

Article Title: Users' Experiences During Cardiac Recovery Following Acute Myocardial Infarction: A Qualitative Study With a Gender Perspective

Article References: Santos‐Ruiz, S., Jerez‐Molina, C., Rodriguez‐Romero, R., Zamora‐Sánchez, J. J., & González‐De Paz, L. (2026). Users' Experiences During Cardiac Recovery Following Acute Myocardial Infarction: A Qualitative Study With a Gender Perspective. Nursing Open, 13(10), Article e70886. https://doi.org/10.1002/nop2.70886

Image Credits: AI Generated

DOI: 10.1002/nop2.70886

Keywords: myocardial infarction, cardiac recovery, gender roles, qualitative study, cardiac rehabilitation, self-care, employment, patient experience, nursing care, healthcare follow-up, Users', Experiences