Information Needs of Myocardial Infarction Patients: An Integrative Review

Abstract

Cardiovascular diseases including myocardial infarction, heart failure, heart attacks and other related risk factors are on the rise in Pakistan. This heart disease is generating a high burden of coronary artery disease on healthcare services and becoming a leading cause of death in developing countries like Pakistan. Health information is an integral part of patient education and ultimately for patient care. Thus, understanding the information needs of heart patients are seriously important and essential in ensuring quality care, controlling heart diseases and improving the self-care abilities of heart patients alongside the advanced medication and treatment strategies. This integrative review intends to outline information needs of patients with myocardial infarction (MI) and related symptoms such as heart failure (HF), and heart attack (HA). The present integrative review has used the methodology of (Whittemore & Knafl, 2005) to analyze the existing literature on information needs of MI patients. This integrative review includes qualitative, quantitative, and peer-reviewed research articles that have been published from 2001 to 2020 in the databases of Scopus, PubMed, and Web of Science. Those studies are included to summarize and understand the information needs of MI patients from multiple perspectives that have addressed the objectives of this paper. Out of 15 published articles, 9 used quantitative research design and 6 used exploratory qualitative research approach. Out of 9 quantitative studies, four adopted HFLNI scale, three adopted CPLNI scale, and rest of three developed/adapted a new scale. Out of six qualitative studies, four used interview methods and two used focus group technique to collect data from MI patients. The top most information needs were identified related to “signs and symptoms management; medication, physical activities, risk factors, diet, psychological factors and treatment and hospitalization”. The less important information needs were including “anatomy and physiology; postoperative complications; discharge instructions; disease management strategy; emergency care; lifestyle factors; community support; and counseling about sexual activity”. The study also found unmet information needs due to disparity in the provision of information to MI patients. This review has identified several similarities in information needs of MI patients across studies. The findings of this review may be helpful for heart specialists, cardiologists, healthcare professionals, heart care organizations, and researchers to assess and provide the preferred information to MI patients for disease control and high-quality cardiac care.

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University of Nebraska - Lincoln University of Nebraska - Lincoln
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Spring 3-1-2021
Information Needs of Myocardial Infarction Patients: An Information Needs of Myocardial Infarction Patients: An
Integrative Review Integrative Review
Nazeer Hussain
PhD Student, Institute of Information Management, University of the Punjab, Lahore, Pakistan
,
ha7znazeerhussain@gmail.com
Khalid Mahmood
Institute of Information Management, University of the Punjab, Lahore, Pakistan
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Hussain, Nazeer and Mahmood, Khalid, "Information Needs of Myocardial Infarction Patients: An
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1
Information Needs of Myocardial Infarction Patients: An Integrative Review
By
Nazeer Hussain
PhD Student, Institute of Information Management, University of the Punjab, Lahore, Pakistan
hafiznazeerhussain@gmail.com
Khalid Mahmood
Professor, Institute of Information Management, University of the Punjab, Lahore, Pakistan
khalid.im@pu.edu.pk
Abstract
Cardiovascular diseases including myocardial infarction, heart failure, heart attacks and other
related risk factors are on the rise in Pakistan. This heart disease is generating a high burden of
coronary artery disease on healthcare services and becoming a leading cause of death in the
developing countries like Pakistan. Health information is an integral part of patient education
and ultimately for patient care. Thus, understanding information needs of heart patients is
seriously important and essential in ensuring quality care, controlling heart diseases and
improving the self-care abilities of heart patients alongside the advanced medication and
treatment strategies. This integrative review intends to outline information needs of patients
with myocardial infarction (MI) and related symptoms such as heart failure (HF), and heart
attack (HA). The present integrative review has used the methodology of (Whittemore & Knafl,
2005) to analyze the existing literature on information needs of MI patients. This integrative
review includes qualitative, quantitative and peer-reviewed research articles that have been
published from 2001 to 2020 in the databases of Scopus, PubMed and Web of Science. Those
studies are included to summarize and understand information needs of MI patients from
multiple perspectives that have addressed the objectives of this paper. Out of 15 published
articles, 9 used quantitative research design and 6 used exploratory qualitative research
approach. Out of 9 quantitative studies, four adopted HFLNI scale, three adopted CPLNI
scale, and rest of three developed/adapted a new scale. Out of six qualitative studies, four
used interview methods and two used focus group technique to collect data from MI patients.
The top most information needs were identified related to “signs and symptoms management;
medication, physical activities, risk factors, diet, psychological factors and treatment and
hospitalization”. The less important information needs were including “anatomy and
physiology; postoperative complications; discharge instructions; disease management strategy;
emergency care; lifestyle factors; community support; and counselling about sexual activity”.
The study also found unmet information needs due to disparity in the provision of information
to MI patients. This review has identified several similarities in information needs of MI
patients across studies. The findings of this review may be helpful for heart specialists,
cardiologists, healthcare professionals, heart care organizations and researchers to assess and
provide preferred information to MI patients for disease control and high quality cardiac care.
Keywords: Health information needs; Myocardial infarction; Heart failure; Heart attack;
Integrative review

2
Introduction
Globally, heart diseases (HDs) are the foremost cause of and the largest single
contributor to morbidity and mortality and may dominate in future. Comparatively, the rate of
mortality is high in in low-to-middle-income countries for men and women due to the
cardiovascular diseases (CVDs) including coronary artery, cerebrovascular, rheumatic and
other diseases (CDC, 2021; WHO, 2021). Developing countries including Pakistan are equally
affected by non-communicable diseases such CVDs across the world (Afrose & Qamar, 2018).
Heart disease risk factors are on the rise that cause of ischemic, chronic, acute
myocardial infarction, heart failure, heart attack and coronary artery diseases in all over the
world particularly in developing countries. Thus, the adult natives of subcontinent have
generally a high burden of CVDs and myocardial infarction, coronary artery, ischemic. The
CVDs are now the leading cause of death across the world, specifically in the subcontinent
(Hafeez, Javed, & Kayani, 2010). Whatsoever, myocardial infarction (MI) is a critical heart
disease which leads to quick death or serious complications. Moreover, MI and its precursors
are a life-threatening problems and its globally prevalence is significantly increasing in both
developed and developing countries (Mechanic & Grossman, 2021; Sanchis-Gomar et al.,
2016). It is an established fact that the major risks contributing to CVDs can modified with
life-style changes (Carlsson et al., 2013). However, patients generally fail to adhere correctly
to medical advice or to change their unhealthy behaviors that produces the causes of continuous
hospital readmissions (Greco et al., 2016; Odegaard et al., 2011).
Previous research exhibits that important characterizes such as behavioral change,
adherence to medicaments, reducing psychological distress, increased satisfaction and greater
disease control are associated with the appropriate and effective provision of health information
to the patients (Booth et al., 2005; Greco et al., 2016). Generally, the outcomes of providing
information to patients are positively reported. Undoubtedly, empowering patients with
information that they want increases their knowledge, improves functional ability, reduces
stress and facilitates coping, well-being and personal control, enhance patients’ competency;
develops self-management, self-care and inculcates compliance with treatment; and decreases
dependency on health services (Ormandy, 2011; Shu-Fen et al., 2017).
Information need is an identification of inadequate knowledge to achieve an aim (Mai,
2016) within a situation or context that anyone finds oneself at a specific point in the time”.
Concerning health-related information, people compare their current knowledge level against
their health goals. a perceived gap drives them to seek further health information to satisfy their
needs of detailed information about health issues, such as illness symptoms, medicine or

3
surgery information, prevention or treatment choices, type of health services (Abrahamson et
al., 2008; Wilson, 2008; Zhao et al., 2019).
Patients are the individuals who require information about their disorders or conditions
in a way to be enabled them in finding appropriate medical services, reducing risks of their
illness, controlling their diseases, recognizing the side effects of medicines, and making
informed health decisions about their care and treatments. Patients’ preferred information
needs are related to the aspects of their diagnosis, variety of symptoms, treatment, and side
effects of therapy (Güleser, Taşci, & Kaplan, 2012). Prior studies highlight that the heart
patients’ information needs are very important required to be met. The evidences suggested
that the heart patients perceived information needs as important with preferences related to risk
factors, symptoms management, diagnosis, medication, cardiac anatomy and physiology,
treatment, diet and physical activity (Astin et al., 2008; Greco et al., 2016).
A systematic review underlines that patient education is seriously important and
essential in controlling heart diseases and improving the self-care abilities of heart patients (Yu
et al., 2016). Correspondingly, understanding what type of information the patients need to
know is essential to ensure quality care (Rutten et al., 2005), and enhance effectiveness and
efficacy of education in reducing hospitalization. Moreover, provision of needed information
about care and treatment algorithms (clear, undoubted, concise treatment pathways)
encourages effective interaction with clinicians, reduces limitations of patients’ functional
ability produced by the disease, and endorses patient active involvement in making health
decision. Therefore, assessment of information needs is apropos to make education more
tailored, patient-oriented (Yu et al., 2016) and effective involvement in treatment decision
making of heart patients (Decker et al., 2007).
Purpose of the Integrative Review
This integrative review intends to examine the quantitative research to date in order to
identify, evaluate, and summarize the patterns of health-information needs of patients with MI
precursors. A focused literature review reveals that various quantitative and qualitative studies
are carried to investigate and explore health-information needs of patients with the antecedents
of MI (Scott & Thompson, 2003); however, scarcity is found for an integrative study. The
scope of this review is then expanded to design a comprehensive study to integrate the patterns
of patients’ information needs related to MI precursors for potential implications. The study is
primarily intended to facilitate cardiac health professionals and heart related organizations in
developing heart patients’ education programs, patient-clinician communication and health
decision-making and to provide an important methodological resource in the field.

4
Methods
The integrative review is an approach to explore the literature, critically appraise,
synthesize, and summarizes the empirical facts, results, and outcomes published in preiveis
research in order to make effort for in-depth understandings, and apprehension or identify
aspects of the phenomenon being researched and create new knowledge (Anthony & Jack,
2009; Torraco, 2016). The present integrative review is guided by the methodology of
(Whittemore & Knafl, 2005) as it consists of five strategic steps including identifying problem,
searching, evaluating, analyzing literature, followed by synthesizing and presenting results as
illustrated in Figure 1. The reason of using Whittemore and Knafl’s approach is as it allows to
include diverse data sources such as qualitative explorations, quantitative investigations, and
grey literature to reflect a problem. Thus, an extensive literature search is carried out in
accordance with Whittemore and Knafl’s methodology to evaluate what has been presently
explored about patients’ information needs related to myocardial infarction. This study is also
intended to identify gaps in existing research and suggest future research that may target the
information needs of heart patients (Whittemore & Knafl, 2005).
Search Methods
Databases. A comprehensive search strategy has been formulated to identify empirical
literature from online databases including PubMed, Web of Science and Scopus according to
the flowchart of literature search presented in Figure 2. A hand-searching in various journals
(for the articles not indexed in databases) has also been conducted.
Search strategy. Different keywords are used to search and identify research studies
addressing the information, learning and educational needs of heart patients to ensure a robust
and definitive conclusion (Whittemore & Knafl, 2005). A list of keywords used in online
databases is presented in search query.
Search Query. The following search query is applied to locate literature in the selected
databases in the fields of title, abstract and keywords.
("information needs" OR "informational needs" OR "information requirements"
OR "informational requirements" OR "information wants" OR "informational
wants" OR "information preferences" OR "informational preferences" OR
"learning needs" OR "educational needs" OR "care needs") AND ("myocardial
infarction*" OR "coronary artery*")
Figure 1. Whittemore and Knafl’s Methodology for Integrative Review
Identifying
the problem
Conducting
a structured
literature
search
Appraising
the quality of
data
Extracting &
analyzing
the data
Synthesizing
& presenting
the findings

5
Figure 2: Flowchart of Literature Search
Inclusion criteria. The inclusion criteria for selecting and synthesizing articles is based
on the studies of (1) peer-reviewed; (2) addressing adults with age (≥60 years); (3) being
published in English; (4) using qualitative and (5) quantitative research. Although the inclusion
of all available related research is ideal for a study based on integrative review; however, a
justifiable sampling decisions can be applied in order achieve the objective of review timely
and cost-effectively (Whittemore & Knafl, 2005).
Total articles identified [N= 4578]
PubMed (n= 3,995)
Web of Science (n= 159)
Scopus (n= 424)
Duplicates Removed [N=285]
Titles and Abstract Screened [N=4293]
Full Articles Screened [N=21]
Excluded [N=4272]
Excluded [N=6]
Posters=2
Out-dated=4
Systematic Review=1
Included Articles [N=15]

6
Exclusion criteria. The studies were excluded if published under (1) Non-English
languages; (2) focus on children or younger subjects (<25 years); (3) psychometric
measurements/ assessments or tool developments; (4) study protocols, posters, unpublished
dissertations, conference abstracts, or commentaries; (5) systematic reviews; (6) focusing on
congenital heart disease or did not explore information needs. Only the primary article is
included if multiple articles have been articulated on a single research study.
Results
Out of 21 studies related to patients’ information needs about MI, 15 published studies
met our inclusion criteria. Out of 15 included studies, three have used CPLNI, five have
adopted HFLNI and two studies have developed or adapted their data collection tools. Whereas,
two exploratory studies have been carried out using focus group technique and four with
interview method as presented in Table 1. Most important domains of information needs for
patients with MI, HF and HA are including “risk factors, sign and symptoms management,
information about medication, diet, physical activity and treatment” have been indicated that
patients are required for their heart health.
Identification of studies
A searched is being made in selected databases to locate studies on patients’
information needs, learning needs, educational needs, information preferences, etc. related to
myocardial infarction and its precursor such as heart failure, heart attack using any media or
methods. Literature searched is made in the database including: Scopus, PubMed and Web of
Science. Bibliographies of relevant papers have been searched and experts in the field
contacted. Studies used either quantitative or qualitative method have been included to gather
data on the self-perceived information needs of MI patients.
Quality Assessment
Quality assessment shows that majority of selected studies f=9(60%) have used
quantitative research approach (Boyde et al., 2009; Clark & Lan, 2004; Fredericks, 2009; Kim,
2013; Shu-Fen et al., 2017; Smith & Liles, 2007; Timmins & Kaliszer, 2016) and f=6(40%)
have employed qualitative approach (Astin et al., 2008; Decker et al., 2007; Hanssen, 2005;
Harding et al., 2008; Kimani et al.,2018; Yu et al., 2016). Quantitative studies have used cross-
sectional survey, descriptive and correlational methods. On the other hand, four qualitative
studies have used open and closed-ended in-depth interviews (Astin et al., 2008; Hanssen,
2005; Kimani et al.,2018; Yu et al., 2016) and two studies have employed focus group (Decker
et al., 2007; Harding et al., 2008) as method of data collection. All the studies clearly stated the
study purpose or objective.

7
Table 1: Characteristics and outcomes of studies that quantify or explore information needs of patients’ with myocardial infarction and its precursors
Author (Year)
Objective
Methods & Setting
Sample
Characteristics
Top Information Needs
Conclusion
Astin et al., (2008)
 Explored information
needs of patients treated
with heart attack
angioplasty
Qualitative/ Interview
conducted among post
discharge patients
29 angioplasty
HA patients
Male= 17
Female=12
- Risk of recurrence
- Heart muscle damage
- Discharge medications
- Physical activity
- Diet
- Patients were satisfied with health information
provision and it should be individualized to
reflect patients’ preferences.
Baert et al., (2019)
 Investigated information
needs HF patients
regarding sexual activity
and problems
Quantitative/ Survey
self-administered at hospital
74 HF patients
Male= 54
Female=24
- Counselling about sexual
activity
- Relationships
- Symptoms
- Relaxation
- Patients needed information about counselling of
sexual activity, relationships and relaxation
Boyde et al., (2009)
 Investigated learning style
and learning needs of HF
patients
Quantitative/ Survey
administered at
hospital
55 HF patients
Male=38
Female=17
- Signs and symptoms
- Prognosis
- Patients preferred learning style
- read/write
- auditory
- kinaesthetic
Clark & Lan, (2004)
 Examine the perceived
learning needs of HF
patients
Quantitative/ Survey
administered after post
discharge
33 HF patients
Male=16
Female=17
- Signs & symptoms
- Medications
- Prognosis
- Risk factors
- General HF Information
- Diet
- Activity
- Psychological factors
- Due to lack of information about disease, patients
could not be able to participate in assessments and
did not have awareness about diagnosis of
disease.
Decker et al., (2007)
 Describe MI patient
preferences for
involvement in decision
making
Qualitative/ Focus Group
conducted at cardiac center
19 MI Patients
Male=15
Female=4
- Event and emergency care.
- Treatment and hospitalization.
- Discharge instructions.
- Transfer to home.
- Rehabilitation and recovery.
- Information needs changed as the patient
progressed to recovery
- Clinicians would assess preferences and increase
awareness of evolving information needs
Fredericks, (2009)
 Identified learning needs
of CABG patients
 Examined the
relationships between
identified LNs and
demographic variables
Quantitative/ Survey
administered at Hospitals
38 CABG Patients
Male=29
Female=9
- Physical activities
- Recognizing complications
- Medication
- Anxiety
- Emotional reactions
- Symptoms management
Learning needs significantly related to
-patients’ age
- gender
- cultural background
- level of education

8
Author (Year)
Objective
Methods & Setting
Sample
Characteristics
Top Information Needs
Conclusion
Hanssen (2005)
 Explored information
needs and preferences
for follow-up contact
Qualitative/ Focus Group
conducted after discharge from
hospital
14 AMI Patients
Male=12
Female=2
- Hospital stay
- Coming home
- Patients’ follow-up preferences
Patients had unmet information needs
regarding
- in-hospital and
- Post-discharge.
Harding et al., (2008)
 Explored information
needs of CHF patients to
generate guidance for
appropriate information
provision to patients and
their families
Qualitative/ Interview
conducted in-hospital
20 CHF patients
Male=16
Female=4
- Symptoms management
- Symptom control efficacy
Patients had poor understanding regarding
- Symptoms management
- Symptom control efficacy
- Disease progression and future care
- Absence of discussion with staff
- No choices offered for managing
future exacerbations
- Confusion regarding implications
of diagnosis
- Living with inadequate information
that create uncertainty& anxiety
- Psychological morbidity
- Inability to plan appropriately
Ivarsson et al., (2009)
 Determined information
types needed after MI to
patients and their partners
about sexual and
relationships
Quantitative/ Survey
administered at
Coronary care units
MI patients at
73 Hospitals
- Counselling on sexual activity
- Relationships
- Symptoms
- Relaxation
- Patients perceived cardiac specialists did not have
sufficient competence and information regarding
the topics of sexual and coexistence
Kim, (2013)
 Assessed the learning
needs of HF patients
Quantitative/ Survey
administered at hospital
121 HF Patients
Male=80
Female=41
- Signs and symptoms
- Medication
- Risk factors
- General HF information
- Prognosis
Korean patients had
- Lower learning needs than
Western countries.
- Low level of knowledge
- Not recognise the importance
of being informed
- Depend on their physicians to
make health decisions.

9
Author (Year)
Objective
Methods & Setting
Sample
Characteristics
Top Information Needs
Conclusion
Kimani, Murray,
& Grant, (2018)
 Explored the experiences
of patients living and
dying with HF
Qualitative
(Interview)
18 HF patients
Female=10
Male=8
- Information about illness
- Prognosis
- Self-care
- Lifestyle changes
- Prevention strategies
Patients experienced
- Physical, psychosocial, spiritual and
financial distress
- Unmet needs for information about illness
- Not know how it would affect
them and how they could get better.
Shu-Fen et al., (2017)
 Investigate the learning
needs of HF hospitalized
patients
Quantitative/ Survey
administered at hospital
97 HF Patients
Male=69
Female=28
- Signs & symptoms
- Risk factors
- General HF information
Medication
- Patients required essential information before
discharge in line with reducing risk of
readmissions, and learning needs.
Smith & Liles, (2007)
 Explore the information
needs of MI patients who
have received treatment
before their discharge
from hospital.
Quantitative/ Survey
administered at hospital
20 MI Patients
Male=17
Female=3
- Medications
- Complications & symptoms
- Treatment & activities of living
- Need information before discharge
Timmins & Kaliszer,
(2003)
 Assessed post-MI
patients’ perceptions in a
cardiac education
programme at 1st week
 Compared their
perceptions 1st week with
6th week after the event
Quantitative/ Survey
administered at hospital
27 MI Patients
- Physical activity
- Symptom management
- Medication information
- Lifestyle factors
- Sexual activity
- Patients required to be educated for the provision
of important information to enable them to focus
on recovery and prevention from disease.
Yu et al., (2016)
 Assessed information
needs of older people with
HF
Qualitative/ Interview conduct
among HF patients at hospital
26 HF Patients
Male=15
Female=11
- HF patients had little knowledge
of disease
- Coping strategies want to learn
manage their disease.
Living with inadequate information
- Content of INs
- Motivators for information learning
- Barriers to information acquisition
- Preference for information delivery
HF= Heart failure
HA= Heart attack
MI= Myocardial infarction
AMI= Acute myocardial infarction
INs= Information needs
LNs= Learning needs

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Furthermore, out of 15 selected studies, four adopted HFLNI (Boyde et al., 2009; Clark
& Lan, 2004; Kim, 2013; Shu-Fen et al., 2017), three CPLNS or PLNS (Fredericks, 2009;
Smith & Liles, 2007; Timmins & Kaliszer, 2016), and two used developed or adapted
questionnaires (Baert et al., 2019; Ivarsson et al.,2009) for data collection. Gerard and Peterson
(1984) formulated an instrument “Cardiac Patient Learning Needs Inventory (CPLNI)” for
their study that was consisted of 43 items segmented into 8 domains: “cardiac anatomy &
physiology, risk factors, medications, psychological concerns, physical activity information,
dietary information, introduction to CCU and miscellaneous information”. Each category
contains between four and seven items and the patients were asked to rate on two Likert-type
scales. Additionally, a miscellaneous section as well as an open question were added at the
closure of the tool (Gerard & Peterson, 1984) as presented in Table 1.
Similarly, the tool “Heart Failure Learning Style and Needs Inventory (HFLNI)”, is a
blend of two formerly validated survey tools (Clark & Lan, 2004; Fleming & Mills, 1992)
including (VARK: visual–aural–read/write–kinesthetic) and modified (Outpatients HFLNI).
The HFLSNI consisted of 46 closed-response items; 13 multiple-choice; and one open-ended
question segmented into 8 domains such as “risk factors, signs & symptoms, prognosis,
medications, psychological factors, activity, diet, and general heart failure information” (Clark
& Lan, 2004; Fleming & Mills, 1992) as presented in Table 1.
As the two studies were found non-CPLNI and HFLNI (Baert et al., 2019; Ivarsson et
al.,2009). These studies used different instruments and produced heterogeneous results. A
narrative summary is quantitative as well as qualitative studies presented in the meta-analysis.
Discussion
The present integrative review tends to synthesize previous research produced to
investigate and explore perceived information, learning and educational needs of MI patients
as well as the study addressing the precursors of MI. Although several studies have focused on
learning, educational and information needs of MI patients; however, the study in hand is the
first integrative review that has synthesized empirical literature concentrating on information
needs of MI patients.
A focus group based study by Decker et al. (2007) had explored information needs of
MI patients. The study explained the key information needs were including “event and
emergency care; treatment and hospitalization; discharge instructions and clear understanding
about map of directions”. The study concluded both the role of the patient in decision making
and information needs changed as the patient progressed from the acute event to recovery.
Moreover, well informed patients reported active involvement in their rehabilitation and
recovery and they took a very proactive role in re-establishing their health. Another similar

11
study by Harding et al. (2008) underlined the HF patients’ major information needs including
“symptoms and management understanding of disease, symptom control efficacy, and disease
progression and future care”. Astin et al. (2008) synthesized and highlighted the important
information needs of patients with heart attack including a “need for more specific information
about the risk of recurrence, the level of heart muscle damage, discharge medications,
appropriate levels of physical activity and diet”. The study concluded that health information
provision should be individualized to reflect patients’ preferences.
Yu et al. (2016) underlined that HF patients were living with inadequate
information, poor understanding of heart disease, inadequate knowledge of medication and feel
uncertainty about coping strategies. However, the study summarized the important information
needs of HF patients were regarding “risk factors, medication, and disease management
strategy.” The study concluded that by addressing patients’ information needs, health
professionals therefore could assist patients to adapt and manage their disease effectively.
Kimani, Murray, and Grant (2018) explored the information needs and found out that the HF
patients experienced physical, psychosocial, spiritual and financial distress. The study
summarized the important information needs were “information about illness, how it affects
and be recovered better, symptoms and responsive treatment”.
CPLNS studies reported highly important information needs of MI patients were related
to “medications, complications and physical activities” alongside “driving, returning to work
and community support” (Smith & Liles, 2007). Second study based on CPLNS added the most
frequently learning needs including “performance of physical activities, recognizing the
complications, prevention and management of sudden swelling, decreasing and avoiding
postoperative complications, and dealing with chest and/or incision pain (Fredericks et al.,
2009). Furthermore, another used CPLNS and identified highest ranks of information domains
including “symptoms management; medication information; lifestyle factors; anatomy and
physiology” (Timmins & Kaliszer, 2003).
The studies based on HFLNI or HFLNI suggested that HF patients’ top information
needs in post-discharge settings were related to the topics of “signs and symptoms,
medications, diet, activity, and psychological factors” (Clark & Lan, 2004). Similar, another
such type of study highlighted that HF patients wanted to learn educational topics including
“signs and symptoms followed by prognosis” (Boyde et al., 2009). The descriptive and
exploratory study of Kim (2013) assessed the learning needs of HF patients HFLNI. The study
indicated that HF patients had a low level of knowledge about heart failure and did not
recognize the importance of being informed about their disease., which was why Korean
patients with heart failure tended to depend on their physicians to make decisions related to

12
their health management. Later on, the study of Shu-Fen et al. (2017) revealed that HF patients
wanted to learn about “signs and symptoms, risk factors, general HF information, and
medications”. However, the topics relating to diet, activity, and psychological factors were
poorly valued.
The non-CPLNI or non-HFLNI studies (Baert et al., 2019; Ivarsson et al.,2009)
reported that the patients and their partners did receive adequate oral or written information
about sexual function and coexistence, besides it is a central aspect of human life and
wellbeing. However, the important information needs of MI patients were related to sexual
function and coexistence with their partners (Ivarsson, Fridlund, & Sjoberg, 2009). The second
similar study also indicated the important information needs of HF patients regarding the topics
of “counselling about sexual activity, relationships, symptoms and relaxation” (Baert et al.,
2019).
Limitations
Due to the inclusion of small body of literature, several limitations can hinder the
generalizability of integrative review. First, only three databases such Scopus, PubMed, and
Web of Science were selected to search literature on the information needs of MI patients.
Therefore, social desirability bias could be a potential confounder of including studies.
Methodologically, only a few studies were identified using qualitative and quantitative research
approaches that could not address extensively and provide a complete picture of a MI patient’s
information needs and ultimately capture the results. Additionally, symptomatic information
needs of patients with MI disease were only assessed in a minimal number of studies. There
were to this integrative review. Moreover, other limitations include the selection of only peer-
reviewed articles, exclusion of non-English studies, gray literature, reports, thesis, systematic
reviews, etc. might yield additional findings. Lastly, the author has made filtered search in
selected databases (PubMed, Web of Science and Scopus) and fields (Title, Abstract and
Keyword) within the time span of 2001 to 2020 that may unable to determine all published
articles.
Despite the limitations, the studies indicated that MI patients had unmet information
needs after discharged from hospital as they were served inadequately and could not be
provided appropriate information about follow-up support (Hanssen, 2005). Additionally, the
health staff did not provide proper information regarding the symptoms; therefore, the patients
and their carers severely lacked understanding of chronic heart failure condition (Harding et
al., 2008). Alike the study of Yu et al. (2016) exhibited that HF patients had inadequate
knowledge of their information needs. They did not have understanding of heart disease,
medication and coping strategies. The study of Kimani et al. (2018) found out that the HF

13
patients had unmet needs for information about their illness, how it would affect them and how
they could get better. However, the study of (Astin et al., 2008) indicated that the patients were
found satisfied with the provision of health information after discharge from hospital.
Therefore, it was suggested that older and retired people would be given more attention
to deliver information than younger and employed patients (Smith & Liles, 2007). Similarly,
the learning needs are differed by gender as the male patients reported a higher needs of
information than their counterparts in addition to across cultural groups and age groups
(Fredericks et al., 2009).
Conclusion
Findings of this integrative review demonstrates that the MI patients exhibited the key
information needs related to “anatomy and physiology; risk factors; signs and symptoms;
symptom control efficacy; treatment and hospitalization; prognosis; medication; emergency
care; psychological factors; physical activity; lifestyle factors; disease management strategy;
diet; discharge instructions; community support; postoperative care and sexual activity”. The
studies reviewed indicated that a disparity in providing proper information to MI patients is
existed and several included studies found unmet information needs among the patients with
myocardial infarction including heart failure, heart attack, etc. Although some differences
among subgroups are existing, this integrative review has identified several similarities in
information needs of MI patients across studies. Assessments of information needs among MI
patients is found in Pakistan. Healthcare organizations and researchers can use the results from
this integrative review to design health-information needs assessments, compare the results that
they obtain with those previously disseminated, and to inform higher quality service provision.
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