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Funding Acknowledgements Type of funding sources: Public Institution(s). Main funding source(s): Liverpool John Moores University Background  The Covid-19 pandemic has resulted in excess mortality. With efforts to reduce population movement and the spread of the disease, non-emergency patients are deterred from seeking help. Reduction in the number of patients presenting with acute cardiac conditions has dropped significantly, impacting initial and follow-up treatment. In a national survey, 71% reported they were afraid to visit hospital due to fear of being exposed to the virus, and 46% worried about putting pressure on the health service. Internet searches for chest pain symptoms increased following the announcement of lockdown and public health messages, suggesting an influence of government messaging on patient behaviour. Current work suggests that patients are turning to informal support networks to facilitate decision making, while more formalised networks are blocked. Purpose  To qualitatively explore decision making of patients and their family members’ when faced with an acute cardiac event. This methodology provides insight into why patients made said decisions, and what factors influenced their decision making, during the Covid-19 pandemic. Methods  A qualitative methodology was employed using purposive sampling of cardiac patients, who had attended hospital during a Covid-19 lockdown. Data was collected using semi-structured, digitally recorded, telephone or video call interviews. Interviews were transcribed verbatim and subjected to thematic analysis. Results  Twenty-four participants were recruited, from three sites throughout England.  Three themes were generated from the study Reliance on informal support network, including disclosing their symptoms to family and friends, in turn leading to displaced or co-decision making. Secondly, a lack of awareness of cardiac symptoms leading to delayed help-seeking. Finally, an indirect Covid-19 effect, in which patients suggest that Covid-19 did not influence their decisions, yet a perception that their condition was non-urgent combined with a belief that GP services were limited resulted in delayed help-seeking Conclusions  Patients have turned to informal health support networks, especially when the cause of symptoms are unknown. While the presence of Covid-19 is not explicitly noted as being influential, indirect effects are noted. Findings highlight the need for informed public health messages, that allow those in need of treatment to access care as and when they need.

Should I stay or should I go? An exploration of the decision-making behaviour of acute cardiac patients during the Covid-19 pandemic