“Shortly Afterwards I Was Practically Dead”—Temporal Experiences of Middle-Aged Individuals With Heart Disease: An Interpretative Phenomenological Analysis

Abstract

Changes in the experience of time have originally been described in mental disorders within the framework of the phenomenological psychopathology of the lived time. Both phenomenological and qualitative empirical studies have shown that physical illnesses, such as cancer or chronic pain, can be accompanied by a change in experienced temporality. Likewise, the sudden onset of severe heart disease in early and middle age represents a biographical break for the patient and can lead to numerous changes in the experience of time. In our qualitative study, a purposive sample of sixteen patients aged 30–59 years was included. Of these, four patients had sudden cardiac arrest, seven had myocardial infarction, and five had other severe cardiac diseases. Phenomenological semi-structured interviews were conducted and analyzed using interpretative phenomenological analysis. Patients reported that their temporality changed after serious heart disease. The experience of the participants can be summarized in five themes: “Heart disease as a biographical turning point,” “The clock can stop any moment,” “Feeling prematurely aged by heart disease,” “Other people’s time is not my time,” and “Just living in the moment.” From a psychocardiological perspective, a temporal analysis of severe heart disease can help caregivers understand and support patients better. Further studies should be conducted on cardiac patients with a lower disease burden, sex-specific issues, and young cardiac patients with congenital heart disease.

Introduction

Disturbed experiences of time have been described and discussed for over 100 years in the context of mental illness (e.g., Juckel et al., 2022; Kupke, 2009). The so-called psychopathology of the lived time (Minkowski, 1933/1971) was strongly inspired by Bergson (1920/2006, 1927), Husserl (1928/1980), and Heidegger (1927/2006). In contrast to the objectivist concept of time as an a priori container, these life philosophers and phenomenologists understood temporality as extended, closely interwoven with human intentionality, and oriented toward the future. Philosophical reflections like these led to temporal analyses of mental disorders (Minkowski, 1933/1971; Straus, 1928/1963). In the paradigmatic case of melancholic depression, patients report a slowing down of the flow of time, an impoverishment of the future perspective, and a stronger dominance of the past. At present, initial investigations have been confirmed and deepened by contemporary phenomenological and qualitative research (Fuchs, 2013; Stanghellini et al., 2017; Vogel et al., 2018). In addition, in recent years, a variety of other disturbed temporal experiences have been reported in mental illnesses (Moskalewicz & Schwartz, 2020) such as schizophrenia (Stanghellini et al., 2016; Vogel et al., 2019), post-traumatic stress disorder (Broschmann, 2023; Micali, 2022), and addiction (Kemp, 2009).

Temporality also plays a crucial role in somatic medicine: it is “medicine’s necessary axis – in diagnosis, prevention, palliation, or cure” (Charon, 2006, p. 44). Chronic physical illnesses affect the experience and organization of time. Toombs (1995) described a rupture in life due to the diagnosis of multiple sclerosis, loss of hope for the future, and a shortened perspective. In her phenomenological analysis of chronic illness, using the example of a progressive lung disease, Carel (2016, 2018) analyzed the rupture with the previous experience of bodily coherence, the experience of a shrinking future in middle age, and the presence of death in life. Qualitative empirical studies have also demonstrated that patients’ experience of temporality is altered by severe physical illnesses, such as HIV (Zhou, 2010), chronic pain (Nilsen & Elstad, 2009; Råheim & Håland, 2006), or in conditions of gynecological cancer (Laranjeira et al., 2015; Moskalewicz et al., 2022).

Disturbances of temporality can also be suspected in cardiovascular diseases (CVDs). The heart is often understood as the “motor of life.” Therefore, in most cases, surviving a cardiac event is a life-changing experience in a person’s life. CVDs such as myocardial infarction (MI) account for 32% of global deaths (World Health Organization, 2021). In most developed countries, only 11% of patients survive out-of-hospital cardiac arrest (OHCA) (Gräsner et al., 2011). Recent qualitative research—also in a parallel study (Broschmann et al., 2025)—has shown that serious cardiac diseases, such as MI, lead to profound bodily insecurity and lifestyle changes (Aristidou et al., 2018; Haydon et al., 2017). Haydon et al. (2017) also described an interruption in the biographical flow of time, a sudden confrontation with death, and a shortening of the expected future (Haydon et al., 2017). Similar temporal experiences have been described in most qualitative works on patients with sudden cardiac arrest (SCA); however, data on this have not been systematically collected (Bremer et al., 2009; Forslund et al., 2014; Ketilsdottir et al., 2014; Palacios-Ceña et al., 2011; Whitehead et al., 2020).

Using an existential-phenomenological approach, Aho (2019, 2022) reported his experience after a heart attack as feeling trapped in a meaningless present with a limited horizon for the future and suddenly feeling prematurely old. Empirical findings indicate that younger patients with MI are increasingly experiencing fragility of life (Allison & Campbell, 2009; Andersson et al., 2013; Merritt et al., 2017). Psychocardiological research has shown that patients affected by heart disease at an earlier stage of life are often more psychologically impaired (Yusuf et al., 2004) and have a lower quality of life (Edelmann et al., 2011) than older patients. Since heart disease is usually considered a disease of the elderly, it can be assumed that disturbances in temporality also occur in a more distinctive form in younger and middle-aged patients. Although there have been initial results on temporal phenomena in heart disease, there is a lack of systematic qualitative investigations on altered temporality in people with severe heart disease, especially when they are affected prematurely. In clinical and psychological practice, it can be assumed that a lack of understanding of altered time experiences in cardiac patients can lead to communication problems, a deteriorated therapeutic relationship, and impaired patient adherence.

Study Focus and Aims

In dealing with the current state of research, our question for the study presented here is which changes in the experience of time are reported in patients with heart disease who, from an epidemiological point of view, are affected by the disease prematurely, namely, in middle age (between 30 and 59 years).

Methods

Theoretical Background

The methodological basis of this study was interpretative phenomenological analysis (IPA). IPA is a qualitative analysis method that allows for an understanding of people’s lived experiences and is well-established in the field of health psychology (Brocki & Wearden, 2006). IPA studies have been conducted on fatigue syndrome (Arroll & Senior, 2008), chronic back pain (Smith & Osborn, 2007), and stroke at a young age (Dwyer et al., 2019). IPA is an in-depth analysis that investigates how people make sense of lived experiences and has an ideographic focus; it works out the attribution of meaning and the personal horizon of meaning of the experiences made. The IPA has methodological origins in phenomenological and hermeneutic-interpretative research traditions (Smith et al., 2022).

Phenomenology is a philosophical movement that goes back to the beginning of the 20th century, when Husserl tried to investigate the “things themselves.” Husserl argued that implicit phenomena in everyday life are obscured by prejudices from idealistic or materialistic thinking. Bracketing one’s own prejudices could be a method for investigating everyday phenomena (Husserl, 2009, p. 40). Husserl also dealt intensively with questions of temporality. In a discussion of Bergson’s concept of duration (durée), Husserl investigated the intentional structures of inner time consciousness; he succeeded in showing that the present is not constructed from now-points but from a network of present impressions, lingering retentions, and anticipatory protentions (Husserl, 1928/1980). Heidegger (1927/2006) gave phenomenology an existential twist: in his early work “Being and Time,” he tried to show that phenomena are buried under our prejudices and must be uncovered. Heidegger argued that time does not exist objectively but temporalizes itself. He also investigated the co-origin of the temporal ecstasies of the future and past in the present, and analyzed the experiences of finitude through the phenomenon of being-toward-death (Heidegger, 1927/2006). Finally, Merleau-Ponty analyzed the bodily being-to-the-world of human existence and distinguished between the material and the lived body (Merleau-Ponty, 1966/1974). In his temporal analysis of the lived body, Merleau-Ponty showed that temporality should not be viewed as something separate from human beings; instead, the subject itself must be understood as time (Merleau-Ponty, 1966/1974, 480).

In contrast to phenomenology, hermeneutic philosophy is a science that has its origins in text interpretation and was developed scientifically by philosophers like Gadamer (2010) and Ricœur (1984). Hermeneutical scope involves understanding narratives, texts, and other people. Narrating and interpreting are processes in which human beings are doing all the time, and sometimes prejudices might help them get in contact with another person or text (Gadamer, 2010). In his work, Ricœur (1984, p. 51) showed that through narrative temporality acquires a human character and that narrative only acquires its “full meaning” through temporality. Bruner called the temporal difference between the original experience and the narrative “narrative diachronicity” (Bruner, 1991). Owing to the temporal, diachronic, and situational character of the narrative, there is not such a thing as an objective phenomenon in hermeneutic philosophy but the possibility of reflecting own assumptions and prejudices from an “outside perspective.”

Sampling Approach

This study was approved by the Ethics Committee at the University Medical Center Göttingen on 19.01.2022 (approval no. 18/8/20). All participants provided written informed consent before enrollment in the study. The study protocol was drafted in accordance with the Declaration of Helsinki. Registration took place on 19.01.2022 at the German Trials Register under project number DRKS00028096. The study participants were recruited by physicians or psychologists at a university hospital during their inpatient hospital stay between March 1 and December 31, 2023. The inclusion criteria were middle-aged patients with cardiac conditions (30–59 years) which are treated in an acute cardiological or psychocardiological setting because of the symptom burden of the disease. We included all types and etiologies of cardiac diseases. The exclusion criteria were insufficient German language skills, pronounced cognitive impairment, or severe mental illness (e.g., addiction, schizophrenia, or severe depression). The intention was that mental illnesses are common among cardiac patients; however, the experiences of patients with severe mental disorders could be overlaid by their mental symptoms.

A recruitment strategy using posters and brochures with detailed information on the study objectives and participant eligibility was used and distributed in the clinical setting. Furthermore, we informed the hospital wards (from cardiological and psychocardiological settings) about the project and the inclusion criteria. In most cases, ward physicians and psychologists provide a brochure containing study information to suitable patients. After obtaining information about interest in participating in the study from the patients themselves or the ward team, the research team contacted the patients during their stay in the hospital to make an appointment for a preliminary information session via telephone. During this telephone appointment, informed consent was obtained from the participants; patients were informed in detail about the study’s procedure and focus as well as the pseudonymization and use of the data. Using examples from other somatic (e.g., oncological) diseases, the participants were provided a vivid explanation of the fact that it is known that the perception of time (e.g., the view into the future) can change and that this study is intended to examine heart diseases in this regard. They were also assured that the research team was not clinically active in the ward and that their physicians and caregivers would not receive any information about whether they had participated in the study.

Procedure and Interview

After obtaining informed consent, phenomenological interviews lasting between 50 and 100 minutes were conducted with a member of the research team (see below) in a separate room of the clinic. The interviews were all video and audio recorded and then transcribed verbatim with support from a writing service for analysis. The phenomenological interviews were based on a previously developed semi-structured interview guide (Appendix 1). The interview guide was developed through literature research, reflection, discussion, and reduction processes within the research team. The creation of the interview guide also incorporated reflections that arose from engagements with phenomenological authors (e.g., Heidegger on finitude) and discussions with a team of associated philosophical researchers on aspects of temporality (e.g., time rhythms and rituals; the influence of the past, present, and future; and perceived age). Previously, a semi-structured interview guide was tested on selected patients in the pilot phase. Owing to the pilot phase, the number of questions was reduced, and the questions were simplified again for better understanding. Interviews were conducted with a phenomenological attitude of openness, nonjudgment, and interest in curiosity.

It was important for us trying to enable trust in the participants’ relationships. To obtain good rapport and relevant information about lived experiences, we tried to make the interview schedule as open and flexible as possible, allowing the participants to speak about the issues that are important to them and tell their stories. The interviewer should attempt to keep the questions broad and open-ended and should be sensitive and spontaneous when considering the participants’ answers. The interviewer covered the topics tangentially rather than confrontationally. The interviews were conducted with a focus on relevant topics in response to the patients’ statements. It began with general questions about heart disease (“Would you like to start by telling us about your heart disease?” or “How does heart disease affect your life?”). In most cases, participants had already begun to talk about temporal phenomena, such as escaping death or feeling prematurely aged, since the cardiac event. In these cases, attempts were made to better understand the temporal phenomena experienced by asking questions about specific situations and providing detailed descriptions. If temporal phenomena were not addressed, the topic of temporality was initially addressed very broadly to leave the possibility for various meaningful associations (“How does time feel in your life?” and “Has the heart disease changed anything?”). If participants found these questions too general and abstract, they asked very specific questions about temporality (“How do you think about your own death?”, “What role do mortality and finitude play for you?”, “Are there significant temporal repetitions and rituals in your everyday life?”, “What significance do they have for you?”, “How do you experience your past, present, and future?”, “What roles do they play in your life?”, and “Has the perceived age changed in contrast to the actual age due to the heart disease?”). However, in most cases, it was not necessary to intentionally ask about all areas, as the participants brought them up themselves.

Implementation of the Analytical Approach

A 29-year-old female (L.N.) psychologist and a 36-year-old male physician (D.B.) were equally involved in the data collection and analysis. While both authors have previous experience in qualitative research, the physician has been working in the fields of psychiatry and psychosomatics for eight years and wrote his dissertation in the fields of philosophy and phenomenological psychopathology. The specific sociocultural backgrounds of both raters were reflected and recorded in advance (including sex, age, heterosexuality, educational background, white ethnicity, and religiosity). To ensure methodological rigor, each rater was required to create a document during the pilot phase that presented key background information and associations related to the research topic. This document served as the basis for reflective discussion between the two raters. For example, during this reflective discussion, a memory emerged that one rater had to resuscitate his father because of an acute cardiac event. A meta-level was adopted in the interview, deliberately bracketing this background information, emotional involvement, and preconceptions. Furthermore, each interviewer received feedback from the other after the video recordings were viewed.

After the interviews, first impressions and relevant passages were recorded on a reflection sheet. Each interview was reviewed twice and commented on regarding the conduct of the interviews and interpretation of the themes discussed. The interviews were then transcribed line by line with the support of a writing team according to the transcription rules of Dresing and Pehl (2010). All identifying information (including names, cities, and occupations) was pseudonymized. After the interview was transcribed, each researcher listened again to the interview and read the transcript. The transcripts were transferred to MAXQDA and read again. On second reading, initial exploratory comments were made with linguistic (e.g., a laconic, euphemistic, or verbose language) or conceptual comments (e.g., reflections on “What does it mean for the participant to be old?”). Each researcher then separately coded the initial themes by interpreting the passage as closely as possible to the lived experience and text. In weekly meetings, themes were discussed and a concerted decision was made about the themes. A third person, a sociological assistant with extensive expertise in qualitative research, was often involved in the discussion and evaluation processes. The next step was creating a separate Word file connecting the themes among the participants and finding superordinate and subordinate themes based on similarities and differences. At this level, weekly meetings within the research team took place to discuss themes that were more appropriate for the material. Finally, superordinate themes were identified and condensed into relevant themes for all the participants. Finally, the raters examined in detail whether the coded text passages fit the overarching themes, and what parallels and differences existed between the various interview passages. Due to time and personnel constraints, member checking was omitted.

Results

Sixteen participants aged 30–59 years were recruited for the study. There were no dropouts due to the inclusion criteria or patient decisions. Data saturation was achieved after conducting thirteen interviews. To ensure that no additional time phenomena were reported by the other participants, we conducted three additional interviews; the last three participants had the function checking that no additional themes emerged from the material. Only minor sub-aspects of the themes were found, and no new themes were found. Of the 16 participants, ten were male and six were female. The median patient age was 49 years. Among the 16 participants, four had SCA, seven had MI, and five had other severe cardiac conditions, such as cardiac arrhythmia. Eleven participants had mental disorders such as major depressive disorder, post-traumatic stress disorder, or anxiety disorders. In most cases, mental illness is diagnosed only after the onset of the heart disease. The participants represented a wide range of professional and social backgrounds, ranging from academics to craftspeople and early retirees. One person had other than German cultural background. We found five major recurring themes in the interviews, which are described in more detail below: (1) “Heart disease as a biographical turning point,” (2) “The clock can stop at any moment,” (3) “Feeling pre-aged by heart disease,” (4) “Others’ time is not my time,” and (5) “Just living in the moment.”

Heart Disease as a Biographical Turning Point

An acute cardiac event interrupts everyday life and creates a new chronology: the time before the event and that after the event. Experiencing an acute cardiac event is a physically threatening and frightening situation, and participants often described it as a turning point, especially if the person becomes ill at a younger age, and thus prematurely. They report experiencing acute symptoms in the middle of everyday life such as fainting, severe pain, and/or struggling to breathe. In some cases, the acute situation is preceded by non-specific complaints such as dizziness, back pain, or fatigue, which are often misinterpreted by patients. Participants feel helpless and anxious; often, time is pressing, and immediate help is needed. Johannes, for example, is perfectly healthy at the age of 30 when he suddenly faints at work, just before climbing onto a construction scaffold, and must be resuscitated by his colleagues. Like most participants, the disease attacks him “out of nowhere,” after he got up in the morning without any symptoms. Sarah (37 years), a young mother, also reports that she suddenly and unexpectedly developed cardiac arrhythmia from a state of health:

Well, that was completely new to me. So, I was 30. And until then, I never thought that anything bad could happen to me. And from one day to the next, I was seriously ill and was really afraid that I would not be able to get out of it.

Sarah reports the destroyed illusion of health and basic trust that nothing bad will happen to her in the future. While she had previously experienced herself as a healthy person, she suddenly finds herself developing heart disease. Frank (45 years), a patient with MI and CAD, also describes the suddenness of the event, which represented a biographical turning point:

Well, what can I say? It came suddenly, without warning. It was a heart attack, a myocardial infarction. I then found out that they had resuscitated me twice and I was in a coma ... And then it comes all at once, and then it is just like that in that moment. It turns your life by 180 degrees, I would say.

In the further interview, Frank explains what he means by saying that life has turned “180 degrees” owing to the heart disease:

Yes, it is just not anymore, especially the future is no longer the way I would like it to be. Somehow. Something is missing. I said yes, I want to continue to actively do something everywhere and so on ... The way I feel right now in terms of strength, endurance, I tell myself: it will never be again.

The biographical break thus affects participants’ identity from healthy to heart-sick people, who are aware that things will not be the same in the future as they were before the heart disease. Most participants had difficulty processing the drastic experience, found it difficult to connect with their healthy past, and struggled to adapt to the new situation.

The Clock Can Stop at Any Moment

The anticipation of one’s own finitude and the limitation of one’s lifespan has played a central role in the history of Western philosophy, since before Heidegger’s (1927/2006) phenomenological investigations in “Being and Time.” However, for the participants, it is not an abstract representation in the sense of being-to-death, which leads to more authenticity; rather, it is a concrete experience of death owing to an acute cardiac event, which makes the future horizon shorter and more uncertain. Being suddenly torn from life and being seriously ill confronts the participants with the possibility of dying prematurely. The image of death becomes more concrete, especially if patients had an SCA and had to be resuscitated. Being “escaped from death” (Henriette, 51 years, cardiac sarcoidosis) becomes an existential experience that frightens the participants. Death and dying thus become real possibilities that can occur at any time in the participants’ lives. Georg (52 years), a patient with recurrent cardiac arrhythmia, summarized the experience of sudden death from health and everyday life.

I got up from the sofa, did not think anything bad and shortly afterwards I was practically dead.

The drastic and absurd nature of the situation becomes clear by describing everyday situations from the outside. The participants’ experiences of being suddenly dead shake them to their foundations. Georg describes this profound uncertainty as follows:

And it can / I am still sitting here and talking to you and go out the door and then / (...) It could just have been the end.

The abstract realization that one can die at any time can mature anyone; it becomes a life-threatening experience that is concrete and vitally threatening. Paula (59 years), a patient with CAD and a history of MI, also described the risk of falling dead at any time:

Many die in the first year and have another heart attack. You live every day with this feeling that you are really on the hit list. That is hard. That is really hard.

Paula used the metaphor of the hit list to make a military comparison, implying the personification of death, which could shoot one down at any time. This underlines the experience of being at the mercy of others, of injustice, and of possibly dying at any given time. Paula’s future horizon has drastically shortened and has become more uncertain because of the experience of being on the hit list for death. Sarah (37 years) also complained that she could no longer make plans for the future:

But since … you cannot predict whether my condition will remain stable for the next 10 years. Whether it—I don’t know… drastically change in the next two weeks. It is hard for me. […] I already have the feeling; there is always a sword of Damocles hovering over me.

The constant possibility that the physical situation deteriorates or leads to SCA makes long-term planning impossible for Sarah; therefore, she agrees with her spouse to not have another child. For some participants, the prospect of dying at any time also led to considerable time pressure to get things done or enjoy life. However, some participants attempted to prepare for this final possibility. To gain control over the feeling that they could stand still at any moment, some participants engaged in health-related decisions. Eddy (52 years) thought about advance health directives:

Well, recently, the advance health directive has been in the drawer and then /. To prepare myself, I do not know, but to prepare for the fact that the next one [heart attack] might be the last.

In a distant yet impressive manner, Eddy stated that the next heart attack could be fatal. Like Eddy, Barbara (57 years) also deals with legal options, illustrating how the future horizon has narrowed and become more uncertain:

I talked to my children about the will, becoming a nursing case, everything you do, asked if everything was okay, if there was anything between us (sighs). And that is what I always do now. There is nothing between us and everything is always told. That means if I drop dead tomorrow (cries), no one can say (cries) that something is open.

In contrast to Eddy, Barbara expresses herself more emotionally in view of her potential death. Barbara does not want to be a burden to her children; when she dies, everything should be settled, and there should be no more open conflicts. The feeling of having everything sorted gives patients control over what is happening.

Feeling Pre-Aged by Heart Disease

One’s own perceived age represents a temporal experience that is connected to the lived body (Merleau-Ponty, 1966/1974): while the experience of bodily fitness opens a space of possibilities about the future, a loss of bodily trust and bodily possibilities after a cardiac event can close off the future horizon. In one fell swoop, not only are finiteness and fear of death consciously experienced in the lives of patients with heart disease, but most participants also suddenly feel pre-aged. While the participants were previously in the middle of life and had little or no need to think about their own bodies, the acute cardiac event and chronic heart disease left them physically compromised and dependent on medications, devices, and/or outside help. While a few participants experienced resuscitation as rebirth and felt younger, most felt frail and older. Klaus (54 years), a former competitive athlete, described sudden physical deterioration.

So, it was really the case that you were happy when you got up a floor, as I said. Because we have the bedroom upstairs. I was 34 years old. It felt like 84. That you practically must work your way up the stairs step by step on the handrail and when you are at the top, you must stop first, must take a deep breath so that you have gathered strength again. So that you are able to reach the bed.

For Klaus, as for most of the other participants, the feeling of being pre-aged comes from a reduction in power and, thus, the speed of the lived body. Some participants feel only a few years older than their peers, while others feel like their grandparents. Frequently, there is a discrepancy between a pre-aged body and a young mind, as in the case of Barbara (57 years), a former nurse.

It is with old ladies, if you wash them in the hospital, when they are 70, they do not have any muscles anymore, like I do NOW. That is when I think I somehow feel much older than I am, and in my head, I always think I'm always me [...].

In particular, participants reported losing their pace of life due to heart disease. Eddy, a 52-year-old patient with a history of MI who enjoys doing handicrafts at home besides his work as a craftsperson, also experiences the heart attack as drastic:

Yes. Slowed down to zero, slowed down from 100% to zero. And you don't need that. If I were 60 or 70 now, then life would be quieter anyway. But like this. All my creative power comes to a standstill. When I say I am going to work, and I have had a lot of work so far. I am very unhappy now.

Eddy cannot be satisfied with the reduced pace of life but struggles with it because working is a central part of his life. Participants realize that they must adapt to the new life situation and “slow down.” On one hand, they no longer feel able to cope with the demands of the disease; on the other hand, they would otherwise maneuver themselves back into a dangerous situation. However, at first, the participants could not enjoy this deceleration as a timeout. Instead, it feels “strange, still wrong,” as Peter (40 years, cardiac valve insufficiency and CAD) states.

Others’ Time Is Not My Time

In the participants, the cardiac event also leads to a phenomenon of temporal experience that phenomenologist Fuchs (2013) called “desynchronization” in depressive patients: all participants describe experiences of not feeling in tune with other’s time. This experience occurs both in contact with physicians and other people who can live without heart disease. The slowing pace of life plays an important role, as does the loss of the time structure of daily routines.

The divergence from the time of the treating person arises from the fact that the participants do not feel that their justified fear of developing a serious illness has been taken seriously. Time is of the essence for participants as something must be done quickly while the practitioners are engaged in their daily routines. When Paula (59 years) presents herself to a general practitioner, she is sure that she has acute coronary syndrome because of her chest pressure:

And then I went to the doctor, the next day or something, and I said, “I kind of (sighs) have heart problems,” if you could give me an ECG. And then my doctor says: “No, I do not have time, I must vaccinate. It is vaccination day.”

While Paula rightly perceived the heart symptoms as threatening and that time was running out for her, the general practitioner did not seem to give them any importance. He did not take time for them and remained with his weekly algorithm. Georg (52 years), who initially had unclear severe cardiac arrhythmias, also wanted the doctors to take time to diagnose his heart condition and talk to him:

But sometimes I asked, and I often had the feeling that I might have expressed myself badly, and that perhaps the time factor played a role again. The doctors did not have the time either, but I do not really feel that anyone has ever taken the time to explain it to me in more detail.

Due to time pressure in hospitals, there is little time for ward rounds, and Georg feels that he is not getting the information he needs; thus, no real relationship of trust can be established. However, there is also asynchronicity, as patients do not have time to process emotions owing to the rapid sequence of events. Sarah (37 years) also describes this experience of “not being able to keep up”:

So, I think in retrospect I was completely overwhelmed with all these diagnoses and decisions that appeared relatively quickly. So, I did not have the capacity to question it much or think about it.

The image that emerges is that diagnoses and decisions are passed on by the patient rapidly. Patients must passively endure them without being able to understand or influence them. Sarah described a dyssynchronous experience with the treatment team: for her, the steps of medical diagnosis and treatment occur too quickly, while for practitioners, they are everyday routines. Henriette (51 years), who had an implantable cardioverter defibrillator installed because of cardiac arrhythmia, described a similar situation:

So, this feeling, Wednesday surgery, on Tuesday, I should have been operated on Monday and on Tuesday, Wednesday it was only decided. So, this period in between now, I did not even know what to expect […] Actually, you were left alone. So, it is all the time now. Yes. And then came the defibrillator.

Henriette’s chaotic narrative style suggests that the patient is overwhelmed by events even in retrospect and can only integrate the fragments into a chronological sequence with some difficulty. Although the life situation of the participants has changed considerably to a life-threatening acute situation, the experience of medical treatment, and living with a chronic illness, they experience that, for others, life continues as before its structured daily routine. Thorsten (59 years) describes a change in attitude after a heart attack:

My attitude towards others has changed because they do not change much. They are who they are, with only small changes here and there. But overall, they keep living their lives the same way.

Thorsten attempts to demonstrate that there are two aspects: normal temporality and the everyday life of people who have an open horizon for the future. That of him as a heart patient, who has a shorter horizon, is preoccupied with his illness and cannot participate in the everyday life of others. The feeling of being left behind by the timelines of others also arises from the experience of suddenly aging ahead and no longer being able to keep up with the pace of others. Often the daily structure is “completely lost” (Johannes), especially when participation in working life is no longer possible owing to illness. Patients are also unable to understand the “ordinary” problems of everyday life and feel excluded from a normal way of life.

Just Living in the Moment

The time perspective of the participants was drastically reduced. Planning is no longer possible because of the risk of cardiac death at any time, and the future horizon is becoming shorter and more uncertain. Some participants—like Georg (52 years)—also report that they have “no future in mind.” Instead of offering opportunities for personality development, the future appears to be threatening. Most participants report that they only “shimmy” from one day to the next or “live in” the day, while a long-term view is no longer possible. While the participants were forced to plan from one moment to another, they mentally dealt with past events or worries about their future. In contrast, an increased awareness of finiteness also creates the desire to be more aware of the present. Sarah describes, for example, that owing to the heart disease, she no longer feels like she is in the “hamster wheel of daily life”:

So, for me it is nice to sit in the sun with a coffee and watch my children play. So, then the thought often comes: It is nice that you are doing well right now. And you can see this. […] I manage to be in the now for the first time. Because I feel that time is valuable, which I did not do before.

However, for some, such as Peter (40 years), enjoying life also means taking breaks and resting.

Okay, I am so full of life right now. It just feels good. I could now also lie down on the couch and fall asleep, which I would never have thought. Currently, I would not have any problems with it.

Like Sarah and Peter, who live more in the present owing to heart disease and have learned to pursue their own needs (including the need for enjoyable rest), Johannes sums this up.

I do not know, because actually, I actually live every day as it should be, so I try to enjoy everything, everything as it is.

There is an openness to each new moment here, as Johannes reported, while the aspect of self-planning recedes into the background. The conscious experience of being in the moment appears to be a secondary and positive experience that develops in response to heart disease.

Discussion

In the present study, we found that interpretive phenomenological analysis was particularly valuable for investigating the experience of time in individuals with heart disease. Therefore, using IPA as a methodological basis is beneficial and is a strength of this study. On one hand, it focuses on lived experiences from a phenomenological perspective. However, experiences of time often become apparent only in the subtext of what is described, necessitating a hermeneutic-interpretive approach. The results of our study showed that the individuals examined in this context (an acute care unit at a university hospital in Western Europe) and with this severity of illness had an altered experience of time. This change of temporality can be summarized in a slightly different formulation of the results: they reported a biographical break that divided life into before and after the cardiac event and reported that death is a constant companion—in a way that time could still stand at any moment. This has led to a changed perspective on the future, which is more uncertain and shorter. Participants also felt older than their peers, which was partly a consequence of declining physical performance and partly a consequence of a more fragile existence with a narrower future horizon. The participants also reported a discrepancy between their own time and that of their treating physicians and other people who simply continued to live their lives. As a coping strategy, the participants stated that since their heart disease, they had become more aware of the present and were more in the here and now.

Changes in the experience of time reported by prematurely affected middle-aged patients with severe heart disease have been partly described through case studies by Aho (2019, 2022) using a holistic existential-phenomenological approach. However, empirical work on the altered experience of time in heart disease has often addressed only a few aspects of temporality (e.g., a break in continuity or awareness of finitude). Furthermore, previous studies have not focused on the experience of time itself. Rather, the results were primarily collected in the context of other research questions, such as general experiences of illness, quality of life, well-being, and experiences of meaning (cf. Haydon et al., 2017). Nevertheless, the discovery that research with an entirely different focus ultimately reveals insights into a transformed perception of time reinforces the assumption that the phenomenology of time experience is essential for understanding the experience of heart patients, as evidenced by findings in other chronic somatic diseases (e.g., Moskalewicz et al., 2022; Råheim & Håland, 2006). To our knowledge, this is the first study to focus on multiple forms of altered time experience in middle-aged patients with heart disease and to systematically investigate them.

Compared with our systematic recording of altered time experiences in heart disease, there is a significant overlap with other studies regarding the first two emerging themes. A temporal break in everyday life can be found in various studies: in a metasynthesis by Haydon et al. (2017), which deals with the quality of life of patients after SCA, a “disruption in the continuum of time” is described. This break in biographical flow is also explained by a lack of memory of acute cardiac events. The irritation caused by the loss of consciousness and memory as a manifestation of a biographical break was also described in a study by Bremer et al. (2009). Simultaneously, a drastic near-death experience raises existential questions about one’s finiteness. They also concluded that the “sudden and elusive threat” of OHCA interrupts everyday life and leads to a loss of control and helplessness. Andersson and colleagues (2013) found the theme “outlook: life will never be the same” in a study of young adults after MI in the wake of the biographical break. Similarly, Ketilsdottir et al. (2014) described in the struggle with “emotional challenges,” which is characterized by two distinct but interrelated experiences: a newfound sense of insecurity and profound gratitude for the gift of a new lease on life. Olano-Lizarraga et al. (2021) found in a study of patients with chronic heart failure (CHF) the drastic experience of having become a different person because of the disease. Compared with the studies mentioned above, our study found an additional nuance in that the participants described their truly lived experience of the temporal aspect of the turning point.

Moreover, the theme “The clock can stop any moment” is a common theme in the literature. In the case of severe heart disease, the situation is often not only perceived as life-threatening, but it is life-threatening. It is easy to understand that a near-death experience can lead to death and mortality no longer being just abstract categories but gaining concretion. Haydon et al. (2017) elaborated on the theme of “Confrontation with death” in their metasynthesis, which includes a confrontation with the finiteness of life as well as a stronger gratitude for life. Andersson et al. (2013) and Ketilsdottir et al. (2014) described a more uncertain future perspective and stronger gratitude for a second chance. Forslund and colleagues (2014) found the theme “Returning to life”: patients who experienced an OHCA had to realize that it was not yet time to die and they were given a second chance in life. Merritt et al. (2017) reported a shortened future perspective and regretted that life was too short in young men after a heart attack. In a study by Allison and Campbell (2009), male post-infarct patients reported that implicit immortality fantasies were lost due to a heart attack. Olano-Lizarraga et al. (2021, 2022) also found that patients with CHF were aware of the possibility of death at any time. In addition, our study captures the constant presence of a Damocles-sword aspect of the expectation of a time ending in a patient’s lived experiences.

In contrast, there was less overlap for the last three themes, suggesting that relevant new aspects of the changed experience of time may be identified. “Feeling prematurely aged by the heart disease” has been addressed in three studies; Allison and Campbell (2009) found that young men also felt very insecure after a heart attack because they associated such a disease with old age. This uncertainty in young male heart patients was also described by Merritt et al. (2017), leaving them wondering if they were still sufficiently stable and had enough time to continue fulfilling the age-appropriate role of a caregiver. In addition, the feeling of pre-aging can also arise from comparison with fitter older people, as participants in a study by Ryan and Farrelly (2009) indicated. The theme “Other people’s time is not my time” shows that heart patients no longer feel that they share a common experience of time with others. Using the example of her severe lung disease, Carel (2016) impressively described the disparity between the patient’s experience of time pressure or boredom and the practitioner’s daily routine or the patient’s excessive demands on the practitioner’s ability to process information. The divergence in time and action pressure in patients and the relatively slow routine of treating physicians were most likely described in female patients with CAD, as in a study by McSweeney et al. (2005). In some cases, we observed similar results in female participants. It is now well-documented that female patients with CAD are often poorly cared for compared to male patients with CAD, as the symptoms are often atypical and practitioners misjudge the severity of the situation (Sadlonova & Nagel, 2019).

Regarding the final theme “Just living in the moment,” there were also points of contact with other studies. In her phenomenological study of illness, Carel (2016, 2018) argued that chronically ill patients with a potentially progressive disease must focus on the present because of the changed time horizon and that this is a clever coping or survival strategy. The future horizon is uncertain and may be associated with increased deterioration. The past is painful because it reminds us of what has been lost. To maintain their quality of life, chronically ill individuals must focus on the present. In a study by Li et al. (2019), patients with CHF reported that a stronger focus on the present was a helpful coping strategy. Our data also support the findings of numerous qualitative studies on patients with heart disease that gratitude for the gift of a new life leads to increased appreciation and mindful awareness of the moment (Broschmann et al., 2025; Forslund et al., 2014; Haydon et al., 2017; Ketilsdottir et al., 2014). This aspect of conscious present shaping can be considered a form of post-traumatic growth, in addition to the aspect of survival mode (Broschmann & Herrmann-Lingen, 2023; Tedeschi & Calhoun, 1995).

Notably, our study included more men than women. All the studies cited above included no or fewer women than men. This is owing to the epidemiological fact that men develop heart disease earlier than women. The initial signs revealed that women with cardiac diseases sometimes make slightly different observations; for example, their symptoms are more often not taken seriously. However, since sensitivity to sex-specific differences has been growing in cardiology research for some years (e.g., Barton et al., 2023), future studies should be supplemented by sex-specific questions. Another point is that, in our study, we recruited most participants from an inpatient psychocardiology setting, which could lead to bias due to comorbid mental illnesses or psychotherapeutic treatment. However, the five participants from a pure cardiology setting without a diagnosed mental illness had the same themes as the 11 participants from a psychocardiology setting. Further studies should also include outpatient and rehabilitation settings, as our study only recruited participants who received acute university inpatient cardiological or psychocardiological treatment during or shortly before the interviews and were recruited in the inpatient setting. In addition, our study included only one person with a different cultural background and two people with a non-heterosexual orientation. This limitation was based on recruitment in an inpatient setting. However, there was a broad professional and social spectrum, from academic professions to craftsmen and early retirees.

Conclusion

The results showed that patients with heart disease as well as those with mental or other physical illnesses perceived lived experiences of altered temporality. Patients with heart disease perceive the disease as a temporal disruption in their everyday lives, feel prematurely aged, and have a limited future horizon threatened by death. They also experience desynchronization with their caregivers and other people and live more in the present, which includes aspects of coping strategies. The results are highly relevant for several reasons. First, they expand the understanding of what it means to develop serious heart disease. In her work on the phenomenology of illness, Carel (2016, 2018) argues that phenomenology, which includes an understanding of the first-person perspective, can contribute to improving epistemic injustice in everyday medical practice. Specifically, the results indicate that the dyssynchronous experience of patients compared to practitioners can make the discrepancy in everyday clinical practice more visible and give informed doctors and nurses an incentive to spend more time communicating with the patient or, in the absence of time resources, involve mental health professionals. Second, the experience of such a threatening situation, which causes a serious break in everyday and biographical continuity, seems to require psychotherapeutic support, especially when it is accompanied by psychopathological symptoms such as depressive experiences, anxiety, or post-traumatic experiences. The opportunity to talk about one’s experiences can help patients understand the occurrence of an acute cardiac event. Third, our results suggest that similar to psychotherapy in cancer patients, approaches to existential and humanistic therapy are also relevant for psychocardiological-psychotherapeutic treatment. Severe heart disease is a limit situation (Broschmann & Herrmann-Lingen, 2023) that allows growth and failure. The themes of death and dying should be included in treatment based on the existential therapy of Yalom (1980) so that patients can find a way to deal with this stressful topic. In addition to a better acceptance of the possibility to die, therapy could also focus on positive changes in the sense of post-traumatic growth, even if these can never outweigh the illness itself. Finally, the desire to live more in the present despite or because of severe heart disease seems to favor mindfulness-based therapeutic interventions (Hayes et al., 1999; Kabat-Zinn, 2003).