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Tra J, van der Wulp I, de Bruijne MC, Wagner C. Exploring the treatment delay in the care of patients with ST-elevation myocardial infarction undergoing acute percutaneous coronary intervention: a cross-sectional study. BMC Health Serv Res 2015; 15:340. [PMID: 26292969 PMCID: PMC4546199 DOI: 10.1186/s12913-015-0993-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/10/2015] [Indexed: 01/14/2023] Open
Abstract
Background A short delay between diagnosis and treatment for patients diagnosed with ST-elevation myocardial infarction (STEMI) is vital to prevent cardiac damage and mortality. The objective of this study was to explore the treatment delay and associated factors in the management of patients diagnosed with STEMI going for percutaneous coronary intervention (PCI). Methods In a cross-sectional multicenter study, the treatment delay (time between first electrocardiogram and start of PCI procedure) of STEMI patients in seven PCI centers in the Netherlands was measured. Data were analyzed by means of multivariable generalized linear models, accounting for a non-normally distributed outcome and clustering of patients within centers. Results In total, 1017 patient charts were included. The majority of the patients (78.7 %) were treated within the guideline recommended time target of 90 min. Overall, the median treatment delay was 64 min (interquartile range 47–82). A significantly prolonged delay was found among patients of whom their first electrocardiogram was performed at a general practitioner’s practice (+23.9 min; 95 % confidence interval 9.9–40.8) or in-hospital (+9.5 min; 95 % confidence interval 2.5–17.3), patients requiring interhospital transfer (+14.6 min; 95 % confidence interval 7.6–22.4) or presenting with acute heart failure on admission (+17.6 min; 95 % confidence interval 7.9–28.7). Conclusions Despite a short median delay between first electrocardiogram and PCI, the time targets are occasionally exceeded for patients diagnosed with STEMI. To further improve the process of care, PCI centers should focus on improving regional STEMI care networks, involving general practitioners, emergency departments and referring hospitals.
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Affiliation(s)
- Joppe Tra
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Ineke van der Wulp
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,The Netherlands Institute of Health Services Research (NIVEL), Otterstraat 118, 3513 CR, Utrecht, The Netherlands.
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102
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Parsons I, White S, Gill R, Gray HH, Rees P. Coronary artery disease in the military patient. J ROY ARMY MED CORPS 2015; 161:211-22. [PMID: 26246347 DOI: 10.1136/jramc-2015-000495] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/27/2015] [Indexed: 01/17/2023]
Abstract
Ischaemic heart disease is the most common cause of sudden death in the UK, and the most common cardiac cause of medical discharge from the Armed Forces. This paper reviews current evidence pertaining to the diagnosis and management of coronary artery disease from a military perspective, encompassing stable angina and acute coronary syndromes. Emphasis is placed on the limitations inherent in the management of acute coronary syndromes in the deployed environment. Occupational issues affecting patients with coronary artery disease are reviewed. Consideration is also given to the potential for coronary artery disease screening in the military, and the management of modifiable cardiovascular disease risk factors, to help decrease the prevalence of coronary artery disease in the military population.
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Affiliation(s)
- Iain Parsons
- Department of Critical Care, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - S White
- Department of Cardiology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - R Gill
- Department of Regional Occupational Health, Queen Elizabeth Memorial Health Centre, Tidworth, UK
| | - H H Gray
- Department of Cardiology, University Hospital Southampton NHS Foundation Trust & Civilian Consultant Advisor to the British Army, Southampton, UK
| | - P Rees
- Department of Cardiology, Barts Health NHS Trust & Academic Department of Military Medicine, London, UK
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103
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Bray JE, Stub D, Ngu P, Cartledge S, Straney L, Stewart M, Keech W, Patsamanis H, Shaw J, Finn J. Mass Media Campaigns' Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign. J Am Heart Assoc 2015; 4:JAHA.115.001927. [PMID: 26150478 PMCID: PMC4608076 DOI: 10.1161/jaha.115.001927] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to examine the awareness of a recent mass media campaign, and its influence on knowledge and prehospital times, in a cohort of acute coronary syndrome (ACS) patients admitted to an Australian hospital. Methods and Results We conducted 199 semistructured interviews with consecutive ACS patients who were aged 35 to 75 years, competent to provide consent, and English speaking. Questions addressed the factors known to predict prehospital delay, awareness of the campaign, and whether it increased knowledge and influenced actions. Multivariable logistic regression was used to examine the association between campaign awareness and a 1-hour delay in deciding to seek medical attention (patient delay) and a 2-hour delay in presenting to hospital (prehospital delay). The median age was 62 years (IQR=53 to 68 years), and 68% (n=136) were male. Awareness of the campaign was reported by 127 (64%) patients, with most of these patients stating the campaign (1) increased their understanding of what is a heart attack (63%), (2) increased their awareness of the signs and symptoms of heart attack (68%), and (3) influenced their actions in response to symptoms (43%). After adjustment for other predictors, awareness of the campaign was significantly associated with patient delay time of ≤1 hour (adjusted odds ratio [AOR]=2.25, 95% CI: 1.03 to 4.91, P=0.04) and prehospital delay time ≤2 hours (AOR=3.11, 95% CI: 1.36 to 7.08, P=0.007). Conclusions Our study showed reasonably high awareness of the warning signs campaign, which was significantly associated with shorter prehospital decision-making and faster presentation to hospital.
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Affiliation(s)
- Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., S.C., L.S., J.F.) Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.) Prehospital, Resuscitation & Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.)
| | - Dion Stub
- Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.)
| | - Philip Ngu
- Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.)
| | - Susie Cartledge
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., S.C., L.S., J.F.) Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.)
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., S.C., L.S., J.F.)
| | - Michelle Stewart
- Heart Foundation, Melbourne, Victoria, Australia (M.S., W.K., H.P.)
| | - Wendy Keech
- Heart Foundation, Melbourne, Victoria, Australia (M.S., W.K., H.P.)
| | - Harry Patsamanis
- Heart Foundation, Melbourne, Victoria, Australia (M.S., W.K., H.P.)
| | - James Shaw
- Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.)
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., S.C., L.S., J.F.) Prehospital, Resuscitation & Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.)
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104
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Sandhu K, Nadar SK. Percutaneous coronary intervention in the elderly. Int J Cardiol 2015; 199:342-55. [PMID: 26241641 DOI: 10.1016/j.ijcard.2015.05.188] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 05/07/2015] [Accepted: 05/09/2015] [Indexed: 12/20/2022]
Abstract
Our population dynamics are changing. The number of octogenarians and older people in the general population is increasing and therefore the number of older patients presenting with acute coronary syndrome or stable angina is increasing. This group has a larger burden of coronary disease and also a greater number of concomitant comorbidities when compared to younger patients. Many of the studies assessing percutaneous coronary intervention (PCI) to date have actively excluded octogenarians. However, a number of studies, both retrospective and prospective, are now being undertaken to reflect the, "real" population. Despite being a higher risk group for both elective and emergency PCIs, octogenarians have the greatest to gain in terms of prognosis, symptomatic relief, and arguably more importantly, quality of life. Important future development will include assessment of patient frailty, encouraging early presentation, addressing gender differences on treatment strategies, identification of culprit lesion(s) and vascular access to minimise vascular complications. We are now appreciating that the new frontier is perhaps recognising and risk stratifying those elderly patients who have the most to gain from PCI. This review article summarises the most relevant trials and studies.
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Affiliation(s)
- Kully Sandhu
- Royal Stoke Hospital, University Hospitals of North Midlands, Newcastle Road, Stoke on Trent ST46QG, United Kingdom
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105
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Hao K, Takahashi J, Ito K, Miyata S, Nihei T, Nishimiya K, Tsuburaya R, Matsumoto Y, Sakata Y, Yasuda S, Shimokawa H. Clinical Characteristics of Patients With Acute Myocardial Infarction Who Did Not Undergo Primary Percutaneous Coronary Intervention- Report From the MIYAGI-AMI Registry Study. Circ J 2015; 79:2009-16. [PMID: 26118344 DOI: 10.1253/circj.cj-15-0440] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND In the current era of primary percutaneous coronary intervention (PCI), some patients with acute myocardial infarction (AMI) still do not undergo primary PCI. METHODS AND RESULTS To examine the clinical characteristics of AMI patients who did not undergo primary PCI, we analyzed patients enrolled between 2002 and 2010 in the MIYAGI-AMI Registry Study, in which all AMI patients in the Miyagi prefecture have been prospectively registered. Among a total of 8,640 patients, 1,879 (21.7%) did not undergo primary PCI and their in-hospital mortality was significantly worse compared with those who did (21.4% vs. 6.4%, P<0.01). Multivariate analysis demonstrated that female sex was significantly associated with non-performance of primary PCI [odds ratio (95% confidence interval): 1.40 (1.22-1.61), P<0.001], along with age [1.01 (1.01-1.02), P<0.001] and heart failure on admission [2.69 (2.29-3.16), P<0.001]. When dividing by age, the non-performance rate of primary PCI in females showed a U-shaped prevalence, whereas it simply increased with aging in males. Importantly, female patients aged <80 years had a significantly higher non-performance rate of primary PCI compared with male patients, regardless of the severity of AMI. CONCLUSIONS These results indicate that in the current PCI era, various factors, including aging, heart failure on admission and sex differences, are associated with non-performance of primary PCI, which remain to be resolved in order to further improve critical care of AMI.
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Affiliation(s)
- Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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106
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Leshem-Rubinow E, Assa EB, Shacham Y, Zatelman A, Oren-Shamir A, Malov N, Golovner M, Roth A. Expediting Time from Symptoms to Medical Contact Utilizing a Telemedicine Call Center. Telemed J E Health 2015; 21:801-7. [PMID: 26431259 DOI: 10.1089/tmj.2014.0227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND No definitive solution has been forthcoming for the often dangerously long interval between symptom onset and seeking medical care in the prehospital setting. We examined the implementation of telemedicine technology and characterization of its utilizers for its efficacy in reducing this possibly life-threatening time lag. MATERIALS AND METHODS A retrospective observational study was performed on the working database of an operational telemedicine facility that included all subscribers. Time-to-contact measurements throughout 2012 were retrieved from its medical files, and data on age, gender, medical history, and main complaint were analyzed. RESULTS Throughout 2012, 22,274 of a total of 46,556 calls (47.8%) were made ≤60 min from symptom onset. It is important that 26.9% of all calls (12,522/46,556) were made in <15 min. Significantly more males (10,794/22,229 [49%]) contacted in ≤60 min compared with females (11,480/24,327 [47%], p<0.03). Subjects <60 years of age (2,889/5,717 [51%]) called earlier than those >60 years (19,386/40,839 [47%], p<0.001). Patients with prior resuscitation and/or myocardial infarction contacted significantly more rapidly than those with other cardiac diseases. Over one-half of patients with cardiac complaints contacted the call center ≤60 min from symptom onset, as did those who suffered physical trauma, but not patients with gastrointestinal symptoms or pain elsewhere. CONCLUSIONS A telemedicine system with rapid accessibility to a professional call center and prompt triage thereafter could be an additional promising strategy for shortening the interval between symptom onset and call for medical assistance. Implementation of a widespread telemedicine infrastructure may bridge the unmet gap between occurrence of symptoms to initiation of medical treatment.
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Affiliation(s)
- Eran Leshem-Rubinow
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Eyal Ben Assa
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Yacov Shacham
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | | | | | - Nomi Malov
- 2 'SHL'-Telemedicine, Israel, Tel Aviv, Israel
| | | | - Arie Roth
- 1 Department of Cardiology, Tel Aviv Sourasky Medical Center, Affiliated with the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
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107
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Impact of a rapid access protocol on decreasing door-to-balloon time in acute ST elevation myocardial infarction. CAN J EMERG MED 2015; 11:29-35. [DOI: 10.1017/s1481803500010897] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
ABSTRACT
Objective:
Ischemic cardiovascular disease is the leading cause of death in Canada. In ST elevation myocardial infarction (STEMI), time to reperfusion is a key determinant in reducing morbidity and mortality with percutaneous coronary intervention (PCI) being the preferred reperfusion strategy. Where PCI is available, delays to definitive care include times to electrocardiogram (ECG) diagnosis and cardiovascular laboratory access. In 2004, the Cardiac Care Network of Ontario recommended implementation of an emergency department (ED) protocol to reduce reperfusion time by transporting patients with STEMI directly to the nearest catheterization laboratory. The model was implemented in Frontenac County in April 2005. The objective of this study was to assess the effectiveness of a protocol for rapid access to PCI in reducing door-to-balloon times in STEMI.
Methods:
Two 1-year periods before and after implementation of a rapid access to PCI protocol (ending March 2005 and June 2006, respectively) were studied. Administrative databases were used to identify all subjects with STEMI who were transported by regional emergency medical services (EMS) and received emergent PCI. The primary outcome measure was time from ED arrival to first balloon inflation (door-to-balloon time). Times are presented as medians and interquartile ranges (IQRs). Statistical comparisons were made using the Mann–Whitney U test and presented graphically with Kaplan–Meier curves.
Results:
Patients transported under the rapid access protocol (n = 39) were compared with historical controls (n = 42). Median door-to-balloon time was reduced from 87 minutes (IQR 67–108) preprotocol to 62 minutes (IQR 40–80) postprotocol (p < 0.001).
Conclusion:
In our region, implementation of an EMS protocol for rapid access to PCI significantly reduced time to reperfusion for patients with STEMI.
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108
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Mooney M, O'Brien F, McKee G, O'Donnell S, Moser D. Ambulance use in acute coronary syndrome in Ireland: A cross-sectional study. Eur J Cardiovasc Nurs 2015; 15:345-54. [PMID: 25805100 DOI: 10.1177/1474515115579134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/06/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND As myocardial salvage is time dependent, prompt emergency department attendance is imperative in the presence of unresolved acute coronary syndrome symptoms. Although ambulance use is the recommended mode of transport during an acute coronary syndrome event, people regularly have misperceptions about its role. Consequently, many fail to use this service when warranted. AIM To evaluate factors associated with ambulance usage among patients admitted to emergency departments with acute coronary syndrome symptoms in Ireland. METHODS Patients (N=1947) diagnosed with acute coronary syndrome were recruited across five hospitals. The ACS Response Index was used to identify mode of transport to access the emergency department, symptom context and experience and the rationale for non-ambulance use. Using logistic regression, predictors of ambulance use were identified. RESULTS Only 40.1% of the sample used an ambulance. The primary reason for non-ambulance use was the perception that it was unwarranted (31%). A further 23.8% thought another mode of transportation would be faster. Independent predictors of ambulance usage differed among the three sub-diagnoses of acute coronary syndrome. For each group, visiting the general practitioner with symptoms was associated with a greater likelihood of not using an ambulance. CONCLUSION The use of ambulance services is not positively embraced by the public. Furthermore, it appears that general practitioners may not always promote its use, particularly in the early stages of acute coronary syndrome symptom onset. The findings from our study suggest that a public education drive is necessary to promote ambulance usage during an acute coronary syndrome event.
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Affiliation(s)
| | | | | | | | - Debra Moser
- College of Nursing, University of Kentucky, Lexington, USA
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109
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Ryu DR, Choi JW, Lee BK, Cho BR. Effects of critical pathway on the management of patients with ST-elevation acute myocardial infarction in an emergency department. Crit Pathw Cardiol 2015; 14:31-35. [PMID: 25679085 DOI: 10.1097/hpc.0000000000000035] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND AIMS Critical pathways (CP) are clinical management plans that provide the sequence and timing of actions of medical staff. The main goal of a CP is to provide optimal patient care and to improve time-effectiveness. Current guidelines for the treatment of ST-segment elevation myocardial infarction (STEMI) recommend a door-to-balloon time of <90 minutes for patients undergoing primary percutaneous coronary intervention (PCI). The aim of this study was to identify the effects of CP on the management of patients with STEMI in an emergency department. METHODS The study population consisted of 175 patients undergoing primary PCI for STEMI who presented to the emergency department of Kangwon National University Hospital (Chuncheon, South Korea) with chest pain from July 1, 2005 to November 30, 2010. We retrospectively analyzed medication use, symptom onset-to-door times, door-to-balloon times, total ischemic times, and the reperfusion rate within 90 minutes. We also measured the 30-day and 1-year total mortality rates pre- and post-CP implementation. RESULTS The effects of CP implementation on the medication use outcomes in patients with acute myocardial infarction were increased between the pre- and post-CP patients groups. The median door-to-balloon time declined significantly from 85 to 64 minutes after CP implementation (P = 0.001), and the primary PCI rate within 90 minutes was significantly increased (57% vs. 79%, P = 0.01). However, the symptom to door time was not changed between the pre- and post-CP groups (150 minutes vs. 149 minutes; P = 0.841). Although the total ischemic time was decreased after CP implementation, it was not statistically insignificant (352.5 minutes vs. 281 minutes; P = 0.397). Moreover, the 30-day and 1-year total mortality rates of the 2 groups did not change (12.0% vs. 12.0%, P > 0.999; 13.0% vs. 17.3%, P = 0.425, respectively). However, the 1-year mortality rates of 2 groups based on a total ischemic time of 240 minutes, which was median value, decreased significantly from 19.0% to 9.0%. (P = 0. 018) CONCLUSION:: Implementation of a CP resulted in greater use of recommended medications and reductions in the median door-to-balloon time. However, it did not reduce the symptom onset-to-door time, total ischemic time, or the 30-day and 1-year mortality rates. Therefore, additional strategies are needed to reduce mortality in patients with acute myocardial infarction undergoing primary PCI.
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Affiliation(s)
- Dong Ryeol Ryu
- From the *Division of Cardiology, Department of Internal Medicine, School of Medicine, Kangwon National University; and †Department of Internal Medicine, Kangwon National University Hospital, Chuncheon, Korea
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Abstract
Point-of-care testing (POCT) refers to any diagnostic test administered outside the central laboratory at or near the location of the patient. By performing the sample collection and data analysis steps in the same location POCT cuts down on transport and processing delays, resulting in the rapid feedback of test results to medical decision-makers. Over the past decades the availability and use of POCT have steadily increased in Europe and throughout the international community. However, concerns about overall utility and the reliability of benefits to patient care have impeded the growth of POCT in some areas. While there is no agreed-upon standard for how success should be judged, the increases in speed and mobility provided by POCT can lead to substantial advantages over traditional laboratory testing. When properly utilized, POCT has been shown to yield measurable improvements in patient care, workflow efficiency, and even provide significant financial benefits. However, important organizational and quality assurance challenges must be addressed with the implementation of POCT in any health care environment. To ensure maximal benefits it may be necessary to evaluate critically and restructure existing clinical pathways to capitalize better on the rapid test turnaround times provided by POCT.
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Affiliation(s)
- Anders Larsson
- Department of Medical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Albert Huisman
- Department of Clinical Chemistry and Haematology, University Medical Center Utrecht, Utrecht, The Netherlands
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111
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Authors' response to letter by Page and Lee. Heart Lung Circ 2015; 24:420. [PMID: 25637252 DOI: 10.1016/j.hlc.2014.11.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Accepted: 11/26/2014] [Indexed: 11/23/2022]
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112
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Pain modulation efficiency delays seeking medical help in patients with acute myocardial infarction. Pain 2015; 156:192-198. [PMID: 25599315 DOI: 10.1016/j.pain.0000000000000020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Rapid reperfusion is crucial to reduce mortality in patients with ST elevation myocardial infarction. Prehospital patient delay, defined as time from symptoms onset to the decision to seek medical attention, accounts for a large proportion of cases with delayed reperfusion. However, whether pain modulation processes are involved in this phenomenon is not known. We hypothesized that prehospital patient delay may be affected by a reduction of perceived pain perception and pain modulation pattern. Pain threshold, magnitude estimation of suprathreshold stimulation, mechanical temporal summation and conditioned pain modulation (CPM), and recalls of pain magnitude at the onset of chest pain were obtained in 67 patients with first ST elevation myocardial infarction. The study's primary outcome was prehospital patient delay. The median patient delay was 24 (interquartile range, 0.5-72) hours. Of all psychophysical pain measures including pain threshold, magnitude estimation of suprathreshold stimulation, mechanical temporal summation, as well as CPM, only warm sensation threshold was independently associated with lower clinical chest pain intensity (P = 0.01). Multivariable regression analysis (R = 0.449; P < 0.0001) revealed an inverse independent association between chest pain intensity (P < 0.001) and patient delay, whereas efficient CPM was positively associated with prolonged patient delay (P = 0.034). The electrocardiography-derived myocardial ischemic area was not associated with chest pain intensity or patient delay, indicating that the affected ischemic tissue is not a dominant component that determines pain response. In conclusion, beyond the perceived chest pain intensity, the activation pattern of descending inhibition pathways during coronary occlusion affects pain interpretation and behavior during acute coronary occlusion.
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113
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Abstract
This paper reviews the magnitude and empirical findings of social epidemiological neighborhood effects research. An electronic keyword literature search identified 1369 empirical and methodological neighborhood effects papers published in 112 relevant journals between 1990 and 2014. Analyses of temporal trends were conducted by focus, journal type (e.g., epidemiology, public health, or social science), and specific epidemiologic journal. Select papers were then critically reviewed. Results show an ever-increasing number of papers published, notably since the year 2000, with the majority published in public health journals. The variety of health outcomes analyzed is extensive, ranging from infectious disease to obesity to criminal behavior. Papers relying on data from experimental designs are thought to yield the most credible results, but such studies are few and findings are inconsistent. Papers relying on data from observational designs and multilevel models typically show small statistically significant effects, but most fail to appreciate fundamental identification problems. Ultimately, of the 1170 empirically focused neighborhood effects papers published in the last 24 years, only a handful have clearly advanced our understanding of the phenomena. The independent impact of neighborhood contexts on health remains unclear. It is time to expand the social epidemiological imagination.
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114
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Mercuri M, Welsford M, Schwalm JD, Mehta SR, Rao-Melacini P, Sheth T, Rokoss M, Jolly SS, Velianou JL, Natarajan MK. Providing optimal regional care for ST-segment elevation myocardial infarction: a prospective cohort study of patients in the Hamilton Niagara Haldimand Brant Local Health Integration Network. CMAJ Open 2015; 3:E1-7. [PMID: 25844361 PMCID: PMC4382034 DOI: 10.9778/cmajo.20140035] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Although considered the evidence-based best therapy for ST-segment elevation myocardial infarction (STEMI), many patients do not receive primary percutaneous coronary intervention (PCI) because of health care resource distribution and constraints. This study describes the clinical management and outcomes of all patients identified with STEMI within a region, including those who did not receive primary PCI. METHODS This study used a prospective cohort design. Patients presenting with STEMI to PCI- and non-PCI-capable hospitals in one integrated health region in Ontario were included in the study. The primary objective was to examine use of reperfusion strategies and timeliness of care. Secondary objectives included determining (through regression models) which variables were associated with mortality within 90 days, and describing patient uptake of risk-reducing therapies and activities post-STEMI. RESULTS Between Apr. 1, 2010, and Mar. 31, 2013, data were collected on 2247 consecutive patients presenting with STEMI. Patients presenting to the PCI-capable hospital were more likely to receive primary PCI (82.5% v. 65.2%, p < 0.001) and be treated within optimal treatment times. However, there was no appreciable difference in mortality at 90 days post-STEMI between patients presenting to PCI- and non-PCI-capable hospitals (7.8% v. 7.5%, p = 0.82), even after adjustment for acuity on presentation. Despite recognized risk factors, many patients were not taking evidence-based medications for risk factor modification before STEMI. INTERPRETATION A systematic approach to regional STEMI care focusing on timely access to the best available therapies, rather than the type of reperfusion provided alone, can yield favourable outcomes.
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Affiliation(s)
- Mathew Mercuri
- Department of Medicine, Division of Cardiology, Columbia University, New York ; Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ont
| | - Michelle Welsford
- Department of Medicine, Division of Emergency Medicine, McMaster University, Hamilton, Ont. ; Hamilton Health Sciences, Hamilton Ontario, Hamilton, Ont
| | - Jon-David Schwalm
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ont. ; Hamilton Health Sciences, Hamilton Ontario, Hamilton, Ont. ; Population Health Research Institute, Hamilton, Ont
| | - Shamir R Mehta
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ont. ; Hamilton Health Sciences, Hamilton Ontario, Hamilton, Ont. ; Population Health Research Institute, Hamilton, Ont
| | | | - Tej Sheth
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ont. ; Hamilton Health Sciences, Hamilton Ontario, Hamilton, Ont. ; Population Health Research Institute, Hamilton, Ont
| | - Michael Rokoss
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ont. ; Hamilton Health Sciences, Hamilton Ontario, Hamilton, Ont
| | - Sanjit S Jolly
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ont. ; Hamilton Health Sciences, Hamilton Ontario, Hamilton, Ont. ; Population Health Research Institute, Hamilton, Ont
| | - James L Velianou
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ont. ; Hamilton Health Sciences, Hamilton Ontario, Hamilton, Ont
| | - Madhu K Natarajan
- Department of Medicine, Division of Cardiology, McMaster University, Hamilton, Ont. ; Hamilton Health Sciences, Hamilton Ontario, Hamilton, Ont. ; Population Health Research Institute, Hamilton, Ont
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Huo Y, Thompson P, Buddhari W, Ge J, Harding S, Ramanathan L, Reyes E, Santoso A, Tam LW, Vijayaraghavan G, Yeh HI. Challenges and solutions in medically managed ACS in the Asia-Pacific region: expert recommendations from the Asia-Pacific ACS Medical Management Working Group. Int J Cardiol 2014; 183:63-75. [PMID: 25662044 DOI: 10.1016/j.ijcard.2014.11.195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2014] [Revised: 11/12/2014] [Accepted: 11/24/2014] [Indexed: 12/26/2022]
Abstract
Acute coronary syndromes (ACS) remain a leading cause of mortality and morbidity in the Asia-Pacific (APAC) region. International guidelines advocate invasive procedures in all but low-risk ACS patients; however, a high proportion of ACS patients in the APAC region receive solely medical management due to a combination of unique geographical, socioeconomic, and population-specific barriers. The APAC ACS Medical Management Working Group recently convened to discuss the ACS medical management landscape in the APAC region. Local and international ACS guidelines and the global and APAC clinical evidence-base for medical management of ACS were reviewed. Challenges in the provision of optimal care for these patients were identified and broadly categorized into issues related to (1) accessibility/systems of care, (2) risk stratification, (3) education, (4) optimization of pharmacotherapy, and (5) cost/affordability. While ACS guidelines clearly represent a valuable standard of care, the group concluded that these challenges can be best met by establishing cardiac networks and individual hospital models/clinical pathways taking into account local risk factors (including socioeconomic status), affordability and availability of pharmacotherapies/invasive facilities, and the nature of local healthcare systems. Potential solutions central to the optimization of ACS medical management in the APAC region are outlined with specific recommendations.
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Affiliation(s)
| | - Yong Huo
- Peking University First Hospital, Beijing, China.
| | - Peter Thompson
- University of Western Australia, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia.
| | - Wacin Buddhari
- Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Junbo Ge
- Zhongshan Hospital, Fudan University, Shanghai, China
| | - Scott Harding
- Wellington Cardiovascular Research Group and School of Biological Sciences, Victoria University, Wellington, New Zealand
| | | | - Eugenio Reyes
- University of the Philippines, Philippine General Hospital-Section of Cardiology, Manila, Philippines
| | - Anwar Santoso
- Department of Cardiology - Vascular Medicine, Faculty of Medicine, University of Indonesia and National Cardiovascular Center, Harapan Kita, Indonesia
| | | | | | - Hung-I Yeh
- Mackay Memorial Hospital, Mackay Medical College, New Taipei City, Taiwan
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116
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Thuresson M, Haglund P, Ryttberg B, Herlitz J, Nilsson U. Impact of an information campaign on delays and ambulance use in acute coronary syndrome. Am J Emerg Med 2014; 33:297-8. [PMID: 25497696 DOI: 10.1016/j.ajem.2014.11.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/29/2014] [Accepted: 11/01/2014] [Indexed: 11/30/2022] Open
Affiliation(s)
- Marie Thuresson
- Dept of Cardiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
| | - Pernilla Haglund
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Britta Ryttberg
- Department of Cardiology, Örebro University Hospital, Örebro, Sweden
| | - Johan Herlitz
- The Centre of Pre-hospital Research in Western Sweden, University of Borås and Sahlgrenska University Hospital, Göteborg, Sweden
| | - Ulrica Nilsson
- School of Health and Medical Sciences, Örebro University, Örebro, Sweden
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117
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Skolarus LE, Murphy JB, Dome M, Zimmerman MA, Bailey S, Fowlkes S, Morgenstern LB. Creating a Novel Video Vignette Stroke Preparedness Outcome Measure Using a Community-Based Participatory Approach. Health Promot Pract 2014; 16:533-9. [PMID: 25367896 DOI: 10.1177/1524839914557032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Evaluating the efficacy of behavioral interventions for rare outcomes is a challenge. One such topic is stroke preparedness, defined as inteventions to increase stroke symptom recognition and behavioral intent to call 911. Current stroke preparedness intermediate outcome measures are centered on written vignettes or open-ended questions and have been shown to poorly reflect actual behavior. Given that stroke identification and action requires aural and visual processing, video vignettes may improve on current measures. This article discusses an approach for creating a novel stroke preparedness video vignette intermediate outcome measure within a community-based participatory research partnership. A total of 20 video vignettes were filmed of which 13 were unambiguous (stroke or not stroke) as determined by stroke experts and had test discrimination among community participants. Acceptable reliability, high satisfaction, and cultural relevance were found among the 14 community respondents. A community-based participatory approach was effective in creating a video vignette intermediate outcome. Future projects should consider obtaining expert and community feedback prior to filming all the video vignettes to improve the proportion of vignettes that are usable. While content validity and preliminary reliability were established, future studies are needed to confirm the reliability and establish construct validity.
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118
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Windecker S, Kolh P, Alfonso F, Collet JP, Cremer J, Falk V, Filippatos G, Hamm C, Head SJ, Jüni P, Kappetein AP, Kastrati A, Knuuti J, Landmesser U, Laufer G, Neumann FJ, Richter DJ, Schauerte P, Sousa Uva M, Stefanini GG, Taggart DP, Torracca L, Valgimigli M, Wijns W, Witkowski A. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS)Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). Eur Heart J 2014; 35:2541-619. [PMID: 25173339 DOI: 10.1093/eurheartj/ehu278] [Citation(s) in RCA: 3320] [Impact Index Per Article: 332.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Park M, Kim K, Lee JH, Kang C, Jo YH, Kim DH, Kang KW, Lee SH, Park C, Kim J, Chung H, Park H, Jang S. Awareness and knowledge of sepsis in the general Korean population: comparison with the awareness and knowledge of acute myocardial infarction and stroke. Clin Exp Emerg Med 2014; 1:41-48. [PMID: 27752551 PMCID: PMC5052826 DOI: 10.15441/ceem.14.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 08/07/2014] [Accepted: 08/17/2014] [Indexed: 12/29/2022] Open
Abstract
Objective Patients with severe sepsis or septic shock require timely, aggressive management to improve their outcomes, and early presentation of patients to the hospital may also be important. Thus, public awareness about sepsis may be important for improved outcomes. However, there are no studies regarding the public awareness of sepsis in the general Korean population. Therefore, the objective of this survey was to gain insight into the public awareness of sepsis. Methods Prospective paper-based and web-based surveys were issued between May and June 2013 to adults aged ≥18 years. Results A total of 1,081 participants responded to the survey (394 paper-based and 687 web-based). Mean age was 38.7±11.4 years, and 541 participants (50%) were men. Of the 1,081 participants, 831 (76.9%) had heard of the term “sepsis.” Of these participants, only 295 (35%) responded correctly regarding the definition of sepsis. However, 1,019 participants (94.3%) had heard of acute myocardial infarction, and 817 of these (80%) correctly defined acute myocardial infarction. Regarding stroke, 1,047 (96.9%) had heard of stroke, and 975 of these responded (93.1%) correctly to the definition of stroke. Conclusion There is poor public awareness about sepsis compared with that of acute myocardial infarction and stroke. This may limit the timely management of severe sepsis and septic shock.
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Affiliation(s)
- Minji Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Kyuseok Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jae Hyuk Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Changwoo Kang
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - You Hwan Jo
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Dong Hoon Kim
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Kyeong Won Kang
- Department of Emergency Medicine, Jeju National University Hospital, Jeju, Korea
| | - Soo Hoon Lee
- Department of Emergency Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Chanjong Park
- Department of Emergency Medicine, Seoul Veterans Hospital, Seoul, Korea
| | - Joonghee Kim
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Heajin Chung
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyunmi Park
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Sujin Jang
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
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120
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Farshid A, Allada C, Chandrasekhar J, Marley P, McGill D, O'Connor S, Rahman M, Tan R, Shadbolt B. Shorter ischaemic time and improved survival with pre-hospital STEMI diagnosis and direct transfer for primary PCI. Heart Lung Circ 2014; 24:234-40. [PMID: 25456507 DOI: 10.1016/j.hlc.2014.09.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 09/15/2014] [Accepted: 09/20/2014] [Indexed: 12/26/2022]
Abstract
BACKGROUND We sought to determine if our regional program for pre-hospital STEMI diagnosis and direct transfer for primary PCI (PPCI) was associated with shorter ischaemic times and improved survival compared with ED diagnosis. METHODS STEMI diagnosis was made at the scene by pre-hospital ECG or in local EDs depending on patient presentation. Ambulance ECGs were transmitted to our ED for cath lab activation. Patient variables and outcomes at 12 months were recorded. RESULTS We treated 782 consecutive patients with PPCI during January 2008-June 2013. Cath lab activation was initiated prior to hospital arrival (pre-hospital) in 24% of cases and by ED in 76% of cases. Median total ischaemic time was 154 min for pre-hospital and 211 minutes for ED patients (p<0.0001). Mortality at 12 months was 7.9% in the ED group compared with 3.7% in the pre-hospital group (p=0.036). On multivariate Cox regression analysis including baseline and procedural variables, pre-hospital activation remained an independent predictor of mortality (HR 0.45, 95% CI 0.20-1.0, p=0.03). CONCLUSIONS Pre-hospital diagnosis of STEMI and direct transfer to the cath lab reduced total ischaemic time by 57 minutes and mortality by >50% following PPCI. Further efforts are needed to increase the proportion of STEMI patients treated using this strategy.
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Affiliation(s)
- Ahmad Farshid
- Cardiology Unit, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia; College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 2601, Australia.
| | - Chris Allada
- Cardiology Unit, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Jaya Chandrasekhar
- Cardiology Unit, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Paul Marley
- Cardiology Unit, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Darryl McGill
- Cardiology Unit, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Simon O'Connor
- Cardiology Unit, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Moyazur Rahman
- Cardiology Unit, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Ren Tan
- Cardiology Unit, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
| | - Bruce Shadbolt
- College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 2601, Australia; Centre for Advances in Epidemiology and Information Technology, The Canberra Hospital, Yamba Drive, Garran, Australian Capital Territory, Australia
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121
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Neubeck L, Maiorana A. Time to get help? Acute myocardial infarction and delay in calling an ambulance. Heart Lung Circ 2014; 24:1-3. [PMID: 25201029 DOI: 10.1016/j.hlc.2014.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Lis Neubeck
- Sydney Nursing School, Charles Perkins Centre, Building D17, University of Sydney, Camperdown, NSW 2006; The George Institute for Global Health, 83-117 Missenden Road, Camperdown, NSW 2050.
| | - Andrew Maiorana
- Advanced Heart Failure and Cardiac Transplant Service, Royal Perth Hospital, Perth, WA, 6000; School of Physiotherapy and Exercise Science, Curtin University, Bentley, WA, 6102
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122
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Farquharson B, Dombrowski S, Pollock A, Johnston M, Treweek S, Williams B, Smith K, Dougall N, Jones C, Pringle S. Reducing patient delay with symptoms of acute coronary syndrome: a research protocol for a systematic review of previous interventions to investigate which behaviour change techniques are associated with effective interventions. Open Heart 2014; 1:e000079. [PMID: 25332805 PMCID: PMC4189291 DOI: 10.1136/openhrt-2014-000079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2014] [Revised: 06/13/2014] [Accepted: 07/15/2014] [Indexed: 11/17/2022] Open
Abstract
Introduction Delay to presentation with symptoms of acute coronary syndrome (ACS) is common meaning many fail to achieve optimal benefit from treatments. Interventions have had variable success in reducing delay. Evidence suggests inclusion of behaviour change techniques (BCTs) may improve effectiveness of interventions but this has not yet been systematically evaluated. Data from other time-critical conditions may be relevant. Methods and analysis A systematic review will be undertaken to identify which BCTs are associated with effective interventions to reduce patient delay (or prompt rapid help-seeking) among people with time-critical conditions (eg, chest pain, ACS, lumps, stroke, cancer and meningitis). A systematic search of a wide range of databases (including Cochrane Library, MEDLINE, EMBASE, CINAHL, PsycInfo) and grey literature will be undertaken to identify all relevant intervention studies (randomised controlled trials, controlled clinical trials and cohort studies). Two independent reviewers will screen abstracts to identify relevant studies, apply inclusion criteria to full papers, assess methodological quality and extract data. Primary outcome measure Change in patient decision time BCTs reported in each of the included studies will be categorised and presented according to the latest reliable taxonomy. Results of included studies will be synthesised, exploring relationships between inclusion of each BCT and effectiveness of the overall intervention. Where possible, means and SDs for differences in delay time will be calculated and combined within meta-analyses to derive a standardised mean difference and 95% CI. Analysis of (1) all time-critical and (2) ACS-only interventions will be undertaken. Ethics and dissemination No ethical issues are anticipated. Results will be submitted for publication in a relevant peer-reviewed journal.
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Affiliation(s)
- Barbara Farquharson
- Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK
| | | | - Alex Pollock
- Nursing, Midwifery and Allied Health Professionals Research Unit , Glasgow Caledonian University , Glasgow , UK
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen , Aberdeen , UK
| | - Shaun Treweek
- Health Services Research Unit , University of Aberdeen , Aberdeen , UK
| | - Brian Williams
- Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK
| | - Karen Smith
- School of Nursing and Midwifery, University of Dundee , Dundee , UK
| | - Nadine Dougall
- Nursing, Midwifery and Allied Health Professionals Research Unit , University of Stirling , Stirling , UK
| | - Claire Jones
- Health Informatics Centre, University of Dundee , Dundee , UK
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123
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O'Brien F, McKee G, Mooney M, O'Donnell S, Moser D. Improving knowledge, attitudes and beliefs about acute coronary syndrome through an individualized educational intervention: a randomized controlled trial. PATIENT EDUCATION AND COUNSELING 2014; 96:179-187. [PMID: 24973196 DOI: 10.1016/j.pec.2014.05.022] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 05/09/2014] [Accepted: 05/25/2014] [Indexed: 06/03/2023]
Abstract
OBJECTIVE To test the effectiveness of an individualized educational intervention on knowledge, attitudes and beliefs about acute coronary syndrome (ACS). METHODS This multi-site, randomized controlled trial was conducted on 1947 patients with a diagnosis of ACS. Both groups received usual in-hospital education. Participants randomized to the intervention group received a 40-min one to one individualized education session, delivered using motivational interviewing techniques. The intervention was reinforced 1 month and 6 months later. Knowledge, attitudes and beliefs were measured using the ACS Response Index. A total of 1136 patients (control, n=551; intervention, n=585) completed the questionnaire at baseline, 3 and 12 months. Data were analyzed using repeated measures analysis of variance. Ethical approval was obtained. RESULTS There was a significant effect of the intervention on mean knowledge (p<0.001), attitude (p=0.003) and belief (p<0.001) scores at 3 and 12 months. CONCLUSION Ensuring patients retain information post education has always been difficult to attain. This study demonstrated that patient education using motivational interviewing techniques and an individualized approach has the potential to alter knowledge, attitudes and beliefs about ACS among a high risk population. PRACTICE IMPLICATIONS This relatively short, simple and effective educational intervention could be delivered by nurses in multiple settings.
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Affiliation(s)
- Frances O'Brien
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland.
| | - Gabrielle McKee
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Mary Mooney
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Sharon O'Donnell
- School of Nursing and Midwifery, Trinity College Dublin, Dublin, Ireland
| | - Debra Moser
- College of Nursing, University of Kentucky, Lexington, USA
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124
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Tummala SR, Farshid A. Patients' understanding of their heart attack and the impact of exposure to a media campaign on pre-hospital time. Heart Lung Circ 2014; 24:4-10. [PMID: 25240573 DOI: 10.1016/j.hlc.2014.07.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/05/2014] [Accepted: 07/15/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) have a limited understanding of AMI symptoms and risk factors. This can lead to delays in the recognition of an AMI and hospital presentation. We aimed to assess patients' understanding of their AMI symptoms and risk factors and also assess the impact of exposure to a media campaign on their pre-hospital time. METHODS We surveyed 100 AMI patients admitted to the Canberra Hospital. We asked them about their AMI symptoms and risk factors and the impact of the National Heart Foundation (NHF) advertisements on their AMI experience. RESULTS Only 26% of patients recognised that they were having an AMI. In 34% of cases, an ambulance was called. There was no significant difference in the median pre-hospital time between patients who encountered the NHF advertisements and those who had not (133 minutes vs. 137 minutes, p=0.809). Only 22% of patients could identify all of their personal AMI risk factors. CONCLUSIONS Most AMI patients do not initially recognise their condition nor do they call for an ambulance. Exposure to the NHF advertisements had no significant influence on reducing pre-hospital time in this cohort. Most patients have a limited understanding of AMI risk factors and causes.
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Affiliation(s)
- Shrikar R Tummala
- College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 2601, Australia
| | - Ahmad Farshid
- College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 2601, Australia; Department of Cardiology, The Canberra Hospital, Canberra, ACT 2605, Australia.
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125
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Fujii T, Masuda N, Suzuki T, Trii S, Murakami T, Nakano M, Nakazawa G, Shinozaki N, Matsukage T, Ogata N, Yoshimachi F, Ikari Y. Impact of transport pathways on the time from symptom onset of ST-segment elevation myocardial infarction to door of coronary intervention facility. J Cardiol 2014; 64:11-8. [DOI: 10.1016/j.jjcc.2013.11.008] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/06/2013] [Accepted: 11/06/2013] [Indexed: 01/25/2023]
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126
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Canto JG, Canto EA, Goldberg RJ. Time to Standardize and Broaden the Criteria of Acute Coronary Syndrome Symptom Presentations in Women. Can J Cardiol 2014; 30:721-8. [DOI: 10.1016/j.cjca.2013.10.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/20/2013] [Accepted: 10/20/2013] [Indexed: 11/30/2022] Open
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127
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Sohal SS, Soltani A, Reid D, Ward C, Wills KE, Muller HK, Walters EH. A randomized controlled trial of inhaled corticosteroids (ICS) on markers of epithelial-mesenchymal transition (EMT) in large airway samples in COPD: an exploratory proof of concept study. Int J Chron Obstruct Pulmon Dis 2014; 9:533-42. [PMID: 24920891 PMCID: PMC4043431 DOI: 10.2147/copd.s63911] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background We recently reported that epithelial–mesenchymal transition (EMT) is active in the airways in chronic obstructive pulmonary disease (COPD), suggesting presence of an active profibrotic and promalignant stroma. With no data available on potential treatment effects, we undertook a blinded analysis of inhaled corticosteroids (ICS) effects versus placebo on EMT markers in previously obtained endobronchial biopsies in COPD patients, as a “proof of concept” study. Methods Assessment of the effects of inhaled fluticasone propionate (FP; 500 μg twice daily for 6 months) versus placebo in 34 COPD patients (23 on fluticasone propionate and eleven on placebo). The end points were epidermal growth factor receptor (EGFR; marker of epithelial activation) and the biomarkers of EMT: reticular basement membrane (Rbm) fragmentation (“hallmark” structural marker), matrix metalloproteinase-9 (MMP-9) cell expression, and S100A4 expression in basal epithelial and Rbm cells (mesenchymal transition markers). Results Epithelial activation, “clefts/fragmentation” in the Rbm, and changes in the other biomarkers all regressed on ICS, at or close to conventional levels of statistical significance. From these data, we have been able to nominate primary and secondary end points and develop power calculations that would be applicable to a definitive prospective study. Conclusion Although only a pilot “proof of concept” study, this trial provided strong suggestive support for an anti-EMT effect of ICS in COPD airways. A larger and fully powered prospective study is now indicated as this issue is likely to be extremely important. Such studies may clarify the links between ICS use and better clinical outcomes and protection against lung cancer in COPD.
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Affiliation(s)
- Sukhwinder Singh Sohal
- National Health and Medical Research Council Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Amir Soltani
- National Health and Medical Research Council Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - David Reid
- National Health and Medical Research Council Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia ; Iron Metabolism Laboratory, Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Chris Ward
- National Health and Medical Research Council Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia ; Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Karen E Wills
- National Health and Medical Research Council Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia ; Department of Biostatistics, Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - H Konrad Muller
- National Health and Medical Research Council Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
| | - Eugene Haydn Walters
- National Health and Medical Research Council Centre of Research Excellence for Chronic Respiratory Disease, School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
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Goldberg R, Gore JM, Barton B, Gurwitz J. Individual and composite study endpoints: separating the wheat from the chaff. Am J Med 2014; 127:379-84. [PMID: 24486289 PMCID: PMC4019929 DOI: 10.1016/j.amjmed.2014.01.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 01/14/2014] [Accepted: 01/14/2014] [Indexed: 01/08/2023]
Abstract
We provide an overview of the individual and combined clinical endpoints and patient-reported outcomes typically used in clinical trials and prospective epidemiological investigations. We discuss the strengths and limitations associated with the utilization of aggregated study endpoints and surrogate measures of important clinical endpoints and patient-centered outcomes. We hope that the points raised in this overview will lead to the collection of clinically rich, relevant, measurable, and cost-efficient study outcomes.
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Affiliation(s)
- Robert Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass; Meyers Primary Care Institute, Worcester, Mass.
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, Mass
| | - Bruce Barton
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Jerry Gurwitz
- Meyers Primary Care Institute, Worcester, Mass; Department of Medicine, University of Massachusetts Medical School, Worcester, Mass
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129
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Puymirat E, Teixeira N, Simon T, Steg PG, Schiele F, Lamblin N, Probst V, Juillière Y, Ferrières J, Danchin N. Patient education after acute myocardial infarction: cardiologists should adapt their message--French registry of acute ST-elevation or non-ST-elevation myocardial infarction 2010 registry. J Cardiovasc Med (Hagerstown) 2014; 16:761-7. [PMID: 24751516 DOI: 10.2459/jcm.0000000000000092] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS A shorter time delay between onset of symptoms and first call for medical attention would be expected in patients with a history of ischemic heart disease (IHD). We aimed to determine whether time to first call for an ST-elevation myocardial infarction (STEMI) differed between patients with or without history of coronary artery disease from the French registry of acute ST-elevation or non-ST-elevation myocardial infarction (FAST-MI) 2010 registry. METHODS FAST-MI 2010 is a nationwide French registry that included 4169 patients with acute myocardial infarction (AMI, 2193 STEMI) at the end of 2010 in 213 centers. Factors correlated with time to first call were assessed, with a specific emphasis on previous history of IHD (IHD+; n = 402), compared with patients without history of IHD (IHD-; n = 1791). RESULTS Time from onset to first call was 222 ± 420 min (median time 68 min) in IHD+ patients versus 240 ± 4423 min (median time 75 min) in IHD- patients (P = 0.28). In multivariate analysis, only a few factors were significantly related to a shorter time from onset to first call (≤75min); time of onset during the day (7:00 a.m. to 11:00 p.m.), upper socioeconomic class, anterior MI, cardiac arrest as the initial symptom, whereas history of IHD was not associated with a shorter time delay (odds ratio 0.86; 95% confidence interval 0.70-1.05). Similar results were found between patients with previous AMI and IHD- patients. CONCLUSION Patients with a history of IHD do not call earlier than IHD-naïve patients when they are confronted with symptoms of AMI. Cardiologists should spend more time educating their coronary patients to recognize symptoms of AMI.Clinicaltrials.gov identifier: NCT01237418.
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Affiliation(s)
- Etienne Puymirat
- aAssistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Européen Georges Pompidou, Department of Cardiology, Paris, Université Paris-Descartes bINSERM U-970 cAP-HP, Hôpital Saint Antoine, Department of Clinical Pharmacology and Unité de Recherche Clinique (URCEST) dUniversité Pierre et Marie Curie (UPMC-Paris 06) eAP-HP, Hôpital Bichat fParis, France, Université Paris-Diderot, Sorbonne Paris-Cité gINSERM U-698, Paris hUniversity Hospital Jean Minjoz, Department of Cardiology, Besançon iUniversity Hospital of Lille, Department of Cardiology, Lille jUniversity hospital of Nantes, Nantes kUniversity hospital of Nancy, Nancy lToulouse Rangueil University Hospital, Department of Cardiology, UMR1027, INSERM, Toulouse, France
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Mooney M, McKee G, Fealy G, O' Brien F, O'Donnell S, Moser D. A Randomized Controlled Trial to Reduce Prehospital Delay Time in Patients With Acute Coronary Syndrome (ACS). J Emerg Med 2014; 46:495-506. [DOI: 10.1016/j.jemermed.2013.08.114] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 06/12/2013] [Accepted: 08/20/2013] [Indexed: 11/15/2022]
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Austin D, Yan AT, Spratt JC, Kunadian V, Edwards RJ, Egred M, Bagnall AJ. Patient characteristics associated with self-presentation, treatment delay and survival following primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2014; 3:214-22. [DOI: 10.1177/2048872614527011] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- David Austin
- Cardiothoracic Division, The James Cook University Hospital, Middlesbrough, UK
| | - Andrew T Yan
- Department of Cardiology, St Michael’s Hospital, University of Toronto, Canada
| | - James C Spratt
- Department of Cardiology, Forth Valley Hospital, Larbert, UK
| | - Vijay Kunadian
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Richard J Edwards
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Mohaned Egred
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
| | - Alan J Bagnall
- Department of Cardiology, Freeman Hospital, Newcastle upon Tyne, UK
- Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
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Hao K, Takahashi J, Ito K, Miyata S, Sakata Y, Nihei T, Tsuburaya R, Shiroto T, Ito Y, Matsumoto Y, Nakayama M, Yasuda S, Shimokawa H. Emergency care of acute myocardial infarction and the great East Japan earthquake disaster. Circ J 2014; 78:634-43. [PMID: 24451649 DOI: 10.1253/circj.cj-13-1286] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Although emergency care of acute myocardial infarction (AMI) could theoretically be improved through improved patient delay, this notion remains to be confirmed. Additionally, the influence of large earthquakes on the emergency care of AMI cases remains to be elucidated. The Great East Japan Earthquake (March 11, 2011) has enabled us to address these issues. METHODS AND RESULTS We analyzed the data from 2008 to 2011 (n=3,937) in the Miyagi AMI Registry Study. In-hospital mortality was significantly lower in 2011 as compared with the previous 3 years (7.3% vs. 10.5%, P<0.05). This improvement was noted especially during the first 2 months after the Earthquake, associated with shorter elapsing time from onset to admission (120 vs. 240min, P<0.001) and higher performance rate of primary percutaneous coronary intervention (PCI) (86.8% vs. 76.2%, P<0.01). Importantly, after the Earthquake, patients with early admission (≤3h from onset) was significantly increased (59.1% vs. 47.0%, P<0.05) and their prognosis became better (7.9% vs. 11.4%, P=0.02), associated with a lower prevalence of heart failure on admission (6.9% vs. 16.2%, P=0.02) and higher performance rate of primary PCI (89.1% vs. 76.4%, P<0.01). CONCLUSIONS Emergency care of AMI improved soon after the Great East Japan Earthquake compared with ordinary times by the contribution of earlier admission from onset and higher performance rate of primary PCI. (Circ J 2014; 78: 634-643).
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Affiliation(s)
- Kiyotaka Hao
- Department of Cardiovascular Medicine, Tohoku University Graduate School of Medicine
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Direction of first bystander call for help is associated with outcome from out-of-hospital cardiac arrest. Resuscitation 2014; 85:42-8. [DOI: 10.1016/j.resuscitation.2013.08.258] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2013] [Revised: 07/29/2013] [Accepted: 08/22/2013] [Indexed: 11/21/2022]
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Solhpour A, Yusuf SW. Fibrinolytic therapy in patients with ST-elevation myocardial infarction. Expert Rev Cardiovasc Ther 2013; 12:201-15. [DOI: 10.1586/14779072.2014.867805] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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A personal perspective: can legislated state regional STEMI centers provide timely STEMI treatment while overlooking early fibrinolysis? Crit Pathw Cardiol 2013; 12:184-7. [PMID: 24240546 DOI: 10.1097/hpc.0b013e3182a03a13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Because a patient's odds of surviving a ST-Elevation Myocardial Infarction (STEMI) depend on how much myocardium is salvaged by treatment, this article presents information about whether the Missouri Regional STEMI Center Program, created by state law, can provide STEMI treatment in time to preserve the ischemic heart muscle. The law states that "Patients who suffer a STEMI, as defined in Section 190.100, shall be transported to a STEMI Center." Administration is by the Missouri Department of Health and Senior Services (DHSS) which states that the preferred treatment for STEMI is percutaneous coronary intervention (PCI) and does not mention fibrinolysis when eligible. Level I and II receiving centers are hospitals with catheterization laboratories that perform a high volume of PCI procedures. Level I centers have heart surgery facilities. Level II centers may have such services or may have prompt access to nearby facilities. The law states that the smaller level III and IV hospitals are to stabilize patients for transport to a level I or II center. Although the law lists no patients to be excluded from transport, DHSS is limiting the program to patients picked up at the scene by ambulance. The majority of STEMI patients going to community hospitals by car are not included. Data are presented, showing that when blood flow is restored to the ischemic muscle during infarction before the end of the second hour of symptoms most can be saved. Data also show that only a small fraction of patients with PCI receives it before the end of the second hour of symptoms, whereas many more fibrinolysis patients were treated within 2 hours. Clinical practice data are given, showing mortality rates to increase with longer times to treatment. This information clearly defines timely treatment of STEMI to be that carried out before the end of the second hour of symptoms. Setting forth details of how long after symptom onset will be required to get to the catheterization laboratory shows that not many Missouri Program STEMI patients will get there before the end of the second hour of symptoms when salvageable heart muscle remains. The second thrust of this article is to draw attention to the seriousness of the Missouri Program overlooking the extremely important early fibrinolysis option for achieving treatment during the first 2 hours of symptoms.
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Loirat M, Orion L, Fradin P, Dimet J, Boiffard E. [Reperfusion delays in acute coronary syndromes with ST segment elevation (STEMI) depending on prehospital care]. Ann Cardiol Angeiol (Paris) 2013; 62:287-292. [PMID: 24075208 DOI: 10.1016/j.ancard.2013.08.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2013] [Accepted: 08/12/2013] [Indexed: 06/02/2023]
Abstract
INTRODUCTION Acute coronary syndrome with ST segment elevation (STEMI) remains a major cause of morbidity and mortality in France, directly correlated with the time management of the patient to achieve reperfusion of the artery as early as possible. But the delay of reperfusion is related to the course that will take the patient to the revascularization. METHODS To make an observation of departmental practices, we conducted a retrospective monocentric study on the STEMI supported on 4years in the Departmental Hospital of La Roche-sur-Yon by comparing the time of reperfusion in two groups: patients who used the recommended chain=diRect chain (Call the emergency number-specialist mobile emergency unit-Cardiac intensive care unit or cardiac catheterization laboratory), and patients who used another chain=Long chain. RESULTS On 838 patients with STEMI, 356 (42.5%) used the Direct chain. The average time of reperfusion in the Direct chain group is 4.26hours (±3.12), 6.17hours (±4.82) in the Long chain group. There is a significant difference between the two groups of 1.9hours (P<0.001). Of 186 patients who consulted a general practitioner, 40.3% of patients were not supported by the mobile emergency unit. CONCLUSION These results should lead to improved practices, to carry on continuing medical education with all actors in the chain and patient information to shorten up the time of reperfusion.
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Affiliation(s)
- M Loirat
- Centre hospitalier départementale Vendée, Les Oudairies, 85925 La Roche-sur-Yon cedex 9, France
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Hochreuther S, Härtel D, Brockmeier J, Rohde M, Machalke K, Mendrok HC, Bramlage P, Tebbe U. Stellenwert der Lyse im Rettungswesen. Notf Rett Med 2013. [DOI: 10.1007/s10049-013-1727-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Tödt T, Thylén I, Alfredsson J, Swahn E, Janzon M. Strategies TO reduce time delays in patients with AcuTe coronary heart disease treated with primary PCI--the STOP WATCH study: a multistage action research project. BMJ Open 2013; 3:e003493. [PMID: 24002986 PMCID: PMC3773635 DOI: 10.1136/bmjopen-2013-003493] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify, evaluate and reduce system delay times in an ST-elevation myocardial infarction (STEMI) network by targeted reorganisation of logistics and personal feedback to staff on time delays. DESIGN Multistage action research project. Three study phases were used (exploration, tailored intervention and evaluation). SETTING Single centre study, Sweden. PATIENTS Consecutive patients (N=156) with prehospital STEMI onset treated with primary percutaneous coronary intervention (PCI). INTERVENTIONS Areas of delays were identified through participant observations and collaborative discussions. To increase the awareness of delay factors, continuous feedback on time delays was given. Elements of the logistics' reorganisation were (1) prioritised ECG recording by emergency medical services personnel, (2) central evaluation of ECG in all patients and (3) start of PCI procedure when two of three PCI team members were on site. Multiple key time measurements were made before (N=67) and after (N=89) the intervention. MAIN OUTCOMES Time difference (minutes) in system delay between the preintervention and postintervention phases. RESULTS Time from first medical contact (FMC) to a patent artery and time from FMC-to-catheter laboratory (cath-lab) arrival decreased by 6 and 12 min, respectively (ns). Time from FMC-to-ECG recording remained unchanged after the intervention. Time from ECG to decision for primary PCI was reduced by 6 min, p=0.004 and time from ECG-to-cath-lab arrival by 11 min, p=0.02. Total time from diagnosis to a patent artery decreased by 11 min (ns). CONCLUSIONS Identification of time delays in an STEMI network with awareness of delay factors, reorganisation of logistics and continuous feedback can reduce system delay times significantly.
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Affiliation(s)
- Tim Tödt
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University
- Department of Cardiology, County Council of Östergötland, Linköping, Sweden
| | - Ingela Thylén
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University
- Department of Cardiology, County Council of Östergötland, Linköping, Sweden
| | - Joakim Alfredsson
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University
- Department of Cardiology, County Council of Östergötland, Linköping, Sweden
| | - Eva Swahn
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University
- Department of Cardiology, County Council of Östergötland, Linköping, Sweden
| | - Magnus Janzon
- Division of Cardiovascular Medicine, Department of Medical and Health Sciences, Faculty of Health Sciences, Linköping University
- Department of Cardiology, County Council of Östergötland, Linköping, Sweden
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Benedek I, Gyongyosi M, Benedek T. A prospective regional registry of ST-elevation myocardial infarction in Central Romania: impact of the Stent for Life Initiative recommendations on patient outcomes. Am Heart J 2013; 166:457-65. [PMID: 24016494 DOI: 10.1016/j.ahj.2013.03.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Accepted: 03/20/2013] [Indexed: 11/17/2022]
Abstract
BACKGROUND Reperfusion therapy is the treatment of choice in patients with ST-elevation myocardial infarction (STEMI) presenting within 12 hours after the onset of symptoms. However, a significant number of patients do not benefit from it because of the lack of access to well-organized emergency care. We aimed to investigate the evolution of STEMI treatment and mortality between 2004 and 2011 in an unselected population from central Romania and to demonstrate the role of a regional network in increasing the rates of reperfusion therapy with associated reduction of STEMI-related mortality in a region with very low primary percutaneous coronary intervention (pPCI) rates at baseline. METHODS We analyzed the data of 5,899 consecutive patients with STEMI enrolled in this prospective study since 2004, after the initiation of an STEMI network in Central Romania and with continuous support of the Stent for Life Initiative. RESULTS Introduction of the network was associated with an absolute change in the use of reperfusion therapy from 2004 to 2011 (26.94% vs 87.15%, P < .001) and of pPCI (10.88% vs 78.64%, P < .001) for patients presenting within 12 hours after the onset of symptoms, with a decrease of inhospital mortality from 20.73% to 6.35% (P < .001). In addition, the global inhospital mortality of all the STEMI population showed a significant decrease (23.18% vs 13.39%, P < .001). CONCLUSIONS Reduction of STEMI-related mortality was possible via implementation of pPCI, even in a region with low health care expenditures. The organization of an STEMI network led to a significant decrease in STEMI-related mortality, revealing the significant impact of the Stent for Life Initiative recommendations on patient outcomes.
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Affiliation(s)
- Imre Benedek
- University of Medicine and Pharmacy of Targu-Mures, Targu-Mures, Romania
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140
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Gao Y, Zhang HJ. The effect of symptoms on prehospital delay time in patients with acute myocardial infarction. J Int Med Res 2013; 41:1724-31. [DOI: 10.1177/0300060513488511] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To improve time to treatment, the effects of acute myocardial infarction (AMI) symptoms on prehospital delay time (PDT) were investigated. Methods Patients with AMI completed a questionnaire on their AMI symptoms and their general knowledge of AMI symptoms. Results In total, 116 patients completed questionnaires. The mean PDT was 7.3 ± 2.4 h; the median PDT was 2.2 h. Each patient experienced a mean of 3.6 symptoms during their AMI. PDT was significantly shorter in the following groups: patients with chest compression pain/chest discomfort, profuse sweating or dyspnoea than in patients with other symptoms; patients presenting with typical rather than atypical symptoms; patients with pain scores >6 compared with scores ≤6; patients who were aware rather than unaware of AMI symptoms. Patients actually having AMI symptoms and patients being aware of AMI symptoms were inversely correlated with PDT. There was a linear relationship between pain scores and PDT. Conclusion Public awareness of AMI symptoms should be enhanced, in order to shorten PDT and improve AMI survival rates.
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Affiliation(s)
- Yu Gao
- Department of Cardiology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning Province, China
| | - Hui-jun Zhang
- Nursing School, Liaoning Medical University, Jinzhou, Liaoning Province, China
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Acute coronary syndromes: Bypassing the emergency department to treat STEMI. Nat Rev Cardiol 2013; 10:491-2. [PMID: 23900356 DOI: 10.1038/nrcardio.2013.113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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142
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The chain of survival for ST-segment elevation myocardial infarction: insights into the Middle East. Crit Pathw Cardiol 2013; 12:154-60. [PMID: 23892947 DOI: 10.1097/hpc.0b013e3182901f28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although coronary heart disease is the leading cause of morbidity and mortality in the Middle East (ME), not much is known about patients with ST-segment elevation myocardial infarction (STEMI) from this region. The STEMI Chain of Survival can be used to target regional improvements in patient care. We tried to adopt a modified chain of survival for STEMI to highlight the challenges and difficulties and the possible solutions to improve the STEMI care in the Middle East based on the few data available.
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Zoghbi WA, Arend TE, Oetgen WJ, May C, Bradfield L, Keller S, Ramadhan E, Tomaselli GF, Brown N, Robertson RM, Whitman GR, Bezanson JL, Hundley J. 2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Circulation 2013; 127:e663-828. [DOI: 10.1161/cir.0b013e31828478ac] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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145
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DelliFraine J, Langabeer J, Segrest W, Fowler R, King R, Moyer P, Henry TD, Koenig W, Warner J, Stuart L, Griffin R, Fathiamini S, Emert J, Roettig ML, Jollis J. Developing an ST-elevation myocardial infarction system of care in Dallas County. Am Heart J 2013; 165:926-31. [PMID: 23708163 DOI: 10.1016/j.ahj.2013.02.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2012] [Accepted: 02/12/2013] [Indexed: 11/26/2022]
Abstract
BACKGROUND The American Heart Association Caruth Initiative (AHACI) is a multiyear project to increase the speed of coronary reperfusion and create an integrated system of care for patients with ST-elevation myocardial infarction (STEMI) in Dallas County, TX. The purpose of this study was to determine if the AHACI improved key performance metrics, that is, door-to-balloon (D2B) and symptom-onset-to-balloon times, for nontransfer patients with STEMI. METHODS Hospital patient data were obtained through the National Cardiovascular Data Registry Action Registry-Get With The Guidelines, and prehospital data came from emergency medical services (EMS) agencies through their electronic Patient Care Record systems. Initial D2B and symptom-onset-to-balloon times for nontransfer primary percutaneous coronary intervention (PCI) STEMI care were explored using descriptive statistics, generalized linear models, and logistic regression. RESULTS Data were collected by 15 PCI-capable Dallas hospitals and 24 EMS agencies. In the first 18 months, there were 3,853 cases of myocardial infarction, of which 926 (24%) were nontransfer patients with STEMI undergoing primary PCI. D2B time decreased significantly (P < .001), from a median time of 74 to 64 minutes. Symptom-onset-to-balloon time decreased significantly (P < .001), from a median time of 195 to 162 minutes. CONCLUSION The AHACI has improved the system of STEMI care for one of the largest counties in the United States, and it demonstrates the benefits of integrating EMS and hospital data, implementing standardized training and protocols, and providing benchmarking data to hospitals and EMS agencies.
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Impact of first contact on symptom onset–to-door time in patients presenting for primary percutaneous coronary intervention. Am J Emerg Med 2013; 31:922-7. [DOI: 10.1016/j.ajem.2013.03.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/04/2013] [Accepted: 03/04/2013] [Indexed: 11/16/2022] Open
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147
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Jneid H, Ettinger SM, Ganiats TG, Philippides GJ, Jacobs AK, Halperin JL, Albert NM, Creager MA, DeMets D, Guyton RA, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61:e179-347. [PMID: 23639841 DOI: 10.1016/j.jacc.2013.01.014] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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148
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Carta MG, Sancassiani F, Pippia V, Bhat KM, Sardu C, Meloni L. Alexithymia is associated with delayed treatment seeking in acute myocardial infarction. PSYCHOTHERAPY AND PSYCHOSOMATICS 2013; 82:190-2. [PMID: 23548987 DOI: 10.1159/000341181] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 06/16/2012] [Indexed: 11/19/2022]
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O'Conor K, Chang AM, Wu AHB, Hollander JE. Myeloperoxidase and C-reactive protein in patients with cocaine-associated chest pain. Am J Emerg Med 2013; 31:664-9. [PMID: 23380098 DOI: 10.1016/j.ajem.2012.11.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2012] [Revised: 10/31/2012] [Accepted: 11/23/2012] [Indexed: 10/27/2022] Open
Abstract
BACKGROUND Myeloperoxidase (MPO) and C-reactive protein (CRP) are markers of inflammation and elevated levels have been found in patients with acute coronary syndrome (ACS) unrelated to cocaine. We evaluated the utility of MPO and CRP for diagnosis of ACS and the prediction of 30-day adverse cardiovascular events in patients with cocaine-related chest pain. METHODS This is a secondary analysis from a prospective cohort study of ED patients who received evaluation for ACS. Structured data collection at presentation included demographics, chest pain history, laboratory results, and electrocardiographic data. Our primary outcome was diagnosis of ACS at index visit and 30-day adverse events. As a secondary analysis, we provide data on a matched cohort without cocaine use. RESULTS Baseline data and CRP were available for 95 cocaine users; 82 had MPO data also. Patients had a mean age of 46.6 (SD 8.1) years, 90% were black, and 62% were male. Acute coronary syndrome occurred in 7% of cocaine users. With respect to diagnosis of ACS, the area under the curve was poor for both MPO (0.65; 95% confidence interval [CI]: 0.40-0.91) and CRP (0.63; 95% CI: 0.39-0.88). Similar results were found for 30-day events. With respect to prognosis of 30-day adverse cardiovascular events, the area under the curve was 0.68 (95% CI: 0.45-0.91) for MPO and 0.67 (95% CI: 0.45-0.90) for CRP. Similar results were found for 30-day events. In the matched cohort of patients who were not cocaine users, performance of MPO (n = 66) and CRP (n = 86) was also poor. CONCLUSIONS Myeloperoxidase and CRP are not useful for diagnosis or prognosis of patients with cocaine-associated chest pain.
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Affiliation(s)
- Katie O'Conor
- Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Ranney ML, Daya M. Twitter and resuscitation education: Is this the future? Resuscitation 2013; 84:147-8. [DOI: 10.1016/j.resuscitation.2012.12.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2012] [Accepted: 12/02/2012] [Indexed: 10/27/2022]
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