1
|
Ribeiro V, Melão F, Duarte Rodrigues J, Machado Leite S, Garcia RM, Dias P, Maciel MJ. Perception of illness symptoms in patients with acute coronary syndrome: a need to improve. Rev Port Cardiol 2014; 33:519-23. [PMID: 25242678 DOI: 10.1016/j.repc.2013.09.017] [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] [Received: 07/05/2013] [Revised: 09/17/2013] [Accepted: 09/21/2013] [Indexed: 10/24/2022] Open
Abstract
BACKGROUND Interpretation of the symptoms of acute coronary syndrome (ACS) can influence the time of hospital admission and negatively affect patients' prognosis. We decided to explore illness perception and its predictors among patients with ACS. METHODS We conducted a retrospective analysis of all consecutive patients with ACS admitted to the cardiology department of a tertiary hospital between January and September 2011. Data were obtained from patients' medical records and telephone interviews. RESULTS One hundred and eighty-six patients with ACS (mean age 64 ± 12 years; 70% male) were included. The majority (62.6%) had no perception of ACS until informed by their doctor. Only 26% of patients with ST-segment elevation myocardial infarction had perception of cardiac disease. Among those who had perception, 82.6% were men and 58% had a previous diagnosis of ischemic heart disease (IHD). Gender and previous diagnosis of IHD were independent predictors of ACS perception, with male gender and patients with previous IHD having greater illness perception. No association was found between ACS perception and age or residence area (rural vs. urban). CONCLUSIONS The illness perception of ACS patients needs to be improved, independently of sociodemographic factors. An educational program for the general population, but particularly for women and individuals without a past history of IHD, focusing on the alert signs for ACS, may help to improve illness perception in this setting.
Collapse
Affiliation(s)
- Vânia Ribeiro
- Department of Cardiology, Hospital São João, Porto, Portugal.
| | - Filipa Melão
- Department of Cardiology, Hospital São João, Porto, Portugal
| | | | | | - Raquel M Garcia
- Department of Cardiology, Hospital São João, Porto, Portugal
| | - Paula Dias
- Department of Cardiology, Hospital São João, Porto, Portugal
| | | |
Collapse
|
2
|
Ribeiro V, Melão F, Duarte Rodrigues J, Machado Leite S, Garcia RM, Dias P, Maciel MJ. Perception of illness symptoms in patients with acute coronary syndrome: A need to improve. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2014. [DOI: 10.1016/j.repce.2013.09.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
|
3
|
Goel K, Pinto DS, Gibson CM. Association of time to reperfusion with left ventricular function and heart failure in patients with acute myocardial infarction treated with primary percutaneous coronary intervention: a systematic review. Am Heart J 2013; 165:451-67. [PMID: 23537961 DOI: 10.1016/j.ahj.2012.11.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Accepted: 11/11/2012] [Indexed: 01/15/2023]
Abstract
BACKGROUND Shorter time to reperfusion is associated with a significant reduction in mortality; however, its association with heart failure (HF) is not clearly documented. We conducted a systematic review to examine the association between time to reperfusion and incident HF and/or left ventricular dysfunction. METHODS MEDLINE/OVID, EMBASE, Cochrane Library, and Web of Science databases were searched from January 1974 to May 2012 for studies that reported the association between time to reperfusion and incident HF or left ventricular ejection fraction (LVEF) in patients undergoing primary percutaneous coronary intervention. RESULTS Of 362 nonduplicate abstracts, 71 studies were selected for full-text review. Thirty-three studies were included in the final review, of which 16 were single-center studies, 7 were population-based studies, 7 were subanalyses from randomized controlled trials, and 3 were based on national samples. The pooled data demonstrate that every 1-hour delay in time to reperfusion is associated with a 4% to 12% increased risk of new-onset HF and a 4% relative increase in the risk of incident HF during follow-up. Early reperfusion was associated with a 2% to 8% greater LVEF before discharge and a 3% to 12% larger improvement in absolute LVEF at follow-up compared with the index admission. CONCLUSIONS This systematic review presents evidence that longer time to reperfusion is not only associated with worsened left ventricular systolic function and new-onset HF at the time of index admission, but also with increased risk of HF and reduced improvement in left ventricular systolic function during follow-up.
Collapse
Affiliation(s)
- Kashish Goel
- Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA
| | | | | |
Collapse
|
4
|
McMullan JT, Hinckley W, Bentley J, Davis T, Fermann GJ, Gunderman M, Hart KW, Knight WA, Lindsell CJ, Miller C, Shackleford A, Gibler WB. Ground emergency medical services requests for helicopter transfer of ST-segment elevation myocardial infarction patients decrease medical contact to balloon times in rural and suburban settings. Acad Emerg Med 2012; 19:153-60. [PMID: 22320366 DOI: 10.1111/j.1553-2712.2011.01273.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES ST-segment elevation myocardial infarction (STEMI) care is time-dependent. Many STEMI patients require interhospital helicopter transfer for percutaneous coronary intervention (PCI) if ground emergency medical services (EMS) initially transport the patient to a non-PCI center. This investigation models potential time savings of ground EMS requests for helicopter EMS (HEMS) transport of a STEMI patient directly to a PCI center, rather than usual transport to a local hospital with subsequent transfer. METHODS Data from a multicenter retrospective chart review of STEMI patients transferred for primary PCI by a single HEMS agency over 12 months were used to model medical contact to balloon times (MCTB) for two scenarios: a direct-to-scene HEMS response and hospital rendezvous after ground EMS initiation of transfer. RESULTS Actual MCTB median time for 36 hospital-initiated transfers was 160 minutes (range = 116 to 321 minutes). Scene response MCTB median time was estimated as 112 minutes (range = 69 to 187 minutes). The difference in medians was 48 minutes (95% confidence interval [CI] = 33 to 62 minutes). Hospital rendezvous MCTB median time was estimated as 113 minutes (range = 74 to 187 minutes). The difference in medians was 47 minutes (95% CI = 32 to 62 minutes). No patient had an actual MCTB time of less than 90 minutes; in the scene response and hospital rendezvous scenarios, 2 of 36 (6%) and 3 of 36 (8%), respectively, would have had MCTB times under 90 minutes. CONCLUSIONS In this setting, ground EMS initiation of HEMS transfers for STEMI patients has the potential to reduce MCTB time, but most patients will still not achieve MCTB time of less than 90 minutes.
Collapse
Affiliation(s)
- Jason T McMullan
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, OH, USA
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
|
6
|
Impact of prehospital delay in treatment seeking on in-hospital complications after acute myocardial infarction. J Cardiovasc Nurs 2011; 26:184-93. [PMID: 21116191 DOI: 10.1097/jcn.0b013e3181efea66] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Rapid arrival to the hospital for treatment of acute myocardial infarction (AMI) improves long-term outcomes. Whether prehospital delay time is associated with short-term, in-hospital complications remains unknown. OBJECTIVE The purpose of this study was to evaluate the fit of a theoretical model where prehospital delay time was indirectly associated with hospital length of stay through in-hospital complications after AMI considering simultaneously for demographic, clinical, and psychosocial factors using structural equation modeling. METHODS Acute myocardial infarction patients (N = 536; 66% men; mean age, 62 [SD, 14] years) were enrolled in this prospective study. Demographic and clinical data were obtained by patient interview and medical record review. After patient discharge, complications were abstracted from the medical record. RESULTS Prehospital delay, admission Killip class, and in-hospital anxiety were the best predictors of in-hospital complications, including recurrent ischemia, reinfarction, sustained ventricular tachycardia or fibrillation, and cardiac death, after AMI (P = .019). The occurrence of in-hospital complications was related to length of stay in the hospital (P < .001). CONCLUSION Prehospital delay in promptly seeking hospital treatment for AMI symptoms, together with state anxiety and worse heart failure, was associated with the occurrence of more frequent serious complications during the hospital stay. It is essential that research and clinical efforts focus on the complex and dynamic issue of improving prehospital delay in AMI patients.
Collapse
|
7
|
McMullan JT, Hinckley W, Bentley J, Davis T, Fermann GJ, Gunderman M, Hart KW, Knight WA, Lindsell CJ, Shackleford A, Gibler WB. Reperfusion Is Delayed Beyond Guideline Recommendations in Patients Requiring Interhospital Helicopter Transfer for Treatment of ST-segment Elevation Myocardial Infarction. Ann Emerg Med 2011; 57:213-220.e1. [DOI: 10.1016/j.annemergmed.2010.08.031] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 07/20/2010] [Accepted: 08/10/2010] [Indexed: 11/25/2022]
|
8
|
McKinley S, Aitken LM, Marshall AP, Buckley T, Baker H, Davidson PM, Dracup K. Delays in presentation with acute coronary syndrome in people with coronary artery disease in Australia and New Zealand. Emerg Med Australas 2011; 23:153-61. [PMID: 21489162 DOI: 10.1111/j.1742-6723.2011.01385.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To report time from the onset of symptoms to hospital presentation in Australian and New Zealand patients with subsequently confirmed acute coronary syndrome, and to identify factors associated with prehospital delay time in these patients. METHODS Patients with coronary artery disease enrolled in a randomized clinical trial testing an intervention to reduce delay in responding to acute coronary syndrome symptoms had been followed for 24 months. In cases of admission to the ED for possible acute coronary syndrome, medical records were reviewed to determine the diagnosis, prehospital delay time, mode of transport to the hospital and aspirin use before admission. Clinical and demographic data were taken from the trial database. RESULTS Patients (n= 140) had an average (SD) age of 67.3 (11.5) years; 36% were female. Two-thirds of patients went to hospital by ambulance and 89.3% had a final diagnosis of unstable angina. The median time from onset of symptoms to arrival at the ED was 2 h and 25 min (interquartile range 1:25-4:59); 12.1% arrived ≤ 1 h and 66% within 4 h. Multiple linear regression analysis showed that use of ambulance (Beta = 0.247, P= 0.012) and younger age (Beta = 0.198, P= 0.043) were independent predictors of shorter delay times. CONCLUSION The time from the onset of symptoms to hospital presentation was too long for maximal benefit from treatment in most patients. Further efforts are needed to reduce treatment-seeking delay in response to symptoms of acute coronary syndrome.
Collapse
Affiliation(s)
- Sharon McKinley
- Northern Sydney Central Coast Health, Critical Care Nursing Professorial Unit, Sydney, New South Wales, Australia.
| | | | | | | | | | | | | |
Collapse
|
9
|
Becker D, Soos P, Berta B, Nagy A, Fulop G, Szabo G, Barczi G, Belicza E, Martai I, Merkely B. Significance of off-hours in centralized primary percutaneous coronary intervention network. Croat Med J 2010; 50:476-82. [PMID: 19839071 DOI: 10.3325/cmj.2009.50.476] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To analyze the efficacy of a regionally organized primary percutaneous coronary intervention (PCI) network at the Heart Center, Semmelweis University Budapest, part of the "Budapest model," and the factors that influence it. METHODS In order to investigate the differences between regular and off-hours patient care in a 24-hour myocardial infarction primary care system, we included 1890 consecutive, unselected patients with ST-segment elevation myocardial infarction and followed them until at least one year. The follow-up was complete for all participants. RESULTS The difference between regular hours and off-hours mortality was not significant either after 30 days (8.6% vs 8.8%, respectively) or after 1 year (15.3% vs 14.7%, respectively). The rate of patients with re-infarction, frequency of re-intervention, and major adverse cardiac events, including death, re-infarction, re-intervention, and coronary artery bypass graft surgery, were similar in both patient groups. The time delay between the onset of chest pain and arrival to the clinic was 5.9+/-5.8 hours (mean+/- standard deviation) during regular hours and 5.2+/-4.6 hours during off-hours (P=0.235). Direct transport caused significant decrease in the 30-day and 1-year mortality independent of duty time (7.2% vs 9.9%, P=0.027; 12.6% vs 16.7%, P=0.028; respectively). CONCLUSION Centralized primary PCI network of the "Budapest model" achieved the same level of patient care during both off-hours and regular hours.
Collapse
Affiliation(s)
- David Becker
- Heart Center Semmelweis University, Budapest, Hungary
| | | | | | | | | | | | | | | | | | | |
Collapse
|
10
|
Contrast medium induced nephropathy in patients undergoing percutaneous coronary intervention for acute coronary syndrome: differences in STEMI and NSTEMI. Clin Res Cardiol 2009; 98:765-72. [DOI: 10.1007/s00392-009-0058-5] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Accepted: 07/30/2009] [Indexed: 01/10/2023]
|
11
|
A simple MR algorithm for estimation of myocardial salvage following acute ST segment elevation myocardial infarction. Clin Res Cardiol 2009; 98:651-6. [DOI: 10.1007/s00392-009-0051-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2009] [Accepted: 07/07/2009] [Indexed: 10/20/2022]
|
12
|
Kurowski V, Giannitsis E, Killermann DP, Wiegand UKH, Toelg R, Bonnemeier H, Hartmann F, Katus HA, Richardt G. The effects of facilitated primary PCI by guide wire on procedural and clinical outcomes in acute ST-segment elevation myocardial infarction. Clin Res Cardiol 2007; 96:557-65. [PMID: 17534565 DOI: 10.1007/s00392-007-0532-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2006] [Accepted: 04/03/2007] [Indexed: 11/30/2022]
Abstract
BACKGROUND Reperfusion of the infarct related artery (IRA) prior to PCI is prognostically important in patients with acute ST segment elevation myocardial infarction (STEMI). Reperfusion is either achieved spontaneously, facilitated by GP IIb/ IIIa inhibitors, or mechanically by crossing the guide wire beyond the lesion. In order to test the hypothesis that a visible coronary anatomy is independently associated with procedural and clinical outcomes, we evaluated the frequency and prognostic impact of guide wire facilitated reperfusion of the IRA before primary PCI. METHODS AND RESULTS We enrolled 311 consecutive patients with successful primary PCI for STEMI (TIMI grade > or =2 flow) within 12 h after onset of symptoms. Among these, 90 patients (28.9%) had a spontaneously reperfused IRA on initial angiogram, 56 patients (18.0%) achieved reperfusion after crossing of the guide wire, and 165 patients (53.1%) successful reperfusion only after PCI. Variables associated with successful guide wire facilitated reperfusion were younger age, no history of arterial hypertension, active smoking status, negative cardiac troponin T on admission, and an infarct in the territory of the right coronary artery. Patients with spontaneous reperfusion or reperfusion after crossing of the guide wire required less fluoroscopic time and less contrast material during angiography and had higher procedural success rates (TIMI grade 3 flow 91.1 vs 79.4%, p=0.048) than patients without initial reperfusion. In addition, patients with reperfusion after crossing the lesion with the guide wire had lower mortality rates at 30 days (3.6 vs 9.1%) and after a median of 16 months (3.6 vs 13.9%, p=0.03) than those with reperfusion after PCI. CONCLUSIONS Reperfusion of an occluded IRA by crossing the guide wire is associated with higher procedural success rates and better outcomes. Better roadmapping and device selection represent potential reasons but the exact mechanism for these benefits is still illusive.
Collapse
Affiliation(s)
- Volkhard Kurowski
- Medizinische Klinik II, Medizinische Universität zu Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany
| | | | | | | | | | | | | | | | | |
Collapse
|