1
|
Abed MA, Khalil AA, Moser DK. Patient Denial of Myocardial Infarction in the Prehospital Phase: Prevalence and Correlates. J Cardiovasc Nurs 2024; 39:456-464. [PMID: 37738318 DOI: 10.1097/jcn.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
BACKGROUND Limited knowledge exists regarding patients' denial of myocardial infarction (MI) before hospitalization for an MI. OBJECTIVE The aim of this study was to determine the prevalence and correlates of denial of MI in the prehospital phase of a confirmed MI. METHODS This secondary analysis included 166 hospitalized patients (mean [SD] age, 54.1 [10.5] years) who developed MI outside a healthcare facility and had high congruence between their experienced and expected symptoms. Measurements included the Denial subscale of the Brief COPE Inventory, the modified Response to Symptoms Questionnaire, and a Likert scale measuring perceived risk for MI. Patients who arrived at a hospital at least 1 hour after the onset of their symptoms were considered to have prolonged prehospital delay. RESULTS Despite their high symptom congruence, 77% of patients denied the possibility of having an MI before hospitalization. The lower denial group was characterized by cardiac history, whereas the higher denial group was distinguished by nonsmoking, a lower perceived risk of MI, less anxiety at symptom onset, and more concerns about seeking medical help. Compared with the lower denial group, patients in the higher denial group were more likely to underestimate the seriousness of their symptoms and delay seeking medical help. The higher denial group responded to symptoms in a more passive manner (eg, waiting), whereas the lower denial group showed a more problem-solving approach (eg, contacting emergency services). CONCLUSIONS Denial of MI is highly prevalent in the prehospital phase and is negatively linked with cognitive, emotional, and behavioral responses to MI symptoms.
Collapse
|
2
|
Bahr RD. Acute prevention of a heart attack : Early identification of prodromal symptoms as the Rosetta Stone in decoding the heart attack problem. Herz 2024; 49:167-174. [PMID: 38446175 DOI: 10.1007/s00059-024-05239-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/05/2024] [Indexed: 03/07/2024]
Abstract
Chest discomfort before severe chest pain represents a marker of clinical ischemia and indicates live myocardium in jeopardy and often precedes cardiac arrest or acute myocardial infarction (MI). The intermittent or "stuttering" symptoms that precede MI are referred to as "prodromal symptoms." These symptoms have been shown to correlate with cyclic ST changes and repeated episodes of spontaneous reperfusion and occlusion, occurring during a period of hours or days before the acute ischemia proceeds to death or heart damage. These symptoms of premonitory angina have been associated with improved outcomes due to ischemic pre-conditioning or opening of collateral vascular channels around the area of ischemia. Acute prevention of an MI through recognition of prodromal symptoms represents an opportunity to significantly reduce heart attack deaths. The Early Heart Attack Care (EHAC) program puts emphasis on prodromal symptom recognition and allows for a shift in time backward to prevent the ischemic process from proceeding to MI. This strategy has been shown to detect the 15% of patients with ischemia in the low-probability group and to reduce inappropriate admissions to hospital as well as to reduce the number of patients with missed MI being sent home from the emergency department.
Collapse
Affiliation(s)
- Raymond D Bahr
- ACC Accreditation Services, Early Heart Attack Care Subcommittee, Baltimore, MD, USA.
- , 2901 Boston St, Apt. 609, 21224, Baltimore, MD, USA.
| |
Collapse
|
3
|
Giordano V, Guillari A, Sansone V, Catone M, Rea T. Women Acute Myocardial Infarction-Identifying and Understanding the Gender Gap (WAMy-GAP): A Study Protocol. Healthcare (Basel) 2024; 12:972. [PMID: 38786384 PMCID: PMC11121322 DOI: 10.3390/healthcare12100972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/02/2024] [Accepted: 05/05/2024] [Indexed: 05/25/2024] Open
Abstract
Barriers to accessing care and misinterpretations of ischemic heart disease symptoms due to lack of awareness contribute to women's delay in seeking care. Women may delay seeking treatment for up to 3 h or even up to 5 days. They often perceive themselves to be at low risk of cardiovascular disease (CVD) and prioritize family responsibilities or household chores. The causes of this delay are multifactorial and influence the decision-making process, particularly in the pre-hospital phase. The objective of this study protocol is to evaluate prodromal symptoms and identify risk behaviors in women with acute myocardial infarction (AMI). This is a protocol for a multicenter study that will be conducted using the mixed-method methodology using the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) to evaluate symptoms and semi-structured interviews to investigate behaviors. This study protocol is intended to fill an important knowledge gap on premonitory and acute symptoms of AMI in women in Italy, as well as to understand the causes and mechanisms underlying delays in accessing healthcare services during an acute event such as AMI. The investigation of this issue will facilitate the removal of gender-related inequalities in the diagnosis and treatment of acute myocardial infarction while also fostering dialogue on the barriers to behavior change.
Collapse
Affiliation(s)
- Vincenza Giordano
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, 00133 Rome, Italy;
| | - Assunta Guillari
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
| | - Vincenza Sansone
- Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, 81100 Naples, Italy;
| | - Maria Catone
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
| | - Teresa Rea
- Public Health Department, Federico II University Hospital, 80131 Naples, Italy; (M.C.); (T.R.)
| |
Collapse
|
4
|
Helander ME, Formica MK, Bergen-Cico DK. The Daily Patterns of Emergency Medical Events. J Biol Rhythms 2024; 39:79-99. [PMID: 37786272 DOI: 10.1177/07487304231193876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
This study examines population-level daily patterns of time-stamped emergency medical service (EMS) dispatches to establish their situational predictability. Using visualization, sinusoidal regression, and statistical tests to compare empirical cumulative distributions, we analyzed 311,848,450 emergency medical call records from the US National Emergency Medical Services Information System (NEMSIS) for years 2010 through 2022. The analysis revealed a robust daily pattern in the hourly distribution of distress calls across 33 major categories of medical emergency dispatch types. Sinusoidal regression coefficients for all types were statistically significant, mostly at the p < 0.0001 level. The coefficient of determination ( R 2 ) ranged from 0.84 and 0.99 for all models, with most falling in the 0.94 to 0.99 range. The common sinusoidal pattern, peaking in mid-afternoon, demonstrates that all major categories of medical emergency dispatch types appear to be influenced by an underlying daily rhythm that is aligned with daylight hours and common sleep/wake cycles. A comparison of results with previous landmark studies revealed new and contrasting EMS patterns for several long-established peak occurrence hours-specifically for chest pain, heart problems, stroke, convulsions and seizures, and sudden cardiac arrest/death. Upon closer examination, we also found that heart attacks, diagnosed by paramedics in the field via 12-lead cardiac monitoring, followed the identified common daily pattern of a mid-afternoon peak, departing from prior generally accepted morning tendencies. Extended analysis revealed that the normative pattern prevailed across the NEMSIS data when reorganized to consider monthly, seasonal, daylight-savings versus civil time, and pre-/post-COVID-19 periods. The predictable daily EMS patterns provide impetus for more research that links daily variation with causal risk and protective factors. Our methods are straightforward and presented with detail to provide accessible and replicable implementation for researchers and practitioners.
Collapse
Affiliation(s)
- Mary E Helander
- Maxwell School of Citizenship and Public Affairs, Department of Social Science, Syracuse University, Syracuse, New York
- Falk College, Department of Public Health, Syracuse University, Syracuse, New York
| | - Margaret K Formica
- Department of Public Health and Preventive Medicine, Department of Urology, Upstate Medical University, Syracuse, New York
| | - Dessa K Bergen-Cico
- Falk College, Department of Public Health, Syracuse University, Syracuse, New York
| |
Collapse
|
5
|
Li PWC, Yu DSF, Yan BP, Wong CW, Chan CMC. Theory-based cognitive-narrative intervention versus didactic education for promoting prompt care-seeking for acute myocardial infarction: A multisite mixed-methods randomized controlled trial. Int J Nurs Stud 2023; 148:104564. [PMID: 37852046 DOI: 10.1016/j.ijnurstu.2023.104564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 07/06/2023] [Accepted: 07/10/2023] [Indexed: 10/20/2023]
Abstract
BACKGROUND Prolonged delays by patients in making care-seeking decisions remain a significant obstacle to the effective management of acute myocardial infarction. OBJECTIVES This study aimed to compare the effects of a theory-based cognitive-narrative intervention with those of didactic education over a 24-month period on the participants' attitudes, beliefs, and knowledge regarding acute myocardial infarction, prehospital delay time, and the use of an ambulance. We also explored participants' engagement in the intervention. DESIGN This study adopted a sequential mixed-methods design comprising a multisite randomized controlled trial and a qualitative study. METHODS Community-dwelling adult patients with a prior history of acute myocardial infarction in the past year were recruited from four hospitals in Hong Kong. They were randomly assigned to an 8-week theory-based cognitive-narrative intervention that involved a vivid experience of complex decision-making or didactic education. The Acute Coronary Syndrome Response Index questionnaire was administered at baseline (T0) and at 3- (T1), 12- (T2), and 24-month (T3) follow-up time points. Prehospital delay time and the use of an ambulance were evaluated for those participants who had recurrent acute myocardial infarction attacks during the study period. RESULTS A total of 608 participants were randomly assigned to the theory-based cognitive-narrative intervention group (n = 304) or the didactic education group (n = 304). The intervention group reported greater improvements than the control group in their attitudes (β = -1.053, p = 0.002) and beliefs (β = -0.686, p = 0.041) regarding acute myocardial infarction and care-seeking at T1. These effects were sustained at T2 [attitudes (β = -0.797, p = 0.018); beliefs (β = -0.692, p = 0.047)] and T3 [attitudes (β = -0.717, p = 0.024); beliefs (β = -0.701, p = 0.032)]. Sixty-three participants experienced another acute myocardial infarction event by T2. The median delay times for the intervention and control groups were 3.13 h (interquartile range (IQR: 1.15-6.48)) and 4.82 h (IQR: 2.23-9.02), respectively. The prehospital delay time was significantly reduced in the intervention group compared with the control group (β = -0.07, p = 0.011). The qualitative findings echoed the quantitative findings, as participants indicated that the intervention helped them to understand the variable nature of the disease presentation, which enabled them to recognize the symptoms more readily. CONCLUSION The novel cognitive-narrative intervention used in this study effectively improved the participants' attitudes and beliefs regarding acute myocardial infarction and reduced the prehospital delay time. TRIAL REGISTRATION This study was registered with the International Clinical Trials Registry Platform of the World Health Organization (ChiCTR-IIC-17010576) on February 2, 2017; the first participant was recruited on January 11, 2018.
Collapse
Affiliation(s)
- Polly W C Li
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong.
| | - Doris S F Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bryan P Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - C W Wong
- Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong
| | | |
Collapse
|
6
|
Adi NP, Nagata T, Mori K, Kubo T, Fujimoto K, Ohtani M, Odagami K, Nagata M, Kajiki S, Fujino Y, Matsuda S. Seeking Treatment Profile of Male Shift Workers With Hypertension and Diabetes. J Occup Environ Med 2023; 65:783-788. [PMID: 37311081 PMCID: PMC10487365 DOI: 10.1097/jom.0000000000002904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
OBJECTIVE This study was identified seeking treatment for hypertension and diabetes among male shift workers. METHOD This retrospective cohort study included nine large companies in Japan. Data were collected from health checkup, health insurance records, and self-administered questionnaires in 2017 and 2020. Data were analyzed using Kaplan-Meier curves and Cox regression. RESULT Person-days shift workers and day workers seeking treatment for hypertension were 41,604 and 327,301, respectively and, for diabetes, were 7326 and 60,735, respectively. The log ranks were statistically significant. Shift workers were 46% and 56% less likely to seek treatment for hypertension and diabetes, respectively, than day workers were after adjustment for age, marital status, education level, and intention to modify lifestyle (model 2) ( P < 0.01). CONCLUSIONS Male shift workers are less likely to seek treatment for hypertension and diabetes compared with day workers.
Collapse
|
7
|
Sulku SN, Tokatlioglu Y, Cosar K. Receiving or not deemed necessary healthcare services. BMC Public Health 2023; 23:208. [PMID: 36721134 PMCID: PMC9887775 DOI: 10.1186/s12889-023-15135-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 01/19/2023] [Accepted: 01/24/2023] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Avoiding deemed necessary healthcare needs may worsen prognosis and treatment options, and damage people's ability to perform their roles in society. Our study investigates why people avoid healthcare services in an upper-middle-income country, Türkiye. METHODS We apply TurkStat's 2012 Health Survey Data that includes a comprehensive health and social-demographic information of 28,055 survey participants who were 15 + aged. We use bivariate probit model to analyze the avoidance behavior in inpatient level in accordance with outpatient level because of the observed significant correlation between people's avoidance behavior under tertiary and lower level health care. RESULTS The findings show that 2.6% of 15 + aged population avoided deemed necessary hospital services. Furthermore, we found that high cost (31%), organizational factors (21%) and fear (12%) are prominent reasons of avoiding tertiary care. Thereafter, in our bivariate probit model findings, we figure out that being covered by social security schemes decreases the probability of avoiding both outpatient and inpatient health services by 6.9%. Moreover, being female, living in rural area, having lower income increase the chance of being avoider in both stages of healthcare. CONCLUSION We conclude that social inequalities are the main underlying determinants of the avoiding behavior.
Collapse
Affiliation(s)
- Seher Nur Sulku
- grid.509259.20000 0004 7221 6011Department of Econometrics, Ankara Haci Bayram Veli University, Muammer Bostanci Caddesi No: 4, 06500 Ankara, Türkiye Turkey
| | - Yagmur Tokatlioglu
- Department of Econometrics, Ankara Haci Bayram Veli University, Muammer Bostanci Caddesi No: 4, 06500, Ankara, Türkiye, Turkey.
| | - Kubra Cosar
- grid.509259.20000 0004 7221 6011Department of Econometrics, Ankara Haci Bayram Veli University, Muammer Bostanci Caddesi No: 4, 06500 Ankara, Türkiye Turkey
| |
Collapse
|
8
|
Li PWC, Yu DSF, Yan BP, Wong CW, Yue SCS, Chan CMC. Effects of a Narrative-Based Psychoeducational Intervention to Prepare Patients for Responding to Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2239208. [PMID: 36306128 PMCID: PMC9617174 DOI: 10.1001/jamanetworkopen.2022.39208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 08/25/2022] [Indexed: 11/14/2022] Open
Abstract
Importance Despite decades of educational efforts, patients' prolonged delays in seeking care for symptoms of acute myocardial infarction (AMI) remain the greatest obstacle to successful management of the condition. Objective To compare the effects of a narrative-based psychoeducational intervention with a didactic educative approach on AMI survivors' intention to seek care for AMI symptoms and on AMI knowledge. Design, Setting, and Participants A multisite randomized clinical trial recruited community-dwelling patients aged 18 years or older with a history of AMI from 4 hospitals in Hong Kong from January 1, 2018, to January 22, 2021, and followed up participants for 1 year. Interventions An 8-week narrative-based psychoeducational intervention aimed to create a vivid cognitive experience of complex decision-making and modeled desirable behavioral changes through nurse-led, interactive video sessions using model patients. The control group received 4 nurse-led sessions comprising education about AMI and care seeking delivered using a didactic approach. Main Outcomes and Measures The primary outcome was the behavioral intention between the 2 groups, reflected by participants' attitudes and beliefs about care seeking for AMI measured using the Acute Coronary Syndrome Response Index-Chinese version. The secondary outcome was AMI knowledge. Results Six hundred and eight participants (mean [SD] age, 67.2 [8.3] years; 469 [77.1%] male) were randomized to either the narrative-based psychoeducation group (n = 304) or the didactic education group (n = 304). The psychoeducational intervention group reported greater positive changes than the control group in their attitudes (β = -1.053 [95% CI, -1.714 to -0.391]; P < .001) and beliefs (β = -0.686 [95% CI, -1.354 to -0.180]; P = .04) toward care seeking at the 3-month follow-up, and the difference was sustained at 12 months for both attitudes (β = -0.797 [95% CI, -1.477 to -0.117]; P = .02) and beliefs (β = -0.692 [95% CI, -1.309 to -0.012]; P = .047). There were no significant differences in AMI knowledge between the 2 study groups at the 3-month and 12-month time points. Conclusions and Relevance The results of this randomized clinical trial found that a novel approach of narrative-based psychoeducation was effective in improving patients' behavioral intention to seek care for AMI symptoms. Longer-term follow-up to evaluate actual care-seeking behavior and clinical outcomes in patients with AMI is warranted to determine the sustained effects of this intervention. Trial Registration ChiCTR Identifier: ChiCTR-IIC-17010576.
Collapse
Affiliation(s)
- Polly W. C. Li
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Doris S. F. Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bryan P. Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - C. W. Wong
- Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong
| | - Sunny C. S. Yue
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
| | | |
Collapse
|
9
|
9-1-1 Caller-Described Heart Attack Symptoms. Prehosp Disaster Med 2022; 37:609-615. [PMID: 35848225 DOI: 10.1017/s1049023x22001017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Heart attacks (HAs) present clinically with varying symptoms, which are not always described by patients as chest pain (CP) or chest discomfort (CD). Emergency Medical Dispatchers (EMDs) select the CP/CD dispatch protocol for non-chest pain HA symptoms or classic HA complaint of CP/CD. Nevertheless, it is still unknown how often callers report HA symptoms other than CP/CD. OBJECTIVES The objective of this study was to characterize the caller's descriptions of the primary HA symptoms, descriptions of the other HA symptoms, and the use of a case entry (CE) question clarifier. METHODS A retrospective descriptive study analyzed randomly selected EMD audios (where CD/CD protocol was used) from five accredited emergency communication centers in the United States. Several Quality Performance Review (QPR) experts reviewed the audios and recorded callers' initial problem descriptions, the use of and responses to the CE question clarifier, including the EMD-assigned final determinant code. RESULTS A total of 1,261 audios were reviewed. The clarifier was used only 8.5% of the time. The CP/CD symptoms were mentioned alone or with other problems 87.0% of the time. Overall, CP symptom was mentioned alone 70.8%, HA alone 4.0%, and CD symptom alone 1.4% of the time. CONCLUSION 9-1-1 callers report potential HA cases using a variety of terms and descriptions-most commonly CP. Other less-common symptoms associated with a HA may be mentioned. Therefore, EMDs must be well-trained to be prepared to probe the caller with a clarifying query to elicit more specific information when "having a heart attack" is the only complaint initially mentioned.
Collapse
|
10
|
Variation in Seeking Care for Cardiovascular Disease and Ambulance Utilization among Migrants in Australia: Time, Ethnicity, and Delay (TED) Study III. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031516. [PMID: 35162538 PMCID: PMC8834978 DOI: 10.3390/ijerph19031516] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Revised: 01/25/2022] [Accepted: 01/26/2022] [Indexed: 02/04/2023]
Abstract
Insight into differences in seeking medical care for chest pain among migrant populations is limited. This study aimed to determine ethnic differences in seeking care behaviors and using ambulances among migrants compared to an Australian-born group. A total of 607 patients presenting with chest pain to a tertiary hospital between 1 July 2012 and 30 June 2014 were randomly selected. Data from the emergency department dataset and medical record reviews were collected and linked for analysis. The migrant group was stratified into nine ethnic groups for analysis based on the Australian Standard Classification of Cultural and Ethnic Groups. The overall median prehospital delay time was 3.7 (1.5, 10.7) h, which ranged from 2.5 (1.0, 10.7) (Southern and Eastern European group) to 6.0 (2.3, 20.6) (Sub-Saharan African group). The median decision time was 2.0 (0.8, 7.9) h, which ranged from 1.5 (Australian-born group) to 4.5 h (Sub-Saharan African group). Five ethnic groups had significantly longer decision times compared to the Australian-born group. Decision time accounted for 58.4% of pre-hospital delay time. Migrant patients were 60% less likely to seek care for chest pain within one hour (odds ratio 0.40, (0.23–0.68), p = 0.001). There was no significant difference in ambulance utilization between migrant and Australian-born groups. In conclusion, ethnic differences in seeking care for chest pain do exist, and ethnicity plays a vital role in a longer delay in seeking care. To reduce the delays and improve patient outcomes, appropriate health campaigns focusing on ethnic differences among migrant populations and normalizing cultural competency into practice are recommended.
Collapse
|
11
|
Huang YH, How CK, Ho CS. Factors Affecting Delayed Hospital Arrival of Patients with Acute Myocardial Infarction in Kinmen. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:1323. [PMID: 35162347 PMCID: PMC8834892 DOI: 10.3390/ijerph19031323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 12/04/2022]
Abstract
This study explores factors related to delayed emergency medical treatment for acute myocardial infarction patients on Kinmen Island. A cross-sectional study was performed in the only hospital in Kinmen Island. The study group consisted of 116 patients diagnosed with acute myocardial infarction (AMI, ICD-10 codes: I21.9) from November 2015 to May 2019. The binary logistic regression analyses were performed for the inferential statistical analysis. The mean age of the study group was 63.0 ± 14.5 years, 39.7% of the patients arrived at the emergency medicine longer than 6 h after the onset of symptoms. The related factors for delayed arrival the hospital emergency medicine department were female sex, age over 65 years, less than nine years' education, and Killip Class, but only Killip Class reached the significant difference of statistics (OR = 3.616, 95% C.I. = 1.574 to 8.310, p = 0.002), and patients with delayed arrival times (>6 h) were found to have a higher percentage of Killip Class ≥ II. Therefore, it is essential to remind the physicians to proceed with risk stratification for acute coronary syndrome patients. In addition, health authorities should provide effective programs to increase awareness of the symptoms and timely treatment of acute myocardial infraction to the general public, especially the elderly.
Collapse
Affiliation(s)
- Yu-Han Huang
- Cardiovascular Care Center, Kinmen Hospital, Ministry of Health and Welfare, Kinmen 89142, Taiwan;
| | - Chorng-Kuang How
- Emergency Department, Taipei Veterans General Hospital, Taipei 11217, Taiwan;
- Department of Emergency Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Ching-Sung Ho
- Department of Long Term Care, National Quemoy University, 1 University RD. Jinning Township, Kinmen 89250, Taiwan
| |
Collapse
|
12
|
Sancassiani F, Montisci R, Preti A, Paribello P, Meloni L, Romano F, Nardi AE, Carta MG. Surviving to Acute Myocardial Infarction: The Role of Psychological Factors and Alexithymia in Delayed Time to Searching Care: A Systematic Review. J Clin Med 2021; 10:3813. [PMID: 34501261 PMCID: PMC8432253 DOI: 10.3390/jcm10173813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/16/2022] Open
Abstract
The time from symptom onset to reperfusion is a critical determinant of myocardial salvage and clinical outcomes in patients with acute myocardial infarction (AMI). This time period could be delayed if people do not seek help promptly and/or if the health system is not efficient in responding quickly and attending to these individuals. The aim of this study was to identify psychological factors associated with pre-hospital delay (PHD) or patients' decisional delay (PDD) in people with an ongoing AMI. A search in PubMed/Medline from 1990 to 2021 with the keywords "pre-hospital delay" OR "prehospital delay" OR "patient delay" OR "decisional delay" OR "care seeking behavior" AND "psychological factors" OR "alexithymia" AND "myocardial infarction" was performed. Thirty-six studies were included, involving 10.389 patients. Wrong appraisal, interpretation and causal beliefs about symptoms, denial of the severity of the symptoms and high levels of alexithymia were found related to longer PHD or PDD. Alexithymia may be an overarching construct that explains the disparate findings of the studies exploring the role of psychological factors in PHD or PDD. Further studies are needed in order to analyse the role of alexithymia in patients with risk factors for AMI to prevent delay.
Collapse
Affiliation(s)
- Federica Sancassiani
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E. SS 554 Bivio Sestu, 09042 Monserrato, CA, Italy; (F.S.); (P.P.); (L.M.); (M.G.C.)
| | - Roberta Montisci
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E. SS 554 Bivio Sestu, 09042 Monserrato, CA, Italy; (F.S.); (P.P.); (L.M.); (M.G.C.)
| | - Antonio Preti
- Department of Neurosciences, University of Turin, 10126 Turin, Italy;
| | - Pasquale Paribello
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E. SS 554 Bivio Sestu, 09042 Monserrato, CA, Italy; (F.S.); (P.P.); (L.M.); (M.G.C.)
| | - Luigi Meloni
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E. SS 554 Bivio Sestu, 09042 Monserrato, CA, Italy; (F.S.); (P.P.); (L.M.); (M.G.C.)
| | - Ferdinando Romano
- Department of Public Health and Infectious Diseases, University of Rome “La Sapienza”, 00185 Rome, Italy;
| | - Antonio E. Nardi
- Laboratory of Panic and Respiration, Institute of Psychiatry of Federal University of Rio de Janeiro (IPUB/UFRJ), Rio de Janeiro 22290-140, Brazil;
| | - Mauro Giovanni Carta
- Department of Medical Sciences and Public Health, University of Cagliari, Asse Didattico E. SS 554 Bivio Sestu, 09042 Monserrato, CA, Italy; (F.S.); (P.P.); (L.M.); (M.G.C.)
| |
Collapse
|
13
|
Biswas S, Dinh D, Lucas M, Duffy SJ, Brennan A, Liew D, Cox N, Smith K, Andrew E, Nehme Z, Reid CM, Lefkovits J, Stub D. Impact of limited English proficiency on presentation and clinical outcomes of patients undergoing primary percutaneous coronary intervention. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2021; 6:254-262. [PMID: 31782766 DOI: 10.1093/ehjqcco/qcz061] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Revised: 11/06/2019] [Accepted: 11/26/2019] [Indexed: 11/13/2022]
Abstract
AIMS To evaluate the association of limited English proficiency (LEP) with reperfusion times and outcomes in patients undergoing primary percutaneous coronary intervention (PPCI) for ST-elevation myocardial infarction (STEMI). METHODS AND RESULTS This cohort study included 5385 patients who underwent PPCI in 2013-2017 and were prospectively enrolled in the Victorian Cardiac Outcomes Registry. Data linkage to government administrative datasets was performed to identify patients' preferred spoken language, socioeconomic status, and ambulance utilization data. Patients who had a preferred spoken language other than English were defined as having LEP. Of the study cohort, 430 patients (8.0%) had LEP. They had longer mean symptom-to-door time (STDT) [164 (95% confidence interval, CI 149-181) vs. 136 (95% CI 132-140) min, P < 0.001] but similar mean door-to-balloon time [79 (95% CI 72-87) vs. 76 (95% CI 74-78) min, P = 0.41]. They also had higher major adverse cardiovascular and cerebrovascular events (MACCE; 13.5% vs. 9.9%; P = 0.02), severe left ventricular dysfunction (11.0% vs. 8.4%, P = 0.02), and heart failure (HF) hospitalizations within 30 days of PPCI (5.1% vs. 2.0%, P < 0.001). On multivariable analysis, LEP did not independently predict 30-day MACCE [odds ratio (OR) 1.16, 95% CI 0.79-1.69; P = 0.45] but was an independent predictor of both prolonged STDT ≥ 120 min (OR 1.25, 95% CI 1.02-1.52; P = 0.03) and 30-day HF hospitalizations (OR 2.01, 95% CI 1.21-3.36; P = 0.008). CONCLUSION Patients with LEP undergoing PPCI present later and are more likely to have HF readmissions within 30 days of percutaneous coronary intervention, but with similar short-term MACCE. More effort to provide education in varied languages on early presentation in STEMI is required.
Collapse
Affiliation(s)
- Sinjini Biswas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia
| | - Diem Dinh
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mark Lucas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Stephen J Duffy
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia
| | - Angela Brennan
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Danny Liew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of General Medicine, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia
| | - Nicholas Cox
- Department of Cardiology, Western Health, Gordon Street, Footscray, VIC 3011, Australia.,Department of Medicine, Melbourne Medical School-Western Precinct, The University of Melbourne, Furlong Road, St Albans, VIC 3021, Australia
| | - Karen Smith
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Manningham Road, Doncaster, VIC 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Emily Andrew
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Manningham Road, Doncaster, VIC 3108, Australia
| | - Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Manningham Road, Doncaster, VIC 3108, Australia.,Department of Community Emergency Health and Paramedic Practice, Monash University, McMahons Road, Frankston, VIC 3199, Australia
| | - Christopher M Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,School of Public Health, Curtin University, Kent Street, Perth, WA 6102, Australia
| | - Jeffrey Lefkovits
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, Royal Melbourne Hospital, Grattan Street, Melbourne, VIC 3050, Australia
| | - Dion Stub
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.,Department of Cardiology, The Alfred Hospital, Commercial Road, Melbourne, VIC 3004, Australia.,Department of Cardiology, Western Health, Gordon Street, Footscray, VIC 3011, Australia.,Centre for Research and Evaluation, Ambulance Victoria, Manningham Road, Doncaster, VIC 3108, Australia.,Baker Heart and Diabetes Institute, Commercial Road, Melbourne, VIC 3004, Australia
| |
Collapse
|
14
|
Determinants of health care avoidance and avoidance reasons in Turkey. J Public Health (Oxf) 2021. [DOI: 10.1007/s10389-021-01577-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
|
15
|
Alrawashdeh A, Nehme Z, Williams B, Smith K, Stephenson M, Bernard S, Bray J, Stub D. Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction. Eur J Cardiovasc Nurs 2021; 20:243–251. [PMID: 33611404 DOI: 10.1177/1474515120953737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction. METHODS This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011-January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression. RESULTS The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range=17-176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10-11.83; and 8.02; 3.65-17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours. CONCLUSION Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient's decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.
Collapse
Affiliation(s)
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Monash University, Australia
| | - Karen Smith
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Michael Stephenson
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia.,Baker IDI Heart and Diabetes Institute, Australia
| |
Collapse
|
16
|
Caltabellotta T, Magne J, Salerno B, Pradel V, Petitcolin PB, Auzemery G, Virot P, Aboyans V. Characteristics associated with patient delay during the management of ST-segment elevated myocardial infarction, and the influence of awareness campaigns. Arch Cardiovasc Dis 2020; 114:305-315. [PMID: 33272857 DOI: 10.1016/j.acvd.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/03/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The delay between the occurrence of symptoms and the call seeking medical assistance is an important component of the pain-to-balloon delay in patients with ST-segment elevation myocardial infarction (STEMI). Factors affecting this "patient delay" have been poorly studied, and campaigns to raise emergency call awareness have barely been evaluated. AIMS To evaluate the factors related to patient delay, and the effects of public awareness campaigns undertaken in our region. METHODS Data from the regional registry of STEMI in Limousin, France, were analysed, and we performed a survey to assess medical history, clinical signs, context, socioeconomic situation and perception and behaviour of the patient. "Late callers" (i.e. third tertile,>154minutes) were compared with "early callers" (i.e. first and second tertiles,≤154minutes) using univariate and multivariable statistical methods. The influence of public awareness campaigns was studied by comparing the patient delays before and after a regional campaign. RESULTS Among 481 patients, the median patient delay was 87minutes. "Late callers" were older (odds ratio [OR] 1.02 per year, 95% confidence interval [CI] 1.00 to 1.03), more often had symptom onset between 00:00 and 05:59 a.m. (OR 1.86, 95% CI 1.10 to 3.12) and more often sought assistance from a general practitioner (OR 2.58, 95% CI 1.66 to 4.04) or attended the emergency room (OR 4.10, 95% CI 2.04 to 8.32). Sweats and considering the situation to be severe were factors associated with a reduced delay. After awareness campaigns, there was no change in patient delay, but the proportion of patients calling the Emergency Medical Services increased from 55% to 62% (P<0.001). CONCLUSIONS Patient delay is multifactorial. The impact of previous campaigns is mixed. Psychological and behavioural aspects are determinant, and should be taken into consideration to develop awareness messages that target specific groups.
Collapse
Affiliation(s)
- Thibaut Caltabellotta
- Department of Medicine, Monts-et-Barrages Hospital, 87400 Saint-Léonard de Noblat, France
| | - Julien Magne
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France
| | - Baptiste Salerno
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | - Valerie Pradel
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | | | - Gilles Auzemery
- Agence Régionale de Santé-Nouvelle-Aquitaine, 33000 Bordeaux, France
| | - Patrice Virot
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France.
| |
Collapse
|
17
|
Spoletini I, Ferrari R, Rosano GMC. Living with stable angina: patients' pathway and needs in angina. J Cardiovasc Med (Hagerstown) 2020; 21:377-382. [PMID: 32205502 DOI: 10.2459/jcm.0000000000000954] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS There is evidence that stable angina patients may suffer from emotional disorders that further impair their quality of life. However, the emotional experience of living with stable angina from the patient's perspective still has to be explored. Thus, the main aim of this study was to explore patients' emotional experience of having stable angina and their reported needs during the pathway from the first symptoms, through the process of diagnosis, to management and related lifestyle changes. METHODS A survey was conducted in 75 chronic ischemic heart disease patients with angina (Brazil, China, Romania, Russia, and Turkey) using a 75-min, face-to-face in-depth interview. RESULTS AND CONCLUSION Patients' responses highlighted the need to increase individuals' awareness on the first signs and symptoms of the disease. The survey also showed that chronic stable angina patients need constant emotional support to overcome stress, anxiety, and depression. Finally, this study suggests the need to offer greater space for dialogue with healthcare professionals to get more comprehensive and 'patient-friendly' information.
Collapse
Affiliation(s)
- Ilaria Spoletini
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome
| | - Roberto Ferrari
- Cardiological University Centre of Ferrara, University of Ferrara, Maria Cecilia Hospital, GVM Care & Research, Cotignola (RA), Italy
| | - Giuseppe M C Rosano
- Centre for Clinical and Basic Research, Department of Medical Sciences, IRCCS San Raffaele Pisana, Rome
| |
Collapse
|
18
|
Tran P, Tran L. Influence of rurality on the awareness of myocardial infarction symptoms in the US. Ther Adv Cardiovasc Dis 2019; 13:1753944719891691. [PMID: 31797738 PMCID: PMC6893939 DOI: 10.1177/1753944719891691] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Myocardial infarctions (MIs) are the leading cause of death in the United States (US). Differences in MI mortality rates exist between rural and urban areas in the US. Early recognition of MI symptoms can lead to receiving prompt lifesaving treatment. In this study, we identified the influence of living in a rural area, rurality, on disparities in MI symptom awareness across the US. METHODS We examined 2007 and 2009 Behavioral Risk Factor Surveillances System survey data using logistic regressions to model the impact of rurality on MI symptom awareness while controlling for sociodemographic and MI clinical factors. From the results of these models, we created a type of marginal probability, known as average adjusted predictions (AAPs) and the difference in AAPs, called average marginal effects (AMEs), to determine patterns of awareness for each MI symptom between rural, suburban, and urban areas. RESULTS We found that there were similar odds and probabilities of being aware of all five MI symptoms between rural, suburban, and urban areas, although rural residents consistently had a slightly higher odds and probability of being aware of all five MI symptoms compared with suburban and urban residents. Rural, suburban, and urban residents had the highest probability of being aware of chest pain/discomfort (95.5-96.1%) and the lowest probability of being aware of jaw/back/neck pain (68.6-72.0%). After adjustment, more than 25% of rural, suburban, and urban residents were found to be unaware that jaw/back/neck pain and feeling weak/light-headed/faint were symptoms of MI. AMEs were greatest for all areas for jaw/back/neck pain (-3.5% to -3.2%) and smallest for chest pain/discomfort (-0.6% to -0.2%). CONCLUSIONS The study's results highlight the need to increase awareness of the MI symptoms of jaw/back/neck pain and feeling weak/light-headed/faint to shorten hospital delay and time to treatment, especially for rural areas where cardiovascular disease mortality is high.
Collapse
Affiliation(s)
- Phoebe Tran
- Department of Chronic Disease Epidemiology, Yale University, 60 College Street, New Haven, CT 06510, USA
| | - Lam Tran
- Department of Biostatistics, Michigan School of Public Health, Ann Arbor, MI, USA
| |
Collapse
|
19
|
Health conditions, payments, proximity, and opportunity costs: Examining delays in seeking inpatient and outpatient care in the Philippines. Soc Sci Med 2019; 238:112479. [DOI: 10.1016/j.socscimed.2019.112479] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 06/05/2019] [Accepted: 08/02/2019] [Indexed: 11/18/2022]
|
20
|
Pate A, Leeman-Castillo BA, Krantz MJ. Treatment-Seeking Delay Among Hispanic and Non-Hispanic Women with Acute Myocardial Infarction. Health Equity 2019; 3:287-296. [PMID: 31312779 PMCID: PMC6634169 DOI: 10.1089/heq.2018.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Purpose: Women and minorities with acute myocardial infarction (AMI) often fail to recognize prodromal symptoms leading to delays in care. The objective of this study was to conduct a mixed method assessment of the impact of ethnicity on symptom description, recognition, and treatment-seeking behavior in Hispanic and non-Hispanic women before hospitalization for AMI. Methods: We explored differences in symptomatology, treatment-seeking behavior, and delay patterns among a convenience sample of 43 women diagnosed with AMI (17 Hispanic women, 26 non-Hispanic women) in seven rural and urban Colorado hospitals. We performed in-depth interviews to establish patterns (typologies) of treatment-seeking behaviors. Chart abstraction provided delay times as a function of ethnicity. Results: Most (28/43) women reported prodromal symptoms in the weeks before their index AMI. Overall, fewer Hispanic women presented within 24 h of symptom onset (3/18, 17% vs. 15/18, 83%, p<0.01). A typology of treatment-seeking behavior emerged: women who (1) recognized symptoms and promptly sought care; (2) did not recognize symptoms, yet promptly sought care; (3) recognized symptoms and promptly sought care, but providers misconstrued symptoms as noncardiac; and (4) misinterpreted symptoms due to an underlying chronic disease. Conclusion: Women and primary care providers often underappreciate prodromal AMI symptoms. Hispanic women are more likely to misinterpret ischemic symptoms and delay care, suggesting a need for tailored patient and provider education.
Collapse
Affiliation(s)
- Amy Pate
- Department of Family Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado
| | | | - Mori J. Krantz
- Department of Family Medicine, University of Colorado—Anschutz Medical Campus, Aurora, Colorado
- Colorado Prevention Center, Aurora, Colorado
- Cardiology Division, Denver Health Medical Center, Denver, Colorado
| |
Collapse
|
21
|
Li PW, Yu DS. A modeling-based narrative intervention to promote timely care-seeking in patients with acute myocardial infarction: A pilot randomized controlled trial and feasibility analysis. Eur J Cardiovasc Nurs 2018; 18:215-223. [PMID: 30371101 DOI: 10.1177/1474515118810126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prolonged delay in seeking medical attention for acute myocardial infarction persists as a global phenomenon, which limits effective disease management. The effects of previous mass-media campaigns and psycho-educations have been minimal. AIMS This study aimed to develop a modeling-based narrative intervention, and to examine its feasibility and preliminary effects on care-seeking behavioral intention in Chinese acute myocardial infarction patients. METHODS The modeling-based narrative intervention was developed by integrating updated research evidence and participants' perspectives. Ten patients were invited to co-design the intervention. The narrative approach was adopted to engage patients in a mental rehearsal of the decision-making process through a virtual acute myocardial infarction attack experience. A pilot randomized controlled trial was adopted to examine the feasibility and preliminary effects of this intervention. RESULTS A total of 67 participants were randomly allocated to receive either the modeling-based narrative intervention ( n=34) or didactic education ( n=33). The intervention was feasible and well-accepted by the participants as evidenced by high attendance and participant satisfaction. They considered the intervention as informative and interesting. The majority of the participants in the intervention group expressed that they enjoyed the intervention. Although the preliminary data showed non-significant between-group differences, a more prominent improving trend for acute myocardial infarction knowledge, care-seeking attitudes and beliefs in the intervention group were evident. CONCLUSIONS This study is the first of its kind to adopt a novel narrative approach to optimize care-seeking behaviors among patients with acute myocardial infarction. The preliminary findings showed that this approach was highly feasible and accepted by patients.
Collapse
Affiliation(s)
- Polly Wc Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Doris Sf Yu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| |
Collapse
|
22
|
The smoker's paradox in acute coronary syndrome: Is it real? REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2018. [DOI: 10.1016/j.repce.2017.12.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
23
|
Coutinho Cruz M, Ilhão Moreira R, Abreu A, Timóteo AT, Sá Carvalho R, Ferreira L, Cruz Ferreira R. The smoker's paradox in acute coronary syndrome: Is it real? Rev Port Cardiol 2018; 37:847-855. [DOI: 10.1016/j.repc.2017.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 11/25/2017] [Accepted: 12/02/2017] [Indexed: 10/28/2022] Open
|
24
|
Wechkunanukul K, Grantham H, Damarell R, Clark RA. The association between ethnicity and delay in seeking medical care for chest pain: a systematic review. ACTA ACUST UNITED AC 2018; 14:208-35. [PMID: 27532797 DOI: 10.11124/jbisrir-2016-003012] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Acute coronary syndrome (ACS) is a leading cause of mortality and morbidity worldwide, and chest pain is one of the most common symptoms of ACSs. A rapid response to chest pain by patients and appropriate management by health professionals are vital to improve survival rates.People from different ethnic groups are likely to have different perceptions of chest pain, its severity and the need for urgent treatment. These differences in perception may contribute to differences in response to chests pain and precipitate unique coping strategies. Delay in seeking medical care for chest pain in the general population has been well documented; however, limited studies have focused on delay times within ethnic groups. There is little research to date as to whether ethnicity is associated with the time taken to seek medical care for chest pain. Consequently, addressing this gap in knowledge will play a crucial role in improving the health outcomes of culturally and linguistically diverse (CALD) patients suffering from chest pain and for developing appropriate clinical practice and public awareness for these populations. OBJECTIVES The current review aimed to determine if there is an association between ethnicity and delay in seeking medical care for chest pain among CALD populations. INCLUSION CRITERIA TYPES OF PARTICIPANTS Patients from different ethnic minority groups presenting to emergency departments (EDs) with chest pain. TYPES OF EXPOSURE The current review will examine studies that evaluate the association between ethnicity and delay in seeking medical care for chest pain among CALD populations. TYPES OF STUDIES The current review will consider quantitative studies including randomized controlled trials (RCTs), non-RCTs, quasi-experimental, before and after studies, prospective and retrospective cohort studies, case-control studies and analytical cross-sectional studies. OUTCOMES The current review will consider studies that measure delay time as the main outcome. The time will be measured as the interval between the time of symptom onset and time to reach an ED. SEARCH STRATEGY A comprehensive search was undertaken for relevant published and unpublished studies written in English with no date restriction. All searches were conducted in October 2014. We searched the following databases: MEDLINE, PubMed, Cochrane Central Register of Controlled Trials, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, ProQuest (health databases only), Informit, Sociological Abstracts, Scopus and Web of Science. The search for unpublished studies included a wide range of 'gray literature' sources including national libraries, digital theses repositories and clinical trial registries. We also targeted specific health research, specialist cardiac, migrant health, and emergency medicine organizational websites and/or conferences. We also checked the reference lists of included studies and contacted authors when further details about reported data was required to make a decision about eligibility. METHODOLOGICAL QUALITY Papers selected for retrieval were assessed by two independent reviewers for methodological validity prior to being included in the review. Validity was assessed using standardized critical appraisal instruments from the Joanna Briggs Institute. Adjudication was produced by the third reviewer. DATA EXTRACTION Data were extracted from included articles by two independent reviewers using the standardized data extraction tool from the Joanna Briggs Institute. DATA SYNTHESIS The extracted data were synthesized into a narrative summary. Meta-analysis could not be performed due to the heterogeneity of study protocols and methods used to measure outcomes. RESULTS A total of 10 studies, with a total of 1,511,382 participants, investigating the association between ethnicity and delay met the inclusion criteria. Delay times varied across ethnic groups, including Black, Hispanic, Asian, South Asian, Southeast Asian and Chinese. Seven studies reported delay in hours and ranged from 1.90 to 3.10 h. Delay times were longer among CALD populations than the majority population. The other three studies reported delay time in categories of time (e.g. <1, <4 and <6 h) and found larger proportions of later presentations to the EDs among ethnic groups compared with the majority groups. CONCLUSION There is evidence of an association between ethnicity and time taken in seeking medical care for chest pain, with patients from some ethnic minorities (e.g. Black, Asian, Hispanic and South Asian) taking longer than those of the majority population. Health promotions and health campaigns focusing on these populations are indicated.
Collapse
Affiliation(s)
- Kannikar Wechkunanukul
- 1School of Nursing and Midwifery, Flinders University, South Australia, Australia 2Centre for Evidence-based Practice South Australia: an Affiliate Centre of the Joanna Briggs Institute 3Paramedic Unit, School of Medicine, Flinders University, South Australia, Australia 4Flinders University Library, Flinders University, South Australia, Australia
| | | | | | | |
Collapse
|
25
|
Berman N, Jones MM, De Coster DA. 'Just like a normal pain', what do people with diabetes mellitus experience when having a myocardial infarction: a qualitative study recruited from UK hospitals. BMJ Open 2017; 7:e015736. [PMID: 28918410 PMCID: PMC5640147 DOI: 10.1136/bmjopen-2016-015736] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2017] [Revised: 06/14/2017] [Accepted: 07/07/2017] [Indexed: 11/07/2022] Open
Abstract
OBJECTIVE The objective of the study was to investigate the symptoms people with diabetes experience when having a myocardial infarction (MI), their illness narrative and how they present their symptoms to the health service. SETTING Three London (UK) hospitals (coronary care units and medical wards). PARTICIPANTS Patients were recruited with diabetes mellitus (DM) (types 1 and 2) with a clinical presentation of MI (ST elevated MI (STEMI), non-ST elevated MI (NSTEMI), acute MI unspecified and cardiac arrest). A total of 43 participants were recruited, and 39 interviews met the study criteria and were analysed. They were predominantly male (n=30), aged 40-90 years and white British (18/39), and just over a half were from other ethnic groups. The majority had type 2 DM (n=35), 24 had an NSTEMI, 10 had an STEMI and five had other cardiac events. DEFINITIONS OF SELECTION/EXCLUSION CRITERIA A diagnosis of MI and DM and the ability to communicate enough English to complete the interview. Ward staff made a clinical judgement that the participant was post-treatment, clinically stable and well enough to participate. METHODS A qualitative study using taped and transcribed interviews analysed using a thematic analysis. RESULTS While most participants did experience chest pain, it was often not their most striking symptom. As their chest pain did not match their expectations of what a 'heart attack' should be, participants developed narratives to explain these symptoms, including the symptoms being effects of their DM ('hypos'), side effects of medication (oral hypoglycaemics) or symptoms (such as breathlessness and indigestion) related to other comorbidities, often leading to delays in seeking care. CONCLUSIONS While truly absent chest pain during MI among people with DM was rare in this study, patients' attenuated symptoms often led to delay in seeking attention, and this may result in delays in receiving treatment.
Collapse
Affiliation(s)
- Nikita Berman
- Research Department of Primary Care and Population Health, UCL Medical School, London, UK
- Dept of Psychiatry,Swn-y-Gwynt Day Hospital, Plymouth Hospitals NHS Trust, Plymouth, UK
| | - Melvyn Mark Jones
- Research Department of Primary Care and Population Health, UCL Medical School, London, UK
| | - Daan A De Coster
- Core Medical Trainee, Princess Royal University Hospital Bromley, King's College NHS Trust, Bromley, UK
| |
Collapse
|
26
|
Kim HS, Lee KS, Eun SJ, Choi SW, Kim DH, Park TH, Yun KH, Yang DH, Hwang SJ, Park KS, Kim RB. Gender Differences in Factors Related to Prehospital Delay in Patients with ST-Segment Elevation Myocardial Infarction. Yonsei Med J 2017; 58:710-719. [PMID: 28540982 PMCID: PMC5447100 DOI: 10.3349/ymj.2017.58.4.710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/22/2017] [Accepted: 03/19/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The aim of our study was to investigate gender differences in factors related to prehospital delay and identify whether the knowledge of acute myocardial infarction symptoms affects this delay in Korean patients with ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS A total of 350 patients (286 men, 64 women) with confirmed STEMI were interviewed to investigate socio-demographics, history of disease, symptom onset time, and factors that contributed to delayed decision time in seeking treatment and hospital arrival time from symptom onset. Factors associated with prehospital delay were examined separately by gender using univariate and multivariate analyses. RESULTS Female patients had higher proportions of ≥60-minute decision time and ≥120-minute arrival time compared to male patients (33.9% vs. 23.1%, 60.9% vs. 52.1%, respectively). However, the difference was not statistically significant (p=0.093 and 0.214, respectively). Previous cardiovascular disease (CVD) was associated with increased decision time in men, whereas, in women, lower educational status caused a greater delay in decision time. Factors associated with hospital arrival time excluding delayed decision time were referral from another hospital, previous CVD, and percutaneous coronary intervention in men, and referral from another hospital in women. CONCLUSION Gender differences exist in factors related to prehospital delay. Therefore, public education to reduce prehospital delay should be conducted according to gender with a focus on the pertinent factors.
Collapse
Affiliation(s)
- Hee Sook Kim
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Korea
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Department of Internal Medicine, Chungnam National University Hospital and School of Medicine, Daejeon, Korea
| | - Dae Hyeok Kim
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Tae Ho Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Ho Yun
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Hospital, Jinju, Korea
| | - Ki Soo Park
- Department of Preventive Medicine, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea.
| | - Rock Bum Kim
- Center for Regional Cardiocerebrovascular Disease, Gyeongsang National University Hospital, Jinju, Korea.
| |
Collapse
|
27
|
Delays in Treatment-Seeking Decisions Among Women With Myocardial Infarction. Dimens Crit Care Nurs 2017; 36:298-303. [DOI: 10.1097/dcc.0000000000000260] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
|
28
|
Wechkunanukul K, Grantham H, Clark RA. Global review of delay time in seeking medical care for chest pain: An integrative literature review. Aust Crit Care 2017; 30:13-20. [DOI: 10.1016/j.aucc.2016.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 01/09/2023] Open
|
29
|
MacInnes JD. The Illness Perceptions of Women Following Symptoms of Acute Myocardial Infarction: A Self-Regulatory Approach. Eur J Cardiovasc Nurs 2016; 5:280-8. [PMID: 16545615 DOI: 10.1016/j.ejcnurse.2006.02.003] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2005] [Revised: 01/30/2006] [Accepted: 02/08/2006] [Indexed: 11/20/2022]
Abstract
BACKGROUND Coronary Heart Disease (CHD) has been socially constructed as a gender-specific disease with women not seen to be at risk. Women tend to delay seeking help following the onset of symptoms of acute myocardial infarction (MI). An illness perceptions approach has been used to explain treatment-seeking behaviour. AIMS The aim of this study was to explore the illness perceptions of a sample of women following acute MI using the self-regulatory model of illness behaviour as the theoretical framework. METHODS Ten women, with a range of ages, took part in semi-structured interviews, 3 months following an acute infarct. Data were analysed thematically according to the theoretical framework. RESULTS The development of a serious model of the illness and the decision to seek help was influenced by the experience of severe, unusual symptoms especially if of sudden onset; the absence of co-morbidities and similarities to the known experience of others. Perceived lack of susceptibility to the disease and a belief that symptoms were benign may have resulted in a delay in seeking help. Coping strategies were initially aimed at relieving symptoms before seeking help from families and friends. This resulted in a call for professional help. CONCLUSION Health promotion strategies need to emphasis the uniqueness of the individual's experience. Interventions designed to alter illness perceptions may influence treatment-seeking behaviour.
Collapse
Affiliation(s)
- Julie D MacInnes
- Department of Adult Nursing, Faculty of Health and Social Care, Canterbury Christ Church University, North Holmes Rd. Canterbury, Kent, CT1 1QU, UK.
| |
Collapse
|
30
|
Kowalski RM, Morgan M, Taylor K. Stigma of mental and physical illness and the use of mobile technology. The Journal of Social Psychology 2016; 157:602-610. [PMID: 27841705 DOI: 10.1080/00224545.2016.1259981] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Research has shown the stigma attached to mental disabilities, yet little research has directly compared the experiences of people with physical disabilities and those with mental disabilities. Not only are both conditions likely perceived as stigmatizing, but the pervasive use of mobile technology may be one means by which people with disabilities can manage and understand their disability. Four hundred and eighty-seven individuals with physical and/or psychological disabilities completed a survey examining whether they would be willing to use mobile technology to manage their disability and how stigmatizing they perceived their disability to be. Willingness to use mobile technology was related to the age of the sample as well as the type of disability. Individuals with psychological disabilities were more likely to use certain forms of mobile technology relative to those with physical disabilities. Observed differences between physical and psychological disabilities are discussed in terms of the symbolic interaction stigma model.
Collapse
|
31
|
Brink E, Karlson BW, Hallberg LRM. To Be Stricken with Acute Myocardial Infarction: A Grounded Theory Study of Symptom Perception and Care-seeking Behaviour. J Health Psychol 2016; 7:533-43. [DOI: 10.1177/1359105302007005673] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The process of perceiving symptoms of illness is complex, and many patients delay seeking care when symptoms of acute myocardial infarction occur. However delayed treatment can have great consequences for the prognosis. This article reports on a grounded theory study, the aim of which was to increase our understanding of the individual’s thoughts, feelings and actions at the onset of an acute heart attack. Qualitative analysis of semi-structured interviews revealed four different ways of perceiving the onset of symptoms: understanding, misinterpretation, amazement and disregard. The symptom perception categories were related to two core categories labelled health beliefs and acute reactions. Some persons were aware of risks for coronary heart disease and were ready to seek care immediately. Several others had illusions of invulnerability. Such illusions caused people to delay seeking care at the onset of symptoms of myocardial infarction.
Collapse
Affiliation(s)
- Eva Brink
- University of Göteborg & University of Trollhättan/Uddevalla, Sweden,
| | | | | |
Collapse
|
32
|
Noureddine S, Adra M, Arevian M, Dumit NY, Puzantian H, Shehab D, Abchee A. Delay in Seeking Health Care for Acute Coronary Syndromes in a Lebanese Sample. J Transcult Nurs 2016; 17:341-8. [PMID: 16946116 DOI: 10.1177/1043659606291544] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Early treatment of patients with acute coronary syndromes (ACS) is crucial to reduce morbidity and mortality. The purpose of this study was to examine delay in seeking care for ACS symptoms in a Lebanese sample and identify predictors of delay. Medical record reviews and interviews using the Response to Symptoms Questionnaire were conducted with 204 ACS patients in coronary care within 72 hours of admission. Median time from symptom onset to hospital arrival was 4.5 hours. Higher education, presence of dyspnea, intermittent symptoms, and waiting for symptoms to go away predicted longer delays, whereas intensity of symptoms and active response (going to the hospital) predicted shorter delays. The findings suggest lack of knowledge of ACS symptoms and the need for public education in this regard.
Collapse
|
33
|
Wechkunanukul K, Grantham H, Teubner D, Hyun KK, Clark RA. Presenting characteristics and processing times for culturally and linguistically diverse (CALD) patients with chest pain in an emergency department: Time, Ethnicity, and Delay (TED) Study II. Int J Cardiol 2016; 220:901-8. [PMID: 27404505 DOI: 10.1016/j.ijcard.2016.06.244] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Accepted: 06/26/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND To date there has been limited published data presenting the characteristics and timeliness of the management in an Emergency Department (ED) for culturally and linguistically diverse (CALD) patients presenting with chest pain. This study aimed to describe the presenting characteristics and processing times for CALD patients with chest pain compared to the Australian-born population, and current guidelines. METHODS This study was a cross sectional analysis of a cohort of patients who presented with chest pain to the metropolitan hospital between 1 July 2012 and 30 June 2014. RESULTS Of the total study population (n=6640), 1241 (18.7%) were CALD and 5399 (81.3%) were Australian-born. CALD patients were significantly older than Australian-born patients (mean age 62 vs 56years, p<0.001). There were no differences in the proportion of patients who had central chest pain (74.9% vs 75.7%, p=0.526); ambulance utilisation (41.7% vs 41.1%, p=0.697); and time to initial treatment in ED (21 vs 22min, p=0.375). However, CALD patients spent a significantly longer total time in ED (5.4 vs 4.3h, p<0.001). There was no difference in guideline concordance between the two groups with low rates of 12.5% vs 13%, p=0.556. Nonetheless, CALD patients were 22% (95% CI, 0.65, 0.95, p=0.015) less likely to receive the guideline management for chest pain. CONCLUSIONS The initial emergency care was equally provided to all patients in the context of a low rate of concordance with three chest pain related standards from the two guidelines. Nonetheless, CALD patients spent a longer time in ED compared to the Australian-born group.
Collapse
Affiliation(s)
- Kannikar Wechkunanukul
- School of Nursing and Midwifery, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia.
| | - Hugh Grantham
- Paramedic Department, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia.
| | - David Teubner
- Paramedic Department, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia.
| | - Karice K Hyun
- The George Institute for Global Health, Cardiovascular division, Sydney Medical School, University of Sydney, Level 10, King George V Building, 83-117 Missenden Rd, Camperdown, NSW 2050, Australia.
| | - Robyn A Clark
- School of Nursing and Midwifery, Flinders University, GPO BOX 2100, Adelaide, SA 5001, Australia.
| |
Collapse
|
34
|
Buckley T, McKinley S, Gallagher R, Dracup K, Moser DK, Aitken LM. The Effect of Education and Counselling on Knowledge, Attitudes and Beliefs about Responses to Acute Myocardial Infarction Symptoms. Eur J Cardiovasc Nurs 2016; 6:105-11. [PMID: 16839819 DOI: 10.1016/j.ejcnurse.2006.05.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 05/21/2006] [Accepted: 05/24/2006] [Indexed: 11/23/2022]
Abstract
The time that elapses from the onset of symptoms of acute myocardial infarction (AMI) to treatment has a significant effect on mortality and morbidity. This study reports the effectiveness of an education and counselling intervention on knowledge, attitudes and beliefs about AMI symptoms and the appropriate response to symptoms. The intervention was tested in a randomised controlled trial of 200 people with a history of coronary heart disease (CHD). The groups were equivalent at baseline on study outcomes, clinical history and sociodemographic characteristics with the exception of more women in the intervention group (38% vs. 24%). The results of repeated measures ANOVA showed that the intervention resulted in improved knowledge of CHD, AMI symptoms and the appropriate response to symptoms that was sustained to 12 months (p=0.02). There were no differences between groups' attitudes and beliefs over time. It is concluded that a short individual teaching and counselling intervention resulted in improved knowledge of CHD, AMI symptoms and the appropriate response to symptoms in people at risk of AMI sustained to 12 months.
Collapse
Affiliation(s)
- T Buckley
- University of Technology Sydney, Faculty of Nursing, Midwifery and Health, Sydney, NSW, Australia.
| | | | | | | | | | | |
Collapse
|
35
|
Meischke H, Diehr P, Rowe S, Cagle A, Eisenberg M. Evaluation of a Public Education Program Delivered by Firefighters on Early Recognition of a Heart Attack. Eval Health Prof 2016; 27:3-21. [PMID: 14994556 DOI: 10.1177/0163278703261199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Heart Attack Survival Kit (HASK) project is a prospective, randomized trial, testing the effectiveness of an intervention delivered door-to-door by firefighters to increase use of 911 and ingestion of aspirin for symptoms of acute myocardial infarction (AMI) among seniors in King County, Washington. Firefighters visited 24,582seniors in King County, Washington and delivered a Heart Attack Survival Kit. Another 24,191 senior households served as the control group. Outcomes of the program were measured by tracking 911 calls as well as survey data. This study reports on the results of the telephone survey with a random sample of seniors (N = 323) to assess their knowledge of and intentions to act during a heart emergency. Results of a logistic regression analysis showed that being female, be ing younger, and remembering the kit was significantly related to intentions to act appropriately to AMI symptoms. The results are discussed in terms of public education around AMI.
Collapse
|
36
|
Testing a Model to Reveal the Predictive Mechanism of Care-Seeking Decisions Among Patients With Acute Myocardial Infarction. J Cardiovasc Nurs 2016; 32:393-400. [PMID: 27281057 DOI: 10.1097/jcn.0000000000000355] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Extensive research has been conducted to examine the factors affecting care-seeking decisions in patients with acute myocardial infarction (AMI). Such a decision-making process is multifactorial, and its underlying mechanism is yet to be determined. OBJECTIVES Our aim was to test a theoretically integrated model to identify the mechanisms underlying patients' care-seeking decisions in the context of AMI. METHODS On the basis of both empirical and theoretical evidence, we proposed that patients' care-seeking decisions are driven by 2 sequential perceptual-cognitive processes concerned with illness labeling and interpretation, as well as the contextual influences of perceived barriers to care seeking and cues from others. A sample of 301 patients was recruited to test this model using structural equation modeling. RESULTS The model testing revealed good fit with the data (χ = 38.48, df = 30, P = .72; root-mean-square error of approximation = 0.03, normed fit index = 0.96, nonnormed fit index = 0.98, and comparative fit index = 0.99) and explained 46% of the variance in AMI care-seeking delay. Successful action relied on whether patients could correctly attribute the symptom experience to AMI, were aware of their own susceptibility to the condition, and had a good understanding of how the disease manifested itself. Lowering perceived barriers and positive cues from others in advising care seeking played favorable roles to promote care-seeking behaviors. CONCLUSIONS This integrative theoretical model is shown to be valid in explaining care-seeking delay among AMI patients and can guide the development of interventions to promote appropriate care-seeking behaviors among high-risk individuals.
Collapse
|
37
|
Nilsson G, Mooe T, Söderström L, Samuelsson E. Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population. BMC Cardiovasc Disord 2016; 16:93. [PMID: 27176816 PMCID: PMC4866271 DOI: 10.1186/s12872-016-0271-x] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/04/2016] [Indexed: 11/10/2022] Open
Abstract
Background In myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased possibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish population and identified determinants of a pre-hospital delay ≥ 2 h. Methods A total of 89 women (mean age 72.6 years) and 176 men (mean age 65.8 years) from a secondary prevention study were enrolled in an observational study after first time MI between November 2009 and March 2012. Total pre-hospital delay was defined as the time from the onset of symptoms suggestive of MI to admission to the hospital. Decision time was defined as the time from the onset of symptoms until the call to Emergency Medical Services (EMS). The time of symptom onset was assessed during the episode of care, and the time of call to EMS and admission to the hospital was based on recorded data. The first medical contact was determined from a mailed questionnaire. Determinants associated with pre-hospital delay ≥ 2 h were identified by multivariable logistic regression. Results The median total pre-hospital delay was 5.1 h (IQR 18.1), decision time 3.1 h (IQR 10.4), and transport time 1.2 h (IQR 1.0). The first medical contact was to primary care in 52.3 % of cases (22.3 % as a visit to a general practitioner and 30 % by telephone counselling), 37.3 % called the EMS, and 10.4 % self-referred to the hospital. Determinants of a pre-hospital delay ≥ 2 h were a visit to a general practitioner (OR 10.77, 95 % CI 2.39–48.59), call to primary care telephone counselling (OR 3.82, 95 % CI 1.68–8.68), chest pain as the predominant presenting symptom (OR 0.24, 95 % CI 0.08–0.77), and distance from the hospital (OR 1.03, 95 % CI 1.02–1.04). Among patients with primary care as the first medical contact, 67.0 % had a decision time ≥ 2 h, compared to 44.7 % of patients who called EMS or self-referred (p = 0.002). Conclusions Pre-hospital delay in patients with first time MI is prolonged considerably, particularly when primary care is the first medical contact. Actions to shorten decision time and increase the use of EMS are still necessary. Electronic supplementary material The online version of this article (doi:10.1186/s12872-016-0271-x) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Gunnar Nilsson
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development - Östersund, Umeå University, Umeå, Sweden.
| | - Thomas Mooe
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Lars Söderström
- Unit of Research, Education and Development, Östersund Hospital, Region Jämtland Härjedalen, Östersund, Sweden
| | - Eva Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| |
Collapse
|
38
|
Makam RP, Erskine N, Yarzebski J, Lessard D, Lau J, Allison J, Gore JM, Gurwitz J, McManus DD, Goldberg RJ. Decade Long Trends (2001-2011) in Duration of Pre-Hospital Delay Among Elderly Patients Hospitalized for an Acute Myocardial Infarction. J Am Heart Assoc 2016; 5:e002664. [PMID: 27101833 PMCID: PMC4843528 DOI: 10.1161/jaha.115.002664] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [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 Early intervention with medical and/or coronary revascularization treatment approaches remains the cornerstone of the management of patients hospitalized with acute myocardial infarction (AMI). However, several patient groups, especially the elderly, are known to delay seeking prompt medical care after onset of AMI-associated symptoms. Current trends, and factors associated with prolonged prehospital delay among elderly patients hospitalized with AMI, are incompletely understood. METHODS AND RESULTS Data from a population-based study of patients hospitalized at all 11 medical centers in central Massachusetts with a confirmed AMI on a biennial basis between 2001 and 2011 were analyzed. Information about duration of prehospital delay after onset of acute coronary symptoms was abstracted from hospital medical records. In patients 65 years and older, the overall median duration of prehospital delay was 2.0 hours, with corresponding median delays of 2.0, 2.1, and 2.0 hours in those aged 65 to 74 years, 75 to 84 years, and in patients 85 years and older, respectively. There were no significant changes over time in median delay times in each of the age strata examined in both crude and multivariable adjusted analyses. A limited number of patient characteristics were associated with prolonged delay in this patient population. CONCLUSIONS The results of this community-wide study demonstrate that delay in seeking prompt medical care continues to be a significant problem among elderly patients hospitalized with AMI. The lack of improvement in the timeliness of patients' care-seeking behavior during the years under study remains of considerable clinical and public health concern.
Collapse
Affiliation(s)
- Raghavendra P Makam
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jason Lau
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jeroan Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | | | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| |
Collapse
|
39
|
Abstract
Supplemental Digital Content is available in the text. Background It is important that patients with symptoms of acute coronary syndrome receive appropriate medical care as soon as possible. Little is known about the preadmission actions that patients with chest pain take before arrival at the Emergency Department (ED). Objective This study aimed to describe the actions of patients with chest pain or pressure after onset of symptoms. What is the first action following onset of symptoms? Who is the first lay or professional person to be contacted? Which steps are taken first? How is the patient transported to the hospital? Methods Consecutive patients, arriving at the ED of two large hospitals in Belgium, were asked additional questions during the initial assessment. Results Overall, 35% of 412 consecutive patients with chest pain admitted to the ED were diagnosed with acute coronary syndrome. A total of 57% contacted a GP between symptom onset and arrival at the ED. Only 32% of the patients were transported to the ED by ambulance, 16% drove themselves and 52% arrived by other means of transport (by family, neighbour, GP, public transport). Conclusion In Belgium, the GP is still the first professional to be contacted for most patients. Other patients initially rely on their partner, family or friends when symptoms emerge. Too often, patients with chest pain rely on other transport to get to the ED instead of calling the Emergency Medical Services. This study included only patients who ultimately attended the ED.
Collapse
|
40
|
Mellon L, Doyle F, Williams D, Brewer L, Hall P, Hickey A. Patient behaviour at the time of stroke onset: a cross-sectional survey of patient response to stroke symptoms. Emerg Med J 2016; 33:396-402. [PMID: 26781460 DOI: 10.1136/emermed-2015-204806] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 12/22/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND AND PURPOSE Revascularisation treatment with thrombolysis must be initiated within 4.5 h following ischaemic stroke symptom onset. Despite its proven benefits, thrombolysis therapy is underused, with patient delay in presenting to hospital with symptoms identified as the leading barrier. This study aimed to examine help-seeking behaviour at stroke onset, in order to understand delays in accessing acute medical care for stroke symptoms. METHODS 149 consecutive patients hospitalised with ischaemic stroke were interviewed at 72 h poststroke with the Stroke Awareness Questionnaire and the Response to Symptoms Questionnaire. RESULTS Sixty per cent of stroke cases presented to the ED within 3.5 h of stroke onset. Knowledge of stroke symptoms and risk factors was poor, with 40% unable to correctly define a stroke. Bystander recognition of symptoms (p=0.03) and bystander initiation of Emergency Medical Services was associated with ED presentation within 3.5 h (p=0.03). CONCLUSIONS This study provides insights into patient response when a stroke occurs, with the presence and action of others highlighted as critical in fast response to stroke symptoms. Knowledge of stroke warning signs and risk factors was low among stroke survivors. Findings highlight the complexity of changing help-seeking behaviour during stroke onset, and provide directions for public education efforts to reduce prehospital delay.
Collapse
Affiliation(s)
- L Mellon
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - F Doyle
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - D Williams
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - L Brewer
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - P Hall
- Department of Geriatric and Stroke Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - A Hickey
- Department of Psychology, Royal College of Surgeons in Ireland, Dublin, Ireland
| |
Collapse
|
41
|
Chen SI, Wang Y, Dreyer R, Strait KM, Spatz ES, Xu X, Smolderen KG, Desai NR, Lorenze NP, Lichtman JH, Spertus JA, D'Onofrio G, Bueno H, Masoudi FA, Krumholz HM. Insurance and Prehospital Delay in Patients ≤55 Years With Acute Myocardial Infarction. Am J Cardiol 2015; 116:1827-32. [PMID: 26541907 PMCID: PMC5323057 DOI: 10.1016/j.amjcard.2015.09.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2015] [Revised: 09/06/2015] [Accepted: 09/06/2015] [Indexed: 10/22/2022]
Abstract
This prospective study assessed whether gender differences in health insurance help explain gender differences in delay in seeking care for patients in the US, with acute myocardial infarction (AMI). We also assessed gender differences in such prehospital delay for AMI in Spain, a country with universal insurance. We used data from 2,951 US and 496 Spanish patients aged 18 to 55 years with AMI. US patients were grouped by insurance status: adequately insured, underinsured, or uninsured. For each country, we assessed the association between gender and prehospital delay (symptom onset to hospital arrival). For the US cohort, we modeled the relation between insurance groups and delay of >12 hours. US women were less likely than men to be uninsured but more likely to be underinsured, and a larger proportion of women than men experienced delays of >12 hours (38% vs 29%). We found no association between insurance status and delays of >12 hours in men or women. Only 17.3% of Spanish patients had delays of >12 hours, and there were no significant gender differences. In conclusion, women were more likely than men to delay, although it was not explained by differences in insurance status. The lack of gender differences in prehospital delays in Spain suggests that these differences may vary by health care system and culture.
Collapse
Affiliation(s)
- Serene I Chen
- Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Yongfei Wang
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Rachel Dreyer
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Kelly M Strait
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut
| | - Erica S Spatz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Kim G Smolderen
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Nancy P Lorenze
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Judith H Lichtman
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut
| | - John A Spertus
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Saint Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Gail D'Onofrio
- Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Héctor Bueno
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain; Instituto de investigación i + 12 and Cardiology Department, Hospital Universitario 12 de Octubre, Madrid, Spain; Universidad Complutense de Madrid, Spain
| | - Frederick A Masoudi
- Division of Cardiology, Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut; Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut; Robert Wood Johnson Foundation Clinical Scholars Program, Department of Internal Medicine, Yale School of Medicine; Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut.
| |
Collapse
|
42
|
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.
Collapse
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.)
| |
Collapse
|
43
|
Nehme Z, Andrew E, Bray JE, Cameron P, Bernard S, Meredith IT, Smith K. The significance of pre-arrest factors in out-of-hospital cardiac arrests witnessed by emergency medical services: a report from the Victorian Ambulance Cardiac Arrest Registry. Resuscitation 2014; 88:35-42. [PMID: 25541430 DOI: 10.1016/j.resuscitation.2014.12.009] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Revised: 12/01/2014] [Accepted: 12/03/2014] [Indexed: 11/19/2022]
Abstract
BACKGROUND The significance of pre-arrest factors in out-of-hospital cardiac arrests (OHCA) witnessed by emergency medical services (EMS) is not well established. The purpose of this study was to assess the association between prodromal symptoms and pre-arrest clinical observations on the arresting rhythm and survival in EMS witnessed OHCA. METHODS Between 1st January 2003 and 31st December 2011, 1056 adult EMS witnessed arrests of a presumed cardiac aetiology were identified from the Victorian Ambulance Cardiac Arrest Registry. Pre-arrest prodromal features and clinical characteristics were extracted from the patient care record. Backward elimination logistic regression was used to identify pre-arrest factors associated with an initial shockable rhythm and survival to hospital discharge. RESULTS The median age was 73.0 years, 690 (65.3%) were male, and the rhythm of arrest was shockable in 465 (44.0%) cases. The most commonly reported prodromal symptoms prior to arrest were chest pain (48.8%), dyspnoea (41.8%) and altered consciousness (37.8%). An unrecordable systolic blood pressure was observed in 34.4%, a respiratory rate <13 or >24min(-1) was present in 43.1%, and 45.5% had a Glasgow coma score <15. In the multivariable analysis, the following pre-arrest factors were significantly associated with survival: age, public location, aged care facility, chest pain, arm or shoulder pain, dyspnoea, dizziness, vomiting, ventricular tachycardia, pulse rate, systolic blood pressure, respiratory rate, Glasgow coma score, aspirin and inotrope administration. CONCLUSION Pre-arrest factors are strongly associated with the arresting rhythm and survival following EMS witnessed OHCA. Potential opportunities to improve outcomes exist by way of early recognition and management of patients at risk of OHCA.
Collapse
Affiliation(s)
- Z Nehme
- Department of Research and Evaluation, Ambulance Victoria, Doncaster, VIC, Australia; Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Prahran, VIC, Australia.
| | - E Andrew
- Department of Research and Evaluation, Ambulance Victoria, Doncaster, VIC, Australia; Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Prahran, VIC, Australia
| | - J E Bray
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Prahran, VIC, Australia
| | - P Cameron
- Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Prahran, VIC, Australia
| | - S Bernard
- Department of Research and Evaluation, Ambulance Victoria, Doncaster, VIC, Australia; Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Prahran, VIC, Australia; Intensive Care Unit, Alfred Hospital, Prahran, VIC, Australia
| | - I T Meredith
- MonashHeart, Monash Medical Centre, Monash Health, Clayton, VIC, Australia
| | - K Smith
- Department of Research and Evaluation, Ambulance Victoria, Doncaster, VIC, Australia; Department of Epidemiology and Preventative Medicine, School of Public Health and Preventative Medicine, Monash University, Prahran, VIC, Australia; Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, WA, Australia
| |
Collapse
|
44
|
Webster RA, Thompson DR, Davidson PM. The first 12 weeks following discharge from hospital: The experience of Gujarati South Asian survivors of acute myocardial infarction and their families. Contemp Nurse 2014; 15:288-99. [PMID: 14649533 DOI: 10.5172/conu.15.3.288] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The period following discharge from hospital after an acute myocardial infarction (MI) is associated with vulnerability and psychosocial and physical morbidity for many survivors and their families. It is reported that people experience interpersonal, family and financial problems, self-care obstacles, work and physical difficulties. Culture and ethnicity undeniably influence the illness experience and the process of recovery and adjustment. This study investigated the perceptions of Gujarati survivors of acute MI and their families in Leicester, United Kingdom in the first 12 weeks following discharge in order to develop a profile of their health seeking beliefs and needs. Thirty-one interviews with 19 Gujarati MI survivors and their families (representing approximately 31 hours of dialogue) were analysed using grounded theory. Qualitative data revealed a period of vulnerability not only for survivors but also their families as they processed recent events and faced the future. Data analysis revealed nine interrelated themes describing the post-discharge experience for Gujarati survivors and their families. Data revealed that normal life was often markedly changed by the MI experience. Reflection, contemplation and resignation characterize this period of vulnerability. Overwhelmingly, data analysis revealed that the Gujarati culture, beliefs and customs influenced the recovery experience.
Collapse
|
45
|
Padilla García CI, Sáenz Montoya X. Respuestas de la mujer frente a los síntomas de Síndrome Coronario Agudo basados en el Modelo Conceptual del Manejo de los Síntomas. AVANCES EN ENFERMERÍA 2014. [DOI: 10.15446/av.enferm.v32n1.46068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
|
46
|
Wechkunanukul K, Grantham H, Damarell R, Clark R. The association between ethnicity (culturally and linguistically diverse migrants) and the time taken in seeking medical care for chest pain: a systematic review protocol. ACTA ACUST UNITED AC 2014. [DOI: 10.11124/jbisrir-2014-1467] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
|
47
|
Scantlebury CE, Perkins E, Pinchbeck GL, Archer DC, Christley RM. Could it be colic? Horse-owner decision making and practices in response to equine colic. BMC Vet Res 2014; 10 Suppl 1:S1. [PMID: 25238026 PMCID: PMC4122872 DOI: 10.1186/1746-6148-10-s1-s1] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Little is known about lay understanding and decision making in response to colic. Horse-owners/carers are key to identifying colic and initiating veterinary intervention. Understanding how owners think and act in relation to colic could assist veterinary surgeons in tailoring information about colic with the aim of improving colic outcomes. METHODS A mixed methods approach was employed including qualitative in-depth interviews and a cross-sectional questionnaire. Qualitative data were analysed using Grounded theory to conceptualise processes involved in horse-owner management of colic. Following this, a cross-sectional survey was designed to test these concepts. Cluster analysis explored the role of the human-horse relationship upon colic management strategies. RESULTS Fifteen horse-owners with a range of colic experience participated in the interviews. A theoretical conceptual model was developed and described how horse-owners' recognised, assessed and responded to colic. Three main management strategies were used including 'wait and see', 'lay treatments' and 'seek veterinary assistance'. Actions in response to colic were moderated by owners' experience of colic and interpretation of the severity of colic signs. A postal questionnaire gathered data from 673 horse-owners from the North-West of the UK. The majority (605, 89.9%) of respondents were female. Cluster analysis revealed 5 meaningful groups of horse-owners based upon assessment of questionnaire items on the human-horse relationship. These groups included 2 professional and 3 amateur owner typologies. There were differences in the responses to some questionnaire items among the identified groups. CONCLUSIONS This study describes lay understanding and management of colic among a population of horse-owners from the North-West of the UK. The information may serve as a basis upon which to tailor existing programmes designed to educate owners about colic management strategies, and may inform veterinarians' interactions with horse-owners.
Collapse
Affiliation(s)
- Claire E Scantlebury
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, CH64 7TE, United Kingdom
| | - Elizabeth Perkins
- Health Services Research Department, Institute of Psychology Health and Society, University of Liverpool, Liverpool, L69 3GL, United Kingdom
| | - Gina L Pinchbeck
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, CH64 7TE, United Kingdom
| | - Debra C Archer
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, CH64 7TE, United Kingdom
| | - Robert M Christley
- Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, CH64 7TE, United Kingdom
| |
Collapse
|
48
|
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.
Collapse
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
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
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]
|
50
|
Villar J, Clement JP, Stotts J, Linnen D, Rubin DJ, Thompson D, Gomez A, Fee C. Many emergency department patients with severe sepsis and septic shock do not meet diagnostic criteria within 3 hours of arrival. Ann Emerg Med 2014; 64:48-54. [PMID: 24680548 DOI: 10.1016/j.annemergmed.2014.02.023] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2013] [Revised: 02/07/2014] [Accepted: 02/24/2014] [Indexed: 01/26/2023]
Abstract
STUDY OBJECTIVE Proposed national performance measures for severe sepsis or septic shock include interventions within 3 hours of emergency department (ED) arrival rather than from time of first meeting diagnostic criteria. We aim to determine the percentage of ED patients who first meet criteria greater than 3 hours after arrival. METHODS We conducted a retrospective analysis of adult patients with severe sepsis or septic shock in 2 EDs (university hospital [September 2012 to June 2013] and public trauma center [December 2012 to May 2013]). Times of ED arrival and first meeting clinical criteria were collected for quality assurance programs, which differed between institutions. At the university hospital, patients with admission diagnoses consistent with infection were included. Clinical presentation was defined as time meeting 2 or more systemic inflammatory response syndrome criteria and evidence of end-organ dysfunction. At the trauma center, only patients with hospital discharge diagnoses consistent with infection were included. Clinical presentation was defined by time of end-organ dysfunction. RESULTS Three hundred seventy-two patients met inclusion criteria at the university hospital and 133 at the trauma center. Median times from ED arrival to first meeting criteria were 68 minutes (interquartile range 34 to 130 minutes) and 31 minutes (interquartile range 8 to 73 minutes), respectively; 15.3% (95% confidence interval 11.9% to 19.3%) and 9.8% (95% confidence interval 5.5% to 15.7%) first met criteria greater than 3 hours from ED arrival, respectively. CONCLUSION Compliance with a performance metric for severe sepsis and septic shock within 3 hours of ED arrival would require application of this measure to patients who do not meet diagnostic criteria, potentially resulting in unnecessary interventions. Measure developers should consider these findings.
Collapse
Affiliation(s)
- Julian Villar
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA; San Francisco General Hospital, San Francisco, CA.
| | | | - Jim Stotts
- Patient Safety and Quality Services, University of California San Francisco, San Francisco, CA
| | - Daniel Linnen
- Division of BioInformatics, National IT, Kaiser Permanente, Oakland, CA
| | | | - David Thompson
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA
| | - Antonio Gomez
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of California San Francisco, San Francisco, CA; San Francisco General Hospital, San Francisco, CA
| | - Christopher Fee
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA.
| |
Collapse
|