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Nehme Z, Cameron P, Nehme E, Finn J, Bosley E, Brink D, Ball S, Doan TN, Bray JE. Effect of a national awareness campaign on ambulance attendances for chest pain and out-of-hospital cardiac arrest. Resuscitation 2023; 191:109932. [PMID: 37562665 DOI: 10.1016/j.resuscitation.2023.109932] [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: 05/19/2023] [Revised: 07/23/2023] [Accepted: 08/01/2023] [Indexed: 08/12/2023]
Abstract
AIM Awareness of heart attack symptoms may enhance health-seeking behaviour and prevent premature deaths from out-of-hospital cardiac arrest (OHCA). We sought to investigate the impact of a national awareness campaign on emergency medical service (EMS) attendances for chest pain and OHCA. METHODS Between January 2005 and December 2017, we included registry data for 97,860 EMS-attended OHCA cases from 3 Australian regions and dispatch data for 1,631,217 EMS attendances for chest pain across 5 Australian regions. Regions were exposed to between 11 and 28 months of television, radio, and print media activity. Multivariable negative binomial models were used to explore the effect of campaign activity on the monthly incidence of EMS attendances for chest pain and OHCA. RESULTS Months with campaign activity were associated with an 8.8% (IRR 1.09, 95% CI: 1.07, 1.11) increase in the incidence of EMS attendances for chest pain and a 5.6% (IRR 0.94, 95% CI: 0.92, 0.97) reduction in OHCA attendances. Larger intervention effects were associated with increasing months of campaign activity, increasing monthly media spending and media exposure in 2013. In stratified analyses of OHCA cases, the largest reduction in incidence during campaign months was observed for unwitnessed arrests (IRR 0.93, 95% CI: 0.90, 0.96), initial non-shockable arrests (IRR 0.93, 95% CI: 0.90, 0.97) and arrests occurring in private residences (IRR 0.95, 95% CI: 0.91, 0.98). CONCLUSION A national awareness campaign targeting knowledge of heart attack symptoms was associated with an increase in EMS use for chest pain and a reduction in OHCA incidence and may serve as an effective primary prevention strategy for OHCA.
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Affiliation(s)
- Ziad Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation,Ambulance Victoria, Blackburn North, Victoria, Australia; Department of Paramedicine, Monash University, Frankston, Victoria, Australia.
| | - Peter Cameron
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Alfred Hospital,Alfred Health, Prahran, Victoria, Australia
| | - Emily Nehme
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation,Ambulance Victoria, Blackburn North, Victoria, Australia
| | - Judith Finn
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Emma Bosley
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia; School of Clinical Sciences, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Deon Brink
- PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Stephen Ball
- PRECRU, School of Nursing, Curtin University, Western Australia, Australia; St John Ambulance, Belmont, Western Australia, Australia
| | - Tan N Doan
- Queensland Ambulance Service, Queensland Government Department of Health, Brisbane, Queensland, Australia; Department of Medicine at The Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
| | - Janet E Bray
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; PRECRU, School of Nursing, Curtin University, Western Australia, Australia
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2
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Gnesin F, Mills EHA, Jensen B, Møller AL, Zylyftari N, Bøggild H, Ringgren KB, Kragholm K, Blomberg SNF, Christensen HC, Lippert F, Køber L, Folke F, Torp-Pedersen C. Symptoms reported in calls to emergency medical services within 24 hours prior to out-of-hospital cardiac arrest. Resuscitation 2022; 181:86-96. [PMID: 36334842 DOI: 10.1016/j.resuscitation.2022.10.021] [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: 09/27/2022] [Revised: 10/24/2022] [Accepted: 10/27/2022] [Indexed: 11/11/2022]
Abstract
AIM There is limited evidence regarding prodromal symptoms of out-of-hospital cardiac arrest (OHCA). We aimed to describe patient characteristics, prodromal symptoms, and prognosis of patients contacting emergency medical services (EMS) within 24 hours before OHCA. METHODS We identified all OHCA treated by Copenhagen EMS from 2016 through 2018 using the Danish Cardiac Arrest Registry and linked them to emergency calls. We included all pre-arrest calls by patients or bystanders if they were performed 1) within 24 hours before the OHCA call or 2) during the OHCA event for EMS-witnessed OHCA. Calls were reviewed by healthcare professionals using a survey guide. RESULTS Among 4,071 patients, 481 patients (12 %) had 539 calls within 24 hours prior to OHCA (60 % male, median age 74 years of age). The patient spoke on the phone in 25 % of calls. The most common symptoms were breathing problems (59 %), confusion (23 %), unconsciousness (20 %), chest pain (20 %), and paleness (19 %). Patients with breathing problems compared to chest pain were more likely to be ≤ 75 years of age (55 % versus 35 %), less likely to be male (52 % versus 73 %), have shockable rhythm (10 % versus 38 %), receive bystander defibrillation (6 % versus 19 %) or EMS defibrillation (15 % versus 65 %), achieve return of spontaneous circulation (37 % versus 68 %) and survive 30 days following OHCA (10 % versus 50 %). CONCLUSION More than 10% of patients with OHCA had a call to EMS within 24 hours before OHCA. The most common symptom was breathing problems which compared to chest pain had lower 30-day survival.
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Affiliation(s)
- Filip Gnesin
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark.
| | | | - Britta Jensen
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg E, Denmark
| | | | - Nertila Zylyftari
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 2900 Hellerup, Denmark
| | - Henrik Bøggild
- Public Health and Epidemiology, Department of Health Science and Technology, Aalborg University, Niels Jernes Vej 14, 9220 Aalborg E, Denmark
| | | | - Kristian Kragholm
- Department of Cardiology, Aalborg University Hospital, Hobrovej 18-22, 9000 Aalborg, Denmark
| | | | - Helle Collatz Christensen
- Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Danish Clinical Quality Program (RKKP), National Clinical Registries, Nordre Fasanvej 57, 2000 Frederiksberg, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Lars Køber
- Department of Cardiology, Heart Center, Rigshospitalet, Copenhagen University Hospital, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Gentofte Hospitalsvej 6, 2900 Hellerup, Denmark; Copenhagen Emergency Medical Services, University of Copenhagen, Telegrafvej 5, 2750 Ballerup, Denmark; Department of Clinical Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjællands Hospital, Dyrehavevej 29, 3400 Hillerød, Denmark; Department of Public Health, University of Copenhagen, Øster Farimagsgade 5, 1353 København K, Denmark
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3
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Stomby A, Strömberg S, Theodorsson E, Olsen Faresjö Å, Jones M, Faresjö T. Standard Modifiable Cardiovascular Risk Factors Mediate the Association Between Elevated Hair Cortisol Concentrations and Coronary Artery Disease. Front Cardiovasc Med 2022; 8:765000. [PMID: 35146006 PMCID: PMC8821522 DOI: 10.3389/fcvm.2021.765000] [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] [Received: 08/26/2021] [Accepted: 12/13/2021] [Indexed: 12/01/2022] Open
Abstract
Background Increased cortisol exposure is a risk factor for coronary artery disease (CAD). It is not clear to what degree this risk is independent from the standard modifiable risk factors (SMuRFs) dyslipidemia, hypertension, and diabetes. Aim To use path analysis to test the direct and indirect association, mediated by SMuRFs, between long-term cortisol levels measured in hair cortisol concentration (HCC) and CAD. Methods Hair was sampled from patients admitted with acute myocardial infarction (n = 203) and a population-based sample without a diagnosis or symptoms of CAD (n = 3,134). The HCC was analyzed using radioimmunoassay and all the participants reported whether they were diagnosed with or treated for diabetes, hypertension, and hyperlipidemia. Path analysis was used to test to what degree the association between logarithmized (ln) HCC and CAD was direct or indirect, mediated by SMuRFs. Results Participants with CAD had elevated HCC compared to those without elevated HCC [median interquartile range (IQR): 75.2 (167.1) vs. 23.6 (35.0) pg/mg, p < 0.0001]. Higher HCC was associated with diabetes, hypertension, and hyperlipidemia, which, in turn, were associated with CAD. In path models, 80% of the association between ln(HCC) and CAD were mediated by SMuRFs, while the direct path between ln(HCC) and CAD was not statistically significant. Conclusion The SMuRFs diabetes, hyperlipidemia, and hypertension mediate the association between ln(HCC) and CAD. Some association between ln(HCC) and CAD did not operate via the SMuRFs considered and might have a pathway through atherosclerosis or inflammation.
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Affiliation(s)
- Andreas Stomby
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
- Råslätts vårdcentral, Region Jönköping County, Jönköping, Sweden
- *Correspondence: Andreas Stomby
| | - Susanna Strömberg
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Elvar Theodorsson
- Department of Biomedical and Clinical Science, Clinical Chemistry, Linköping University, Linköping, Sweden
| | - Åshild Olsen Faresjö
- Division of Society and Health/Public Health, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
| | - Mike Jones
- Faculty of Medicine Health and Human Sciences, School of Psychological Sciences, Macquarie University, North Ryde, NSW, Australia
| | - Tomas Faresjö
- Division of Prevention, Rehabilitation and Community Medicine, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
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4
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Abstract
BACKGROUND Although researchers have shown that prodromal symptoms can predict acute coronary events, the ability of patients with acute coronary syndrome (ACS) to identify these symptoms in a timely manner is limited. OBJECTIVES We aimed to assess prodromal symptoms in Chinese patients with ACS and their responses to symptoms by sex. DESIGN This cross-sectional, multicenter study involved 5 teaching hospitals in China and included 806 patients admitted for ACS between June 2013 and February 2014. The McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (Chinese version) was used to gather data. RESULTS Among 806 patients (including 483 women), 688 (85.4%) experienced at least 1 prodromal symptom before ACS onset. Using adjusted logistic regression models, we determined that women were significantly more likely than men to report back pain, between- or under-shoulder blade pain/discomfort, sleep disturbances, anxiousness, or heart racing. The prevalence of generalized chest pain and loss of appetite was higher among men than women. Only 41% of patients attributed their prodromal symptoms to the heart, and women were more likely than men to attribute prodromal symptoms to a heart attack. CONCLUSIONS More than two-thirds of patients with ACS reported at least 1 prodromal symptom, with some significant sex differences. Most patients do not attribute their symptoms to an impending ACS event.
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Khan B, Basnet AK. The Yentl Syndrome: A Case Report. JNMA J Nepal Med Assoc 2021; 59:910-912. [PMID: 35199715 PMCID: PMC9107882 DOI: 10.31729/jnma.7004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/03/2022] Open
Abstract
Cardiovascular disease, including ischemic heart disease, is one of the most common causes of death and disability in both sexes. The traditional concept of ischemic heart disease as a "man's disease" is debunked. Yentl syndrome is used to describe the underdiagnosis of ischemic heart disease in females and its associated effects. This article reports a 48-year-old female presented to the emergency department with acute epigastric discomfort. Her initial diagnostic tests did not reveal any abnormalities, and she was discharged. Subsequently, after four days, she again visited the emergency department with chest pain, the evaluation of which furthermore revealed no abnormalities. However, we admitted her. After 40 hours of hospitalization, her evaluation revealed anterior wall ST elevation myocardial infarction, and she underwent emergent reperfusion via coronary catheterization. This combination of atypical signs and symptoms and chances of delayed manifestations in the diagnostic investigations provides evidence for a need for thorough assessment in a female with chest pain.
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Affiliation(s)
- Barkadin Khan
- Shahid Gangalal National Heart Center, Kathmandu, Nepal
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Ghali A, Lacout C, Ghali M, Gury A, Delattre E, Lavigne C, Urbanski G. Warning Signals of Post-Exertional Malaise in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Retrospective Analysis of 197 Patients. J Clin Med 2021; 10:jcm10112517. [PMID: 34200126 PMCID: PMC8201170 DOI: 10.3390/jcm10112517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 05/20/2021] [Accepted: 06/04/2021] [Indexed: 11/16/2022] Open
Abstract
Post-exertional malaise (PEM), the key feature of myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), is characterized by baseline symptom exacerbation after exposure to a stressor, and some patients can experience new or non-typical symptoms. We hypothesized that new or non-typical symptoms occurring long enough before onset of baseline symptom exacerbation could be warning signals predicting PEM. Adult ME/CFS patients who attended the internal medicine department of Angers University Hospital (France) between October 2011 and December 2019 were included in a retrospective medical records review. Patients who experienced one or more new or non-typical symptoms before baseline symptom exacerbation were compared with the rest of the study population for PEM features, epidemiological characteristics, fatigue features, and comorbidities. New or non-typical symptoms preceded baseline symptom exacerbation in 27/197 (13.7%) patients, and the most frequent ones were mood disorders (37%). When compared to the rest of the study population, only PEM intensity was significantly lower in these patients (p = 0.004), even after adjustment for sex and age at disease onset (p = 0.007). New or non-typical symptoms preceding baseline symptom exacerbation in some ME/CFS patients could be warning signals for PEM. Their identification could help preventing PEM occurrences or reducing their intensity leading to improving disease prognosis.
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Affiliation(s)
- Alaa Ghali
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 49933 Angers, France; (C.L.); (A.G.); (E.D.); (C.L.); (G.U.)
- Correspondence: ; Tel.: +33-(0)2-4135-4003; Fax: +33-(0)2-4135-4969
| | - Carole Lacout
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 49933 Angers, France; (C.L.); (A.G.); (E.D.); (C.L.); (G.U.)
| | - Maria Ghali
- Department of general medicine, Faculty of Medicine of Angers, 49045 Angers, France;
| | - Aline Gury
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 49933 Angers, France; (C.L.); (A.G.); (E.D.); (C.L.); (G.U.)
| | - Estelle Delattre
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 49933 Angers, France; (C.L.); (A.G.); (E.D.); (C.L.); (G.U.)
| | - Christian Lavigne
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 49933 Angers, France; (C.L.); (A.G.); (E.D.); (C.L.); (G.U.)
| | - Geoffrey Urbanski
- Department of Internal Medicine and Clinical Immunology, Angers University Hospital, 49933 Angers, France; (C.L.); (A.G.); (E.D.); (C.L.); (G.U.)
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7
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Heidarzadeh M, Elyaszadeh S, Dadkhah B, Doustkami H. Specific prodromal symptoms in patients with acute coronary syndrome. Nurs Open 2021; 8:582-591. [PMID: 33570273 PMCID: PMC7877125 DOI: 10.1002/nop2.663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 09/06/2020] [Accepted: 09/30/2020] [Indexed: 11/10/2022] Open
Abstract
AIMS Assessing the prodromal cardiac symptoms in patients with acute coronary syndrome (ACS) and compare them with healthy population. BACKGROUND Identifying specific prodromal cardiac symptoms can play an important role in screening people at risk. DESIGN A comparative study of prodromal symptoms. METHODS In this comparison study, an 80-item checklist of prodromal symptoms was designed and completed by 337 participants in three groups (Patient group I, Patient group II and Healthy group). All participants were studied over a period of six months (from May to October 2017). SPSS-15 software was used to analyse the data. RESULTS The symptoms of pain/discomfort in chest, pain/discomfort centred in the superior part of chest, pain/discomfort in the left breast and numbness or burning of both arms were the most important symptoms to predict ACS incidence in the two patient groups (odds ratio > 4 and p ≤ .05).
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Affiliation(s)
- Mehdi Heidarzadeh
- Department of Medical‐Surgical NursingNursing & Midwifery SchoolArdabil University of Medical SciencesArdabilIran
| | | | - Behrouz Dadkhah
- Department of Medical‐Surgical NursingNursing & Midwifery SchoolArdabil University of Medical SciencesArdabilIran
| | - Hossein Doustkami
- Department of CardiologySchool of MedicineArdabil University of Medical SciencesArdabilIran
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8
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Elevated levels of cortisol in hair precede acute myocardial infarction. Sci Rep 2020; 10:22456. [PMID: 33384452 PMCID: PMC7775435 DOI: 10.1038/s41598-020-80559-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 12/22/2020] [Indexed: 01/06/2023] Open
Abstract
Long term stress exposure is typical for modern societies and might trigger different diseases. This case–control study reveals that persons who had suffered an acute myocardial infarction (AMI) had elevated cortisol concentrations in the month before the acute event. Middle-aged patients admitted to cardiology clinics with acute myocardial infarction (AMI) (n = 174) were compared to 3156 controls from a population-based cohort in southeast Sweden. The median Hair Cortisol Concentrations (HCC) for those who had suffered an AMI was 53.2 pg/mg compared to 22.2 pg/mg for the control group (p < 0.001). In bivariate analysis, higher levels of HCC were strongly (OR = 5.69) and statistically significantly associated with current AMI status. The discrimination of cases with AMI from controls remained statistically significant (OR = 5.04) even after controlling for established cardiovascular risk factors in a multivariate analysis. Middle-aged persons with acute myocardial infarction had significantly elevated cortisol levels during the month before the cardiac event. This was evident for both men and women. The biomarker cortisol concentration was independently and statistically significantly related to AMI. Chronic stress seems to be a new promising risk factor for AMI.
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9
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Kim JS, Kim GS, Kang SM, Chu SH. Symptom experience as a predictor of cardiac rehabilitation education programme attendance after percutaneous coronary intervention: A prospective questionnaire survey. Eur J Cardiovasc Nurs 2020; 20:183–191. [PMID: 33611353 DOI: 10.1177/1474515120940534] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 05/17/2020] [Accepted: 06/18/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite evidence that participation in cardiac rehabilitation programmes after percutaneous coronary intervention is associated with better clinical outcomes, many patients with coronary artery disease do not participate in such programmes. A traditional educational approach is recommended to provide patients with information regarding the benefits of cardiac rehabilitation in relation to their underlying coronary artery disease and modification of risk factors. AIMS The purpose of this study was to examine the role of patient factors (symptom experience and health belief) on cardiac rehabilitation education programme attendance among Korean patients subjected to percutaneous coronary intervention. METHODS A prospective survey was conducted enrolling 173 patients who underwent percutaneous coronary intervention. Information on symptom experience, health belief (perceived susceptibility/severity/benefits/ barriers) and sociodemographic and clinical characteristics was collected at baseline (after percutaneous coronary intervention). Three to four weeks later, information on disease-related knowledge and health behaviour was compared between cardiac rehabilitation education programme attendees and non-attendees. RESULTS Eighty of 173 (46.2%) patients surveyed attended the cardiac rehabilitation education programme. Symptom experience before percutaneous coronary intervention was the most significant predictor of programme attendance (odds ratio=3.46; 95% confidence interval 1.45-8.27), followed by higher perceived socioeconomic status (odds ratio=2.90; 95% confidence interval 1.28-6.58), perceived susceptibility (odds ratio=1.22, 95% confidence interval 1.08-1.39), perceived benefits (odds ratio=1.09; 95% confidence interval 1.02-1.17) and perceived severity (odds ratio=1.04; 95% confidence interval 1.00-1.08). Better disease-related knowledge and health behaviour were significantly associated with cardiac rehabilitation education programme attendance. CONCLUSION This study provides evidence that educational programmes to help improve patients' perceptions of their disease susceptibility and severity, especially health behaviour benefits in patients without symptom experience before percutaneous coronary intervention, are necessary.
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Affiliation(s)
- Ji-Su Kim
- College of Nursing, Yonsei University, Korea
| | - Gwang S Kim
- College of Nursing, Yonsei University, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Korea
| | - Seok-Min Kang
- Cardiology Division, Severance Cardiovascular Hospital and Cardiovascular Research Institute, College of Medicine, Yonsei University, Korea
| | - Sang H Chu
- College of Nursing, Yonsei University, Korea.,Mo-Im Kim Nursing Research Institute, Yonsei University, Korea
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10
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Soltani L, Sabzevari S, Ravari A, Mirzaei T, Bagherian B. The Association between Risk Factors and Prodromal Myocardial Infarction Symptoms: A Cross-Sectional Study in Iran. Ethiop J Health Sci 2019; 29:439-446. [PMID: 31447516 PMCID: PMC6689703 DOI: 10.4314/ejhs.v29i4.4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Prodromal symptoms in individuals with risk factors remain challenging, even though myocardial infarction has been noted in research. This study determined the association of risk factors with patients' baseline myocardial infarction related prodromal symptoms. Methods In a cross-sectional study, 154 Iranian men and women, mean age 59.62 ± 12.74 years were assessed in 2016-2017. The frequency besides severity of 33 prodromal symptoms and risk factors was assessed using McSweeney Prodromal Myocardial Infarction Symptom Survey. Results The main cardiac prodromal symptoms experienced by patients were chest pain/discomfort (n = 99, 64.30%), unusual fatigue (n = 78, 50.60%), and sleep disturbance (n = 33, 20.40%). Women experienced more prodromal symptoms than men (33.26 ± 21.88 vs. 25.48 ± 17.75). Among risk factors, only sex was associated with prodromal symptoms score (P < 0.05). Conclusion The frequently experienced prodromal symptoms, i.e., before MI were chest pain/discomfort, unusual fatigue, and sleep disturbance. A crucial finding was the significant association between sex and prodromal symptoms. Identifying prodromal symptoms in patients with risk factors can prevent the incidence of myocardial infarction.
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Affiliation(s)
- Lida Soltani
- Nursing PhD Student. Nursing Research Center, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Sakine Sabzevari
- Nursing PhD Student. Nursing Research Center, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Ali Ravari
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Tayebeh Mirzaei
- Department of Medical Surgical Nursing, School of Nursing and Midwifery, Geriatric Care Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Behnaz Bagherian
- Nursing PhD Student. Nursing Research Center, Razi School of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
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11
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Affiliation(s)
- Elizabeth P Held
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA
| | - Sumeet S Chugh
- Smidt Heart Institute, Cedars-Sinai Health System, Los Angeles, CA
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12
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Kwong JC, Schwartz KL, Campitelli MA. Acute Myocardial Infarction after Laboratory-Confirmed Influenza Infection. N Engl J Med 2018; 378:2540. [PMID: 29949484 DOI: 10.1056/nejmc1805679] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Affiliation(s)
- Jeffrey C Kwong
- Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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13
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Bowles JR, McEwen MM, Rosenfeld AG. Acute Myocardial Infarction Experience Among Mexican American Women. HISPANIC HEALTH CARE INTERNATIONAL 2018; 16:62-69. [PMID: 29886775 DOI: 10.1177/1540415318779926] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Health disparities in cardiovascular disease risk factors affect a burgeoning segment of the U.S. population-Mexican American (MA) women. MAs experience disparities in the prevalence of heart disease risk factors. However, there are no studies describing acute myocardial infarction (AMI) symptoms unique to this Hispanic subgroup. The aim of the study was to describe MA women's AMI symptom experience. METHODS A qualitative descriptive design guided the study. Data were collected in semistructured interviews with eight MA women who reported having an AMI within the past 18 months. Data were analyzed using qualitative content analysis. RESULTS The overall theme was "The nature of my AMI experience." This theme, composed of four categories, described their prodromal and AMI symptom experience: my perception of AMI, having a heart attack, AMI symptoms, and actions taken. No participants recognized prodromal or symptoms of AMI. Asphyxiatia (asphyxiating) and menos fuerza (less strength) were commonly described symptoms. CONCLUSION Participants attributed both prodromal and AMI symptoms to noncardiac causes, self-managed symptoms, and delay in seeking health care. Findings suggest that community engagement through culturally tailored family-focused heart health education for MA women and their family members may improve recognition of prodromal symptoms.
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14
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Nehme Z, Andrew E, Bernard S, Patsamanis H, Cameron P, Bray JE, Meredith IT, Smith K. Impact of a public awareness campaign on out-of-hospital cardiac arrest incidence and mortality rates. Eur Heart J 2018; 38:1666-1673. [PMID: 28329083 DOI: 10.1093/eurheartj/ehw500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/22/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Increased public awareness of the warning signs of a heart attack and the importance of early medical intervention may help to prevent premature deaths from out-of-hospital cardiac arrest (OHCA). We sought to investigate the impact of the Heart Foundation's public awareness campaigns on the monthly incidence of, and deaths from, OHCA in Melbourne, Australia. Methods and results Between July 2005 and June 2015, we included registry data for 25 060 OHCA of presumed cardiac aetiology. Time series models with distributed lags were used to explore the effect of campaign activity on OHCA outcomes. A sensitivity analysis involving segmented regression of the pre-intervention, intervention, and post-intervention time segments was also performed. The mean monthly incidence of, and deaths from, OHCA was 207 and 189 events respectively. After adjustment for temporal trends, campaign activity was associated with a 6.0% [95% confidence interval (CI): 2.8-9.0%; P < 0.001] reduction in the monthly incidence of OHCA, or 11.7% (95% CI: 7.7-15.5%, P < 0.001) with the addition of residual effects in two additional lag months. Similarly, the rate of deaths from OHCA reduced by 6.4% (95% CI: 2.8-10.0%; P = 0.001) during months with campaign activity. Campaign activity had a greater effect in males and patients aged ≥65 years, and reduced the incidence of OHCA in unwitnessed and initial non-shockable arrests. In the segmented regression analysis, the intervention period was associated with a 15.2% (95% CI: 9.2-20.9%; P < 0.001) reduction in the mean monthly incidence and a 16.6% (95% CI: 9.9-22.7%; P < 0.001) reduction in deaths from OHCA. Conclusion A comprehensive mass media campaign targeting the community's awareness of heart attack symptoms was associated with a substantial reduction in the incidence of OHCA and associated deaths.
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Affiliation(s)
- Ziad Nehme
- Department of Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster Victoria 3108, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Emily Andrew
- Department of Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster Victoria 3108, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Stephen Bernard
- Department of Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster Victoria 3108, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Harry Patsamanis
- National Heart Foundation of Australia, Level 12, 500 Collins Street, Melbourne Victoria 3000, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Ian T Meredith
- Department of Cardiology (MonashHeart), Monash Medical Centre, 246 Clayton Road, Clayton Victoria 3168, Australia
| | - Karen Smith
- Department of Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster Victoria 3108, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia.,Department of Emergency Medicine, University of Western Australia, 35 Stirling Highway, Crawley Western Australia 6009, Australia
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15
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Novak K, Vrdoljak D, Jelaska I, Borovac JA. Sex-specific differences in risk factors for in-hospital mortality and complications in patients with acute coronary syndromes : An observational cohort study. Wien Klin Wochenschr 2017; 129:233-242. [PMID: 27783152 DOI: 10.1007/s00508-016-1105-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 09/23/2016] [Indexed: 12/21/2022]
Abstract
BACKGROUND The goal of this observational cohort study was to examine gender-specific differences in the incidence of acute coronary syndrome (ACS), in-hospital complications and mortality. METHODS A cohort of 1550 patients with the primary diagnosis of ACS were enrolled in the study over a period of 4 years. The in-hospital mortality and complications were analyzed as the main outcome measures. RESULTS Women were significantly older compared to men (71 ± 11 years vs. 64 ± 12 years, p < 0.001) and had higher in-hospital mortality and complications due to this age difference. The prevalence of smoking was lower while hypertension and history of angina pectoris was more frequent in women, independent of age. Percutaneous transluminal coronary angioplasty (PTCA) with or without stenting as well as coronary catheterization significantly reduced in-hospital mortality and complications while thrombolytic therapy was associated with a 3.3 times increased mortality odds ratio (OR, p = 0.01). Other significant predictors of in-hospital mortality were in-hospital complications (OR 25, p < 0.001) and ST segment elevation myocardial infarction (STEMI, OR 4.5, p < 0.001). CONCLUSIONS Women differed from men in terms of ACS clinical characteristics, treatment, invasive procedures and survival outcome and some of these effects were age-related. The future emphasis should be based on the prevention of modifiable risk factors and identification of subgroups of female patients that could benefit from more aggressive therapeutic strategies.
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Affiliation(s)
- Katarina Novak
- Department of Internal Medicine, Division of Cardiology, University of Split Clinical Hospital Center, Spinčićeva 1, 21000, Split, Croatia
| | - Davorka Vrdoljak
- Department of Family Medicine, University of Split School of Medicine (USSM), Šoltanska 2, 21000, Split, Croatia
| | - Igor Jelaska
- Faculty of Kinesiology, University of Split, Teslina 6, 21000, Split, Croatia
| | - Josip Anđelo Borovac
- Department of Pathophysiology, University of Split School of Medicine (USSM), Soltanska 2, 21000, Split, Croatia.
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16
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Abstract
BACKGROUND Recognition of specific and nonspecific cardiac-related prodromal symptoms, indicative of myocardial ischemia, is critical for preemptive coronary heart disease (CHD) screening and effective diagnosis and treatment. In this systematic review, we examined whether prodromal symptoms were predictive of acute symptom presentations, cardiac events, or treatment interventions. METHODS Studies that measured the association of prodromal symptoms with acute coronary syndrome (ACS) symptom presentation, acute cardiac event, and/or intervention in men and/or women with confirmed CHD were included. DATA SOURCES Electronic searches in the Cochrane Library, MEDLINE, PubMed, PsyhINFO, Embase, CINAHL, and Scopus databases from 1990 to 2013 were conducted using medical subject heading terms including prodromal symptoms, ACS, acute myocardial infarction, unstable angina, and CHD. Key words such as shortness of breath, anxiety, atypical pain, sleep disturbance, fatigue, and nausea/vomiting were also used. Abstracts, relevant journals, key authors, and reference lists were reviewed. RESULTS Seven studies that included 6716 individuals with prodromal symptoms (65.7% women). Mean age was 68 ± 13 and 58.5 ± 9 years for women and men, respectively. Cardiac-related prodromal symptoms were predictive of patients' ACS-related symptoms and associated events from 3 to 24 months. Across studies, the prodromal symptoms consistently reported before cardiac event were chest discomfort/pain (n = 4, 57%), arm pain/discomfort (n = 6, 86%), jaw pain (n = 3, 43%), back/shoulder blade pain (n = 3, 43%), unusual fatigue (n = 7, 100%), shortness of breath (n = 6, 86%), sleep disturbance (n = 2, 29%), dizziness (n = 3, 43%), headache (n = 3, 43%), anxiety (n = 7, 100%), and gastrointestinal complaints (nausea, vomiting, indigestion; n = 5, 71%). Patients with prodromal arm, jaw, and back pain; fatigue; and shortness of breath had increased risk of experiencing similar symptoms during an ACS episode. Prodromal symptoms were predictive of adverse cardiac events and cardiac interventions. There is some preliminary evidence to suggest that prodromal symptoms of headache, sleep disturbance, and anxiety may predict ACS symptom presentation during an acute cardiac event. CONCLUSION Future research is warranted that would examine prospectively the predictive value of prodromal headache, sleep disturbance, and anxiety within this cardiovascular population on major adverse cardiac events. Preemptive screening for cardiac-related prodromal symptoms in men and women should be considered as a standard in clinical practice. This may potentiate early diagnosis, effective risk modification, timely pain management, and treatment intervention and decrease CHD-related morbidity and mortality.
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17
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Xuereb R, Magri CJ, Xuereb S, Xuereb M, Mangion MZ, Xuereb RG. Female gender and cardiovascular disease. Br J Hosp Med (Lond) 2016; 77:454-9. [DOI: 10.12968/hmed.2016.77.8.454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Affiliation(s)
- Rachel Xuereb
- Third year medical student at the University of Malta, Malta
| | - Caroline J Magri
- Resident Specialist in the Department of Cardiology, Mater Dei Hospital, Tal-Qroqq, Msida MSD 2090, Malta, and Visiting Lecturer, University of Malta, Malta
| | - Sara Xuereb
- Foundation Year 2 Doctor in the Department of Medicine, Mater Dei Hospital, Malta
| | - Mariosa Xuereb
- Consultant Cardiologist in the Department of Cardiology, Mater Dei Hospital, and Visiting Senior Lecturer, University of Malta, Malta
| | | | - Robert G Xuereb
- Chairman and Consultant Cardiologist in the Department of Cardiology, Mater Dei Hospital, and Visiting Senior Lecturer, University of Malta, Malta
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18
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Blakeman JR, Booker KJ. Prodromal myocardial infarction symptoms experienced by women. Heart Lung 2016; 45:327-35. [DOI: 10.1016/j.hrtlng.2016.04.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Revised: 04/27/2016] [Accepted: 04/28/2016] [Indexed: 11/30/2022]
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19
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DeVon HA, Pettey CM, Vuckovic KM, Koenig MD, McSweeney JC. A Review of the Literature on Cardiac Symptoms in Older and Younger Women. J Obstet Gynecol Neonatal Nurs 2016; 45:426-37. [DOI: 10.1016/j.jogn.2016.02.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/01/2015] [Indexed: 11/17/2022] Open
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20
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Marijon E, Uy-Evanado A, Dumas F, Karam N, Reinier K, Teodorescu C, Narayanan K, Gunson K, Jui J, Jouven X, Chugh SS. Warning Symptoms Are Associated With Survival From Sudden Cardiac Arrest. Ann Intern Med 2016; 164:23-9. [PMID: 26720493 PMCID: PMC5624713 DOI: 10.7326/m14-2342] [Citation(s) in RCA: 98] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Survival after sudden cardiac arrest (SCA) remains low, and tools for improved prediction of patients at long-term risk for SCA are lacking. Alternative short-term approaches aimed at preemptive risk stratification and prevention are needed. OBJECTIVE To assess characteristics of symptoms in the 4 weeks before SCA and whether response to these symptoms is associated with better outcomes. DESIGN Ongoing prospective population-based study. SETTING Northwestern United States (2002 to 2012). PATIENTS Residents aged 35 to 65 years with SCA. MEASUREMENT Assessment of symptoms in the 4 weeks preceding SCA and association with survival to hospital discharge. RESULTS Of 839 patients with SCA and comprehensive assessment of symptoms (mean age, 52.6 years [SD, 8]; 75% men), 430 (51%) had warning symptoms (50% of men vs. 53% of women; P = 0.59), mainly chest pain and dyspnea. In most symptomatic patients (93%), symptoms recurred within the 24 hours preceding SCA. Only 81 patients (19%) called emergency medical services (911) to report symptoms before SCA; these persons were more likely to be patients with a history of heart disease (P < 0.001) or continuous chest pain (P < 0.001). Survival when 911 was called in response to symptoms was 32.1% (95% CI, 21.8% to 42.4%) compared with 6.0% (CI, 3.5% to 8.5%) in those who did not call (P < 0.001). LIMITATION Potential for recall and response bias, symptom assessment not available in 24% of patients, and missing data for some patients and SCA characteristics. CONCLUSION Warning symptoms frequently occur before SCA, but most are ignored. Emergent medical care was associated with survival in patients with symptoms, so new approaches are needed for short-term prevention of SCA. PRIMARY FUNDING SOURCE National Heart, Lung, and Blood Institute.
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21
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Gyberg A, Björck L, Nielsen S, Määttä S, Falk K. Women's help-seeking behaviour during a first acute myocardial infarction. Scand J Caring Sci 2015; 30:670-677. [PMID: 26582252 DOI: 10.1111/scs.12286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 08/04/2015] [Indexed: 11/27/2022]
Abstract
Studies indicate that the time from onset of symptoms to medical treatment has decreased in acute myocardial infarction (AMI). However, there are still variations indicating that women wait longer than men before making the decision to seek medical care. Multidimensional factors hindering and facilitating the decision have been identified in previous studies, though few have fully explored how social context affects women's expectations, interpretations and actions and so influences the decision-making process. The aim of this study was therefore to identify how women's experiences interacted and influenced the decision to seek medical care at their first AMI. Seventeen women, aged 38-75 years, were interviewed, at home or in the hospital, between June 2011 and May 2012. Grounded theory was used as a method, and data collection and analysis were carried out simultaneously. The results showed that before deciding to seek medical care, these women went through three defined but interrelated processes that together hindered their normal activities and made them act according to existential needs. The women's experiences of the progression of the disease, in terms of both symptoms and time, were very different, so they sought medical care at different times, sometimes life-threateningly late and sometimes before developing an AMI. Three mechanisms had to coincide if the women were to receive medical care. First, the women had to acknowledge their symptoms as something more than common bodily changes. Second, the healthcare system had to be accessible when the women made their decision to seek care. Third, the women must have come into contact with healthcare providers when the heart muscle had taken enough damage to measure.
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Affiliation(s)
- Anna Gyberg
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Lena Björck
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Nielsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sylvia Määttä
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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22
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Kholaif N, Zheng Y, Jagasia P, Himmelmann A, James SK, Steg PG, Storey RF, Westerhout CM, Armstrong PW. Baseline Q waves and time from symptom onset to ST-segment elevation myocardial infarction: insights from PLATO on the influence of sex. Am J Med 2015; 128:914.e11-9. [PMID: 25818495 DOI: 10.1016/j.amjmed.2015.03.005] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2015] [Revised: 03/17/2015] [Accepted: 03/17/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The prognostic value of time from symptom onset to reperfusion may be enhanced by the identification of Q waves on the presenting electrocardiogram (ECG) in patients with ST-segment elevation myocardial infarction (STEMI). We evaluated whether the relative prognostic utility of these 2 metrics was altered by sex. METHODS Q waves in the distribution of the ST-segment elevation on the baseline ECG were evaluated by a blinded core laboratory in 2838 STEMI patients (2163 men and 675 women) from the PLATelet inhibition and patient Outcomes (PLATO) trial who underwent percutaneous coronary intervention (PCI) within 12 hours of symptom onset. RESULTS Women were older (median 63 vs 57 years), more likely to be diabetic (24.1% vs 15.5%), hypertensive (69.2% vs 50.9%), and a higher Killip class > I (8.6% vs 5.9%), as compared with men. Whereas the Q waves frequency rose progressively over time to ECG in men, this relationship was attenuated in women (P = .057). Q waves on the baseline ECG were associated with a higher excess hazard of 1-year vascular death in men (hazard ratio [HR] 2.03; 95% confidence interval [CI], 1.13-3.72), and a similar trend existed in women (HR 1.97; 95% CI, 0.86-4.51). Women with baseline Q waves tended to have higher risk of 1-year vascular death than men as continuous time from symptom onset to PCI increased (P[interaction] = .182). CONCLUSIONS These differences in the evolution of baseline Q waves and relationship between time from symptom onset and vascular death in women and men deserve recognition in future studies of STEMI.
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Affiliation(s)
- Naji Kholaif
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Yinggan Zheng
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | - Pushpa Jagasia
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada
| | | | - Stefan K James
- Department of Medical Sciences, Cardiology, and Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden
| | - Philippe Gabriel Steg
- INSERM-Unité 1148, Paris, France; Assistance Publique-Hôpitaux de Paris, Département Hospitalo-Universitaire FIRE, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne-Paris Cité, Paris, France; NHLI Imperial College, ICMS, Royal Brompton Hospital, London, UK
| | - Robert F Storey
- Department of Cardiovascular Science, University of Sheffield, Sheffield, UK
| | | | - Paul W Armstrong
- Canadian VIGOUR Centre, University of Alberta, Edmonton, Canada.
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23
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O'Keefe-McCarthy S, McGillion MH, Victor JC, Jones J, McFetridge-Durdle J. Prodromal symptoms associated with acute coronary syndrome acute symptom presentation. Eur J Cardiovasc Nurs 2015; 15:e52-9. [PMID: 25851233 DOI: 10.1177/1474515115580910] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Accepted: 03/18/2015] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Prodromal symptoms (PS), indicative of myocardial ischemia, are frequently unrecognized by individuals prior to an acute coronary syndrome (ACS). ACSs are the leading cause of death worldwide. This study describes (1) the prevalence and association of PS with patients' baseline ACS-related acute symptoms of pain intensity and state anxiety and (2) the relationship of PS to co-morbidity. METHODS An exploratory sub-analysis was performed. Cross sectional data identified prodromal predictors of ACS pain intensity (numeric rating scale 0-10 (NRS)) and state anxiety (Speilberger state-trait anxiety personality inventory (STAI)). ACS patients (n=121) admitted to a community rural emergency department completed the prodromal symptom screening scale (PS-SS) and reported baseline cardiac pain intensity, state, and trait anxiety. RESULTS Increased ACS pain intensity was associated with PS. Median pain scores were higher by two points for those with prodromal headache, p=0.006, and anxiety, p=0.017, and one point higher for those with sleep disturbances, p=0.012. PS were not associated with state or trait anxiety. Hypertensive individuals were 7.5 times more likely to experience prodromal fatigue prior to their ACS event. CONCLUSION Results extend current knowledge of the predictive value that prodromal headache, sleep disturbance and anxiety may have on individuals' acute symptom presentation. A prospective, prognostic study is required in order to determine whether PS are predictive of adverse cardiac events and if PS are a stronger predictor of ACS acute symptom presentation, compared with typical ACS-related co-morbidities.
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24
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Vaina S, Milkas A, Crysohoou C, Stefanadis C. Coronary artery disease in women: From the yentl syndrome to contemporary treatment. World J Cardiol 2015; 7:10-18. [PMID: 25632314 PMCID: PMC4306201 DOI: 10.4330/wjc.v7.i1.10] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 06/02/2014] [Accepted: 12/10/2014] [Indexed: 02/06/2023] Open
Abstract
In recent years attention has been raised to the fact of increased morbidity and mortality between women who suffer from coronary disease. The identification of the so called Yentl Syndrome has emerged the deeper investigation of the true incidence of coronary disease in women and its outcomes. In this review an effort has been undertaken to understand the interaction of coronary disease and female gender after the implementation of newer therapeutic interventional and pharmaceutics’ approaches of the modern era.
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25
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Baumert J, Meisinger C, Lukaschek K, Emeny RT, Rückert IM, Kruse J, Ladwig KH. A pattern of unspecific somatic symptoms as long-term premonitory signs of type 2 diabetes: findings from the population-based MONICA/KORA cohort study, 1984-2009. BMC Endocr Disord 2014; 14:87. [PMID: 25416641 PMCID: PMC4247721 DOI: 10.1186/1472-6823-14-87] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2014] [Accepted: 11/11/2014] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Unspecific symptoms often proceed a serious chronic disease condition long before the onset of the disease. The role of an unspecific premonitory symptom (UPMS) pattern as premonitory signs of subsequent type 2 diabetes mellitus (T2DM) diagnosis independent of established cardio-metabolic risk factors is unclear and therefore was examined in the present study. METHODS The study population consisted of 10,566 participants aged 25-74 years at baseline drawn from the population-based MONICA/KORA Cohort Study conducted in 1984-2009 in the Augsburg region (Germany). Unspecific premonitory symptoms were assessed following the Somatic Symptom Scale-8 (SSS-8). The impact of the score on T2DM risk within a mean follow-up time of 16 years was estimated by Cox regression. RESULTS Within follow-up, 974 newly diagnosed T2DM cases were observed. The risk for T2DM increased by a hazard ratio (HR) of 1.03 (95% CI 1.01-1.04, p value < 0.001) for a one unit increase of the UPMS score in a Cox model adjusted for age, sex and survey. Additional adjustment for cardio-metabolic risk factors attenuated this effect (HR = 1.02) but significance remained (p value = 0.01). CONCLUSIONS Suffering from an elevated burden of unspecific somatic symptoms is associated with T2DM long before the onset and independent of established cardio-metabolic risk factors. Further research is needed to obtain insight in potential underlying pathophysiological mechanisms.
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Affiliation(s)
- Jens Baumert
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
| | - Christa Meisinger
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
- />Central Hospital of Augsburg, MONICA/KORA Myocardial Infarction Registry, Augsburg, Germany
| | - Karoline Lukaschek
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
| | - Rebecca Thwing Emeny
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
| | - Ina-Maria Rückert
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
| | - Johannes Kruse
- />Department of Psychosomatic Medicine and Psychotherapy, University of Giessen, Giessen, Germany
- />Department of Psychosomatic Medicine and Psychotherapy, University of Marburg, Marburg, Germany
| | - Karl-Heinz Ladwig
- />Institute of Epidemiology II, Helmholtz Zentrum München, German Research Center for Environmental Health, Ingolstädter Landstr. 1, Neuherberg, 85764 Germany
- />Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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McSweeney J, Cleves MA, Fischer EP, Moser DK, Wei J, Pettey C, Rojo MO, Armbya N. Predicting coronary heart disease events in women: a longitudinal cohort study. J Cardiovasc Nurs 2014; 29:482-92. [PMID: 24231895 PMCID: PMC4019730 DOI: 10.1097/jcn.0b013e3182a409cc] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than 240 000 women in the United States die of coronary heart disease annually. Identifying women's symptoms that predict a coronary heart disease event such as myocardial infarction (MI) could decrease mortality. OBJECTIVE For this longitudinal observational study, we recruited 1097 women, who were either clinician referred or self-referred to a cardiologist and undergoing initial evaluation by a cardiologist, to assess the utility of the prodromal symptoms (PS) section of the McSweeney Acute and Prodromal Myocardial Infarction Symptom Survey (MAPMISS) in predicting the occurrence of cardiac events in women. METHODS AND RESULTS Seventy-seven women experienced events (angioplasty, stent placement, coronary artery bypass, MI, death) during the 2-year follow up. The most common events were stents alone (38.9%) or in combination with angioplasty (18.2%). Ten women had MIs; 4 experienced cardiac death. Cox proportional hazards was used to model time to event. The prodromal score was significantly associated with risk of an event (hazard ratio, 1.10; 95% confidence interval, 1.06-1.13), as was the number of PSs endorsed by each woman per visit. After covariate adjustment, 5 symptoms were significantly associated with increased risk: discomfort in jaws/teeth, unusual fatigue, arm discomfort, shortness of breath, and general chest discomfort (hazard ratio, 3.97; 95% confidence interval, 2.32-6.78). Women reporting 1 or more of these symptoms were 4 times as likely to experience a cardiac event as women with none. CONCLUSIONS Both the MAPMISS PS scores and number of PS were significantly associated with cardiac events, independent of risk factors, suggesting that there are specific PSs that can be easily assessed using the MAPMISS. This instrument could be an important component of a predictive screen to assist clinicians in deciding the course of management for women.
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Affiliation(s)
- Jean McSweeney
- Jean McSweeney, PhD, RN, FAHA, FAAN Professor and Associate Dean for Research, College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Mario A. Cleves, PhD Professor, College of Medicine, University of Arkansas for Medical Sciences, Little Rock. Ellen P. Fischer, PhD Research Health Scientist, Center for Mental Healthcare and Outcomes Research, Central Arkansas Veterans Healthcare System, and Associate Professor, Department of Psychiatry & Behavioral Science, University of Arkansas for Medical Sciences, Little Rock. Debra K. Moser, DNSc, RN, FAHA, FAAN Professor and Gill Endowed Chair, College of Nursing, University of Kentucky, Lexington. Jeanne Wei, MD, PhD Professor, College of Medicine, University of Arkansas for Medical Sciences, Little Rock. Christina Pettey, MNSc, FNP-BC, APRN Doctoral Candidate and Clinical Assistant Professor, College of Nursing, University of Arkansas Medical Sciences, Little Rock. Martha O. Rojo, PhD Research Assistant, College of Nursing, University of Arkansas for Medical Sciences, Little Rock. Narain Armbya, MS Statistician, College of Medicine, University of Arkansas for Medical Sciences, Little Rock
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27
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Forsling E, Lundqvist R, Eliasson M, Isaksson RM. Health care contact is higher in the week preceding a first myocardial infarction: A review of medical records in Northern Sweden in 2007. Eur J Cardiovasc Nurs 2014; 14:450-6. [PMID: 24982433 DOI: 10.1177/1474515114541027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2013] [Accepted: 05/28/2014] [Indexed: 11/17/2022]
Abstract
BACKGROUND Prodromal symptoms before myocardial infarction (MI) are common, but there are limited data regarding health care contact prior to the acute onset of MI and the impact of gender on early presentation to health care. AIMS The purpose of this study was to describe and analyse prodromal symptoms reported in medical records and study health care contact in the week before the acute onset of MI in comparison to the general population. METHODS From the Northern Sweden MONICA Study we accessed the medical records of 359 patients aged 32-74 years with a first MI in the county of Norrbotten in 2007. We identified those patients' health care contact during the seven days before the MI and compared them with the weekly number of contacts in the general population aged 45-74 years in the county during 2007. RESULTS We found that 23.1% of the women and 17.6% of the men had at least one contact the week before the MI. With the exception of the 14 women aged 45-55 years, health care consumption in both women and men in all age groups between 45- 74 years of age was 75%-165% higher in the week prior to the MI than in the general population of the same ages. In the first health care contact, pain-related symptoms were most frequent (43%), and fatigue was present in 8% of patients. There were no differences between women and men in health care consumption or presenting symptoms. CONCLUSION Both women and men with a first MI are in contact more frequently than the general population in the week prior to the event.
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Affiliation(s)
- Elin Forsling
- Department of Research, Norrbotten County Council, Sweden Department of Medicine, Sunderby Hospital, Sweden
| | | | - Mats Eliasson
- Department of Medicine, Sunderby Hospital, Sweden Department of Public Health and Clinical Medicine, Umeå University, Sweden
| | - Rose-Marie Isaksson
- Department of Research, Norrbotten County Council, Sweden Division of Nursing, Linköping University, Sweden
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Canto JG, Canto EA, Goldberg RJ. Time to Standardize and Broaden the Criteria of Acute Coronary Syndrome Symptom Presentations in Women. Can J Cardiol 2014; 30:721-8. [DOI: 10.1016/j.cjca.2013.10.015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 10/20/2013] [Accepted: 10/20/2013] [Indexed: 11/30/2022] Open
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Esguerra-Gonzalez A, Ilagan-Honorio M, Fraschilla S, Kehoe P, Lee AJ, Marcarian T, Mayol-Ngo K, Miller PS, Onga J, Rodman B, Ross D, Sommer S, Takayanagi S, Toyama J, Villamor F, Weigt SS, Gawlinski A. CNE article: pain after lung transplant: high-frequency chest wall oscillation vs chest physiotherapy. Am J Crit Care 2013; 22:115-24. [PMID: 23455861 DOI: 10.4037/ajcc2013869] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Background Chest physiotherapy and high-frequency chest wall oscillation (HFCWO) are routinely used after lung transplant to facilitate removal of secretions. To date, no studies have been done to investigate which therapy is more comfortable and preferred by lung transplant recipients. Patients who have less pain may mobilize secretions, heal, and recover faster. Objectives To compare effects of HFCWO versus chest physiotherapy on pain and preference in lung transplant recipients. Methods In a 2-group experimental, repeated-measures design, 45 lung transplant recipients (27 single lung, 18 bilateral) were randomized to chest physiotherapy (10 AM, 2 PM) followed by HFCWO (6 PM, 10 PM; group 1, n=22) or vice versa (group 2, n=23) on postoperative day 3. A verbal numeric rating scale was used to measure pain before and after treatment. At the end of the treatment sequence, a 4-item patient survey was administered to assess treatment preference, pain, and effectiveness. Data were analyzed with χ(2) and t tests and repeated-measures analysis of variance. Results A significant interaction was found between mean difference in pain scores from before to after treatment and treatment method; pain scores decreased more when HFCWO was done at 10 AM and 6 PM (P =.04). Bilateral transplant recipients showed a significant preference for HFCWO over chest physiotherapy (11 [85%] vs 2 [15%], P=.01). However, single lung recipients showed no significant difference in preference between the 2 treatments (11 [42%] vs 14 [54%]). Conclusions HFCWO seems to provide greater decreases in pain scores than does chest physiotherapy. Bilateral lung transplant recipients preferred HFCWO to chest physiotherapy. HFCWO may be an effective, feasible alternative to chest physiotherapy. (American Journal of Critical Care. 2013;22:115-125).
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Affiliation(s)
- Angeli Esguerra-Gonzalez
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Monina Ilagan-Honorio
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Stephanie Fraschilla
- Stephanie Fraschilla and Jay Onga are transplant coordinators for the heart and lung transplant program at Ronald Reagan University of California Los Angeles Medical Center
| | - Priscilla Kehoe
- Priscilla Kehoe is the director of research and Sumiko Takayanagi is a senior statistician in the School of Nursing at the University of California Los Angeles
| | - Ai Jin Lee
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Taline Marcarian
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Kristina Mayol-Ngo
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Pamela S. Miller
- Pamela S. Miller is a postdoctoral scholar in the School of Nursing at the University of California San Francisco
| | - Jay Onga
- Stephanie Fraschilla and Jay Onga are transplant coordinators for the heart and lung transplant program at Ronald Reagan University of California Los Angeles Medical Center
| | - Betty Rodman
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - David Ross
- David Ross is a physician, professor, and medical director of the lung and heart-lung transplant program and S. Samuel Weigt is a physician and assistant professor in the Division of Pulmonary and Critical Care Medicine at David Geffen School of Medicine at University of California Los Angeles Medical Center
| | - Susan Sommer
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - Sumiko Takayanagi
- Priscilla Kehoe is the director of research and Sumiko Takayanagi is a senior statistician in the School of Nursing at the University of California Los Angeles
| | - Joy Toyama
- Joy Toyama is a DrPH student in the Department of Biostatistics and a graduate student researcher in the School of Nursing at the University of California Los Angeles
| | - Filma Villamor
- Angeli Esguerra-Gonzalez, Monina Ilagan-Honorio, Ai Jin Lee, Taline Marcarian, Kristina Mayol-Ngo, Betty Rodman, Susan Sommer, and Filma Villamor are nurses in the cardiothoracic intensive care unit at Ronald Reagan University of California Los Angeles Medical Center
| | - S. Samuel Weigt
- David Ross is a physician, professor, and medical director of the lung and heart-lung transplant program and S. Samuel Weigt is a physician and assistant professor in the Division of Pulmonary and Critical Care Medicine at David Geffen School of Medicine at University of California Los Angeles Medical Center
| | - Anna Gawlinski
- Anna Gawlinski is the director of research and evidence-based practice at Ronald Reagan University of California Los Angeles Medical Center and adjunct professor in the School of Nursing at the University of California Los Angeles
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Kaul P, Fu Y, Westerhout CM, Granger CB, Armstrong PW. Relative prognostic value of baseline Q wave and time from symptom onset among men and women with ST-elevation myocardial infarction undergoing percutaneous coronary intervention. Am J Cardiol 2012; 110:1555-60. [PMID: 22920928 DOI: 10.1016/j.amjcard.2012.07.020] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 07/13/2012] [Accepted: 07/13/2012] [Indexed: 11/19/2022]
Abstract
Q waves have been shown to be a stronger prognostic marker than time from symptom onset to percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction. We examined whether the relative importance of these 2 measurements is modulated by patient gender. Q waves in the area of ST-segment elevation on baseline electrocardiogram were evaluated at a central core laboratory in 4,530 patients with ST-segment elevation myocardial infarction (3,468 men and 1,062 women) without previous infarction and who underwent PCI in the Assessment of Pexelizumab in Acute Myocardial Infarction (APEX-AMI) trial. Women were older and had higher rates of diabetes, hypertension, Killip class >I, and lower creatinine clearance compared to men. Time from symptom onset to PCI >3 hours was associated with a trend toward worse 90-day mortality (adjusted hazard ratio 1.5, 95% confidence interval 0.9 to 2.2) in men but not in women (0.8, 0.5 to 1.4). In contrast, presence of Q waves on baseline electrocardiogram was associated with significantly higher 90-day mortality in men (adjusted hazard ratio 1.7, 95% confidence interval 1.0 to 2.7) and women (2.3, 1.2 to 4.2). In conclusion, in this gender-specific analysis, baseline Q wave was found be a better marker of risk of 90-day mortality than time from symptom onset to PCI, overall, and especially in women.
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Affiliation(s)
- Padma Kaul
- University of Alberta, Edmonton, Alberta, Canada.
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Prodromal symptoms of out-of-hospital cardiac arrests: a report from a large-scale population-based cohort study. Resuscitation 2012; 84:558-63. [PMID: 23069588 DOI: 10.1016/j.resuscitation.2012.10.006] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2012] [Revised: 10/04/2012] [Accepted: 10/07/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Little is known about which symptoms are manifested before out-of-hospital cardiac arrest (OHCA). The objective of this study is to describe the prodromal symptoms of OHCA focusing on the onset of the symptom in relation of etiology of cardiac arrests, and to analyze the association between those symptoms and their outcomes after OHCA. METHODS This prospective, population-based cohort study enrolled all persons aged 18 years or older who had experienced OHCA of presumed cardiac and non-cardiac origin that were witnessed by bystanders or emergency medical system (EMS) personnel in Osaka from 2003 through 2004. RESULTS There were 1042 were presumed to be of cardiac origin and 424 of non-cardiac. Patients with non-cardiac origin were more likely to have prodromal symptoms than those with cardiac etiology (70.0% vs. 61.8%, p=0.003). Over 40% of OHCA regardless of etiology had displayed symptoms at least several minutes before their arrest (40.2% [259/644] in those of cardiac origin and 45.5% [135/297] in those of non-cardiac origin). As to cardiac origin, the most frequent prodromal symptom was dyspnea (27.6%), followed by chest pain (20.7%) and syncope (12.7%). For non-cardiac origin, the most frequent symptom was also dyspnea (40.7%), but chest pain was rarely presented (3.4%). Although, prodromal symptoms themselves were not associated with better neurological outcomes (adjusted odds ratio [AOR], 2.03; 95% confidence interval [CI], 1.00-4.13), earlier contact to a patient yielded better neurological outcomes (AOR per every one-minute increase, 0.90; 95% CI, 0.82-0.99). CONCLUSIONS Many of OHCA regardless of etiology have prodromal symptoms before arrest. Prodromal symptoms induced early activation of the EMS system, and may thus improve outcomes after OHCA.
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Almond SC, Salisbury H, Ziebland S. Women's experience of coronary heart disease: why is it different? ACTA ACUST UNITED AC 2012. [DOI: 10.12968/bjca.2012.7.4.165] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Susanna C Almond
- Health Experiences Research Group, University of Oxford, 2nd Floor, 23–38 Hythe Bridge Street, Oxford, OX1 2ET
| | | | - Sue Ziebland
- Health Experiences Research Group, University of Oxford
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Alter DA, Stukel T, Chong A, Henry D. Lesson from Canada's Universal Care: socially disadvantaged patients use more health services, still have poorer health. Health Aff (Millwood) 2011; 30:274-83. [PMID: 21289349 DOI: 10.1377/hlthaff.2009.0669] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Lower socioeconomic status is commonly related to worse health. If poor access to health care were the only explanation, universal access to care should eliminate the association. We studied 14,800 patients with access to Canada's universal health care system who were initially free of cardiac disease, tracking them for at least ten years and seven months. We found that socially disadvantaged patients used health care services more than did their counterparts with higher incomes and education. We also found that service use by people with lower incomes and less education had little impact on their poorer health outcomes, particularly mortality. Countries contemplating national health insurance cannot rely on universal health care to eliminate historical disparities in outcomes suffered by disadvantaged groups. Universal access can only reduce these disparities. Our findings suggest the need to introduce large-scale preventive strategies early in patients' lives to help change unhealthy behavior.
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Affiliation(s)
- David A Alter
- Institute for Clinical Evaluative Sciences and the research director of theCardiac Rehabilitation and Secondary Prevention Program of the Toronto Rehabilitation Institute, inToronto, Ontario, Canada.
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Impact of prodromal symptoms on prehospital delay in patients with first-time acute myocardial infarction in Korea. J Cardiovasc Nurs 2011; 26:194-201. [PMID: 21099696 DOI: 10.1097/jcn.0b013e3181f3e2e0] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Information is limited concerning how affected individuals respond to early warning signs before their acute coronary event and how the presence of prodromal symptoms impacts prehospital delay. OBJECTIVES This study's aim was to identify the characteristics and interpretation of prodromal symptoms in patients with a first-time acute myocardial infarction (AMI) and to determine whether the presence of prodromal symptoms was predictive of prehospital delay. SUBJECTS AND METHODS This was a descriptive study using semistructured interview. A total of 271 hospitalized patients diagnosed as having AMI were interviewed from November 2007 to December 2008 at a university hospital in Korea. Patients were queried regarding whether they noticed a most troubling prodromal symptom prior to their acute cardiac event and how they responded to the symptom. RESULTS Men (53.0%) and women (54.2%) experienced prodromal symptoms. Patients who reported prodromal symptoms were more likely to be older and to have no chest pain upon hospitalization than those with no prodromes. Many patients did not generally recognize the importance of their warning symptoms; only about 40% visited a clinic in response to any prodromal symptom. Logistic regression analyses revealed that the presence of prodromal symptoms was an independent predictor affecting prehospital delay of more than 3 hours and more than 12 hours. CONCLUSIONS Recognizing prodromal symptoms as needing attention could be a trigger for patients to seek medical help earlier. Educational strategies should focus on improving awareness of prodromal symptoms of AMI, particularly in those with a family history or at high risk for cardiovascular disease.
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Gallagher R, Marshall AP, Fisher MJ. Symptoms and treatment-seeking responses in women experiencing acute coronary syndrome for the first time. Heart Lung 2010; 39:477-84. [DOI: 10.1016/j.hrtlng.2009.10.019] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2009] [Revised: 10/23/2009] [Accepted: 10/30/2009] [Indexed: 10/19/2022]
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Leuzzi C, Sangiorgi GM, Modena MG. Gender-specific aspects in the clinical presentation of cardiovascular disease. Fundam Clin Pharmacol 2010; 24:711-7. [PMID: 20840353 DOI: 10.1111/j.1472-8206.2010.00873.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
More than a quarter of a million women die each year in the industrialized countries from cardiovascular diseases (CVD), and current projections indicate that this number will continue to rise with our ageing population. Important sex-related differences in the prevalence, presentation, management and outcomes of different CVD have discovered in the last two decades of cardiovascular research. Nevertheless, much evidence supporting contemporary recommendations for testing, prevention and treatment of CVD in women is still extrapolated from studies conducted predominantly in men. The compendium of CVD indicates that current research and strategy development must focus on gender-specific issues to address the societal burden and costs related to these incremental shifts in female gender involvement. Indeed, this significant burden of CVD in women places unique diagnostic, treatment and financial encumbrances on our society that are only further intensified by a lack of public awareness about the disease on the part of patients and clinicians alike. This societal burden of the disease is, in part, related to our poor understanding of gender-specific pathophysiologic differences in the presentation and prognosis of CVD and the paucity of diagnostic and treatment guidelines tailored to phenotypic differences in women. In this, scenario is of outmost importance to know these differences to provide the best care for female patients, because under-recognition of CVD in women may contribute to a worse clinical outcome. This review will provide a synopsis of available evidence on gender-based differences in the initial presentation, pathophysiology and clinical outcomes of women affected by CVD.
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Affiliation(s)
- Chiara Leuzzi
- Department of Cardiology, University Hospital of Modena, Modena, Italy
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Luk JKH, Chiu PKC, Chu LW. Gender differences in rehabilitation outcomes among older Chinese patients. Arch Gerontol Geriatr 2010; 52:28-32. [PMID: 20202703 DOI: 10.1016/j.archger.2010.01.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2009] [Revised: 01/22/2010] [Accepted: 01/24/2010] [Indexed: 11/18/2022]
Abstract
Although gender differences have been demonstrated in cardiac and stroke rehabilitation, it remains unclear whether there are gender differences in geriatric rehabilitation. The purpose of this study is to investigate the relationship between gender and rehabilitation outcomes. We studied 1795 patients in two convalescence hospitals in Hong Kong. We defined absolute functional and motor gains as Barthel Index (BI) efficacy and Elderly Mobility Scale (EMS) efficacy while BI and EMS efficiency were efficacy divided by the length of stay. Satisfactory motor and functional outcomes were defined as discharge EMS ≥ 15 and BI ≥ 75. Compared with men, women had higher BI but lower EMS on admission and discharge. EMS and BI efficacy and efficiency were similar in both sexes. Female gender was a significant negative predictor for satisfactory motor outcome (p=0.0002) but a positive predictor for functional outcome (p=0.0007). Other predictors for satisfactory motor outcome were: age (p<0.001); urinary incontinence (p=0.0049); living at home (p=0.0056); admission EMS (p<0.001); admission BI (p=0.044). Other predictors for satisfactory functional outcome were: age (p=0.009); infection other than chest (p=0.047); urinary incontinence (p<0.001); Mini Mental State Examination (MMSE) (p=0.0004); admission EMS (p=0.005); BI (p<0.001). Women achieved a better functional outcome but a poorer motor outcome on discharge. Female gender was a positive predictor for functional outcome but a negative factor for motor outcome.
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Affiliation(s)
- James Ka Hay Luk
- The University of Hong Kong Division of Geriatrics, Department of Medicine, Queen Mary Hospital, Room 801 Administrative Block, Pokfulam Road, Hong Kong SAR, China.
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Shortridge EF, Marsden PV, Ayanian JZ, Cleary PD. Gender differences in the relationships of cardiovascular symptoms and somatosensory amplification to mortality. RESEARCH IN HUMAN DEVELOPMENT 2009; 6:219-234. [PMID: 21218196 PMCID: PMC3017363 DOI: 10.1080/15427600903281236] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Symptoms of angina and dyspnea predict coronary artery disease and death less well in women than in men. Greater somatosensory amplification - a psychosocial propensity to report symptoms of physical discomfort - may lead women to report relatively high levels of angina and dyspnea for reasons unrelated to coronary disease, reducing their associations with mortality. We assessed this hypothesis in a nationally representative survey of U.S. adults. When stratified by gender, angina and dyspnea significantly predicted mortality among men, but predicted it less well among women. After adjusting for amplification, cardiovascular symptoms did not predict mortality among women, but amplification was positively associated with mortality among older women.
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Affiliation(s)
- Emily F Shortridge
- National Opinion Research Center, University of Chicago (E.F.S.), Chicago, IL; Yale School of Public Health (P.D.C.), New Haven, CT; Department of Sociology, Harvard University (P.V.M.), Cambridge, MA; Division of General Medicine and Primary Care, Brigham and Women's Hospital (J.Z.A.), Boston, MA; and Department of Health Care Policy, Harvard Medical School (J.Z.A.), Boston, MA
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