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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.
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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
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Slow-onset and Fast-onset Symptom Presentations In Acute Coronary Syndrome (ACS): New Perspectives on Prehospital Delay in Patients with ACS. J Emerg Med 2014; 46:507-15. [DOI: 10.1016/j.jemermed.2013.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 03/19/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022]
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Mooney M, McKee G, Fealy G, O' Brien F, O'Donnell S, Moser D. A Randomized Controlled Trial to Reduce Prehospital Delay Time in Patients With Acute Coronary Syndrome (ACS). J Emerg Med 2014; 46:495-506. [DOI: 10.1016/j.jemermed.2013.08.114] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2012] [Revised: 06/12/2013] [Accepted: 08/20/2013] [Indexed: 11/15/2022]
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Mackay MH, Ratner PA, Nguyen M, Percy M, Galdas P, Grunau G. Inconsistent measurement of acute coronary syndrome patients' pre-hospital delay in research: a review of the literature. Eur J Cardiovasc Nurs 2014; 13:483-93. [PMID: 24532675 DOI: 10.1177/1474515114524866] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients' treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research. METHODS AND RESULTS We reviewed the English-language literature from 1998-2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing. CONCLUSION We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.
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Affiliation(s)
- Martha H Mackay
- School of Nursing, University of British Columbia, Canada St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | - Michelle Nguyen
- St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | | | - Gilat Grunau
- School of Nursing, University of British Columbia, Canada
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McKee G, Mooney M, O'Donnell S, O'Brien F, Biddle MJ, Moser DK. Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome. Int J Cardiol 2013; 168:2706-13. [DOI: 10.1016/j.ijcard.2013.03.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 02/01/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
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The chain of survival for ST-segment elevation myocardial infarction: insights into the Middle East. Crit Pathw Cardiol 2013; 12:154-60. [PMID: 23892947 DOI: 10.1097/hpc.0b013e3182901f28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Although coronary heart disease is the leading cause of morbidity and mortality in the Middle East (ME), not much is known about patients with ST-segment elevation myocardial infarction (STEMI) from this region. The STEMI Chain of Survival can be used to target regional improvements in patient care. We tried to adopt a modified chain of survival for STEMI to highlight the challenges and difficulties and the possible solutions to improve the STEMI care in the Middle East based on the few data available.
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Factors Affecting Decision Making in Hispanics Experiencing Myocardial Infarction. J Transcult Nurs 2013; 24:117-26. [DOI: 10.1177/1043659612472062] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
It was estimated that 785,000 new myocardial infarctions (MIs), 470,000 recurrent MIs, and 195,000 silent MIs will occur during 2010 in the United States. Cardiovascular disease, including heart disease and stroke, is the cause of death for 27% of Hispanic males and 31.5% of Hispanic females. There has been an increasing discrepancy between Hispanic knowledge in recognition of MI symptoms compared with non-Hispanic Whites. Only 5.6 % to 27.4 % of Hispanics know all MI symptoms and the need to immediately activate emergency medical services, compared with 11.9% to 45.8% of non-Hispanic Whites. The health belief model is used to explore the factors affecting decision making in Hispanics experiencing MI. Modifying factors explored include acculturation, language spoken, education, socioeconomic status, and access to health care. The results include recommendations for future research and clinical practice to assist in planning targeted interventions in Hispanic populations nationwide.
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A review of interventions aimed at reducing pre-hospital delay time in acute coronary syndrome: what has worked and why? Eur J Cardiovasc Nurs 2012; 11:445-53. [PMID: 21565559 DOI: 10.1016/j.ejcnurse.2011.04.003] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND Delay in seeking treatment for acute coronary syndrome (ACS) symptoms is a well recognised problem. While the factors that influence pre-hospital delay have been well researched, to date this information alone has been insufficient in altering delay behaviour. AIM This paper reports the results of a critical appraisal of previously tested interventions designed to reduce pre-hospital delay in seeking treatment for ACS symptoms. METHODS The search was confined to interventions published between 1986 and the present that were written in English and aimed at reducing pre-hospital delay time. The following databases were searched using keywords: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Pubmed, Academic Search Premier, Ovid, Cochrane, British Nursing Index, and Google Scholar. A total of eight intervention studies were identified as relevant. This review was developed following a systematic comparative analysis of those eight studies. RESULTS Seven of the eight interventions were based on mass media campaigns. One campaign was targeted at individuals. All were aimed at raising ACS symptom awareness and/or increasing prompt action in the presence of symptoms. Only two studies reported a statistically significant reduction in pre-hospital delay time. CONCLUSION In response to concerns about prolonged pre-hospital delay time in ACS, interventions targeting the problem have been developed. The literature indicates that responses to symptoms depend on a variety of factors. In light of this, interventions should include the scope of factors that can potentially influence pre-hospital delay time and ideally target those who are at greatest risk of an ACS event.
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Gentil L, Vanasse A, Xhignesse M, Courteau J, Bérubé S. [The ambulatory care of the acute myocardial infarction in Quebec: description, classification and typology]. Ann Cardiol Angeiol (Paris) 2011; 60:183-188. [PMID: 21658674 DOI: 10.1016/j.ancard.2011.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Accepted: 04/18/2011] [Indexed: 05/30/2023]
Abstract
OBJECTIVE Description of ambulatory care of AMI, in Quebec population. DESIGN A retrospective cohort study was designed to classify and propose a typology of ambulatory care. METHODS The studied population was included in all 25 years and older inpatients residing in Quebec, whose admission were from January to December 2000. The principal variables were: the number of medical visits, the type of consulted physicians and the place of consultation. The secondary variables were: age, sex and the presence of a revascularization. RESULTS A typology of ambulatory care was created from principal variables. Men, younger patients and receiving a revascularization in the index hospitalization were cared for by a specialist.
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Affiliation(s)
- L Gentil
- Département de santé communautaire, centre de recherche Étienne-Lebel, université de Sherbrooke, QC, Canada.
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Gravely S, Tamim H, Smith J, Daly T, Grace SL. Non-symptom-related factors contributing to delay in seeking medical care by patients with heart failure: a narrative review. J Card Fail 2011; 17:779-87. [PMID: 21872149 DOI: 10.1016/j.cardfail.2011.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 05/03/2011] [Accepted: 05/05/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Delay in seeking timely medical care by patients with acute coronary syndrome and stroke has been well established in the literature, but less is known about delay in care-seeking behavior by patients with heart failure (HF). The purpose of this narrative review was to synthesize the literature regarding non-symptom-related factors that contribute to delay in seeking medical care for HF symptoms. METHODS AND RESULTS A literature search of Scopus, Medline, and Pubmed was conducted for published articles from database inception to July 2009. Available evidence has shown that non-symptom-related factors, such as HF severity, HF history, age, and ethnocultural background, were related to delay in certain studies; however, null results have also been reported. Other non-symptom-related factors, such as male gender, initial contact with a primary care physician, arriving in the emergency department by means other than ambulance, and patient responses such as self-care, low anxiety, and hopelessness, may play a role in longer delay. CONCLUSIONS Although this review identified several non-symptom-related factors that may be implicated in care-seeking delay, health care professionals should be vigilant in identifying all high-risk individuals and educating them about warning signs of HF. Moreover, access to outpatient chronic disease management programs that may have potential to reduce care-seeking delay behavior should be explored.
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Herlitz J, Wireklintsundström B, Bång A, Berglund A, Svensson L, Blomstrand C. Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities. Scand J Trauma Resusc Emerg Med 2010; 18:48. [PMID: 20815939 PMCID: PMC2944143 DOI: 10.1186/1757-7241-18-48] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2010] [Accepted: 09/06/2010] [Indexed: 12/20/2022] Open
Abstract
Background The two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase. Method A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases. Results In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women). With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke. Conclusion Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.
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Affiliation(s)
- Johan Herlitz
- Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden.
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Khraim FM, Carey MG. Predictors of pre-hospital delay among patients with acute myocardial infarction. PATIENT EDUCATION AND COUNSELING 2009; 75:155-161. [PMID: 19036551 DOI: 10.1016/j.pec.2008.09.019] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2008] [Revised: 09/11/2008] [Accepted: 09/17/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To evaluate current literature on predictors of pre-hospital delay among patients with acute myocardial infarction (AMI). METHODS Medline, CINHAL, and Psych Info databases were searched using keywords: attitude to illness/health, health beliefs, help/health seeking behavior, health behavior, psychosocial factors, treatment delay, socioeconomic factors, time factors, pre-hospital delay, and symptoms. These keywords were combined with AMI to identify literature published during 1995-2008. RESULTS Twenty-six data-based research articles were identified. Delay varied across literature and median pre-hospital delay was often reported due to distribution skewness resulting from extremely prolonged values (1.5-15.2h). Six categories of predictors influenced pre-hospital delay; socio-demographic, symptom onset context, cognitive, affective/psychological, behavioral, and clinical factors. Pre-hospital delay was shortest when the decision to seek healthcare was facilitated by family members or coworkers and when symptoms suggestive of heart attack were continuous and severe. CONCLUSION AND PRACTICE IMPLICATIONS Developing interventions programs to reduce pre-hospital delay for high-risk patients is warranted. Because decision delay is the only modifiable part by intervention, it is recommended that future investigations and interventions attend to decision time as the primary variable of interest instead of combining it with transportation time. Moreover, content of patient education need to emphasize on symptom awareness and recognition, and prompt and proper patient actions for optimum results. Also, in order to eliminate sampling bias resulting from investigating surviving AMI patients, it is recommended that future studies incorporate data from both surviving and surrogates of non-surviving AMI patients.
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Affiliation(s)
- Fadi M Khraim
- School of Nursing, The State University of New York at Buffalo, United States.
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