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Mao Y, Shi Y, Qiao W, Zhang Z, Yang W, Liu H, Li E, Fan H, Liu Q. Symptom clusters and unplanned hospital readmission in Chinese patients with acute myocardial infarction on admission. Front Cardiovasc Med 2024; 11:1388648. [PMID: 38832319 PMCID: PMC11144855 DOI: 10.3389/fcvm.2024.1388648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 05/06/2024] [Indexed: 06/05/2024] Open
Abstract
Backgroud Acute myocardial infarction (AMI) has a high morbidity rate, high mortality rate, high readmission rate, high health care costs, and a high symptomatic, psychological, and economic burden on patients. Patients with AMI usually present with multiple symptoms simultaneously, which are manifested as symptom clusters. Symptom clusters have a profound impact on the quality of survival and clinical outcomes of AMI patients. Objective The purpose of this study was to analyze unplanned hospital readmissions among cluster groups within a 1-year follow-up period, as well as to identify clusters of acute symptoms and the characteristics associated with them that appeared in patients with AMI. Methods Between October 2021 and October 2022, 261 AMI patients in China were individually questioned for symptoms using a structured questionnaire. Mplus 8.3 software was used to conduct latent class analysis in order to find symptom clusters. Univariate analysis is used to examine characteristics associated with each cluster, and multinomial logistic regression is used to analyze a cluster membership as an independent predictor of hospital readmission after 1-year. Results Three unique clusters were found among the 11 acute symptoms: the typical chest symptom cluster (64.4%), the multiple symptom cluster (29.5%), and the atypical symptom cluster (6.1%). The cluster of atypical symptoms was more likely to have anemia and the worse values of Killip class compared with other clusters. The results of multiple logistic regression indicated that, in comparison to the typical chest cluster, the atypical symptom cluster substantially predicted a greater probability of 1-year hospital readmission (odd ratio 8.303, 95% confidence interval 2.550-27.031, P < 0.001). Conclusion Out of the 11 acute symptoms, we have found three clusters: the typical chest symptom, multiple symptom, and atypical symptom clusters. Compared to patients in the other two clusters, those in the atypical symptom cluster-which included anemia and a large percentage of Killip class patients-had worse clinical indicators at hospital readmission during the duration of the 1-year follow-up. Both anemia and high Killip classification suggest that the patient's clinical presentation is poor and therefore the prognosis is worse. Intensive treatment should be considered for anemia and high level of Killip class patients with atypical presentation. Clinicians should focus on patients with atypical symptom clusters, enhance early recognition of symptoms, and develop targeted symptom management strategies to alleviate their discomfort in order to improve symptomatic outcomes.
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Affiliation(s)
- Yijun Mao
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Yuqiong Shi
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Wenfang Qiao
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Zhuo Zhang
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Wei Yang
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Haili Liu
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Erqing Li
- Department of Cardiology, Xianyang Central Hospital, Shaanxi, China
| | - Hui Fan
- Department of Nursing, Xianyang Central Hospital, Shaanxi, China
| | - Qiang Liu
- Department of Orthopedic, Xianyang Central Hospital, Shaanxi, China
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Wang S, Song J, Lee C, Jiang J, Wang M, Liu D, Wang Z, Yuan Y, Li W, Zhou R, Zheng H, Wei J, Hu Y, Wu T, Tian Z, Chen H. Gender disparities in the mediating role of symptom knowledge level in reducing acute coronary syndrome (ACS) decision delay: Findings from a community-based study in China. BMC Emerg Med 2023; 23:146. [PMID: 38104084 PMCID: PMC10725594 DOI: 10.1186/s12873-023-00916-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Accepted: 12/07/2023] [Indexed: 12/19/2023] Open
Abstract
BACKGROUND Implementing training programs to educate patients on the prodromal symptoms of acute coronary syndrome (ACS) may assist patients in accurately recognizing these symptoms, and ultimately decrease their time delay in seeking emergency medical services (EMS). However, the effectiveness of this approach remains uncertain, particularly among the Chinese population. METHODS A cross-sectional study was conducted within 22 communities in Beijing, China between 2015 and 2018, with a total of 1099 participants recruited. The study utilized a standardized questionnaire to evaluate the presence of intentional decision delay in turning to EMS under a hypothetical chest pain, the participants' knowledge of ACS prodromal symptoms, and whether they had ever received any training programs aimed at increasing their symptom knowledge. Mediation analysis was performed with regression models and bootstrapping methods, and gender difference was further analyzed through moderated mediation analysis. RESULTS A total of 1099 participants (58.2% female, median [IQR] age 34 [20]) were included in the study. The results of the mediation analysis indicated that training programs were associated with a decrease risk in decision delay, with increased knowledge playing a mediating role (mediation effect/total effect = 36.59%, P < 0.0001). Gender modified this mediation effect, with it being observed only in the male group. Specifically, training programs were not found to significantly decrease decision delay among females (P > 0.05), even though they did improve women's knowledge of ACS prodromal symptoms (β = 0.57, P = 0.012). CONCLUSION The results suggested a relationship between prior training programs and reduced decision delay, with increased knowledge of prodromal symptoms of ACS serving as a mediator. However, the effect was only observed in male participants and not in female participants. This highlights the notion that mere transfer of knowledge regarding ACS prodromal symptoms may not be sufficient to mitigate decision delay in the female population. Further research is needed to corroborate these results and to gain deeper insights into the gender-specific barriers encountered in this study.
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Affiliation(s)
- Siyue Wang
- Peking University Health Science Center, Beijing, China
| | - Junxian Song
- Center for Cardiovascular Translational Research, Peking University People's Hospital Beijing, Beijing, China
| | - Chongyou Lee
- Center for Cardiovascular Translational Research, Peking University People's Hospital Beijing, Beijing, China
| | - Jin Jiang
- Peking University Health Science Center, Beijing, China
| | - Mengying Wang
- Peking University Health Science Center, Beijing, China
| | - Dongjing Liu
- Peking University Health Science Center, Beijing, China
| | - Zhuqing Wang
- Peking University Health Science Center, Beijing, China
| | - Yuan Yuan
- Peking University Health Science Center, Beijing, China
| | - Wenyong Li
- Peking University Health Science Center, Beijing, China
| | - Ren Zhou
- Peking University Health Science Center, Beijing, China
| | | | - Jianmin Wei
- Beijing Red Cross Emergency Rescue Center, Beijing, China
| | - Yonghua Hu
- Peking University Health Science Center, Beijing, China.
| | - Tao Wu
- Peking University Health Science Center, Beijing, China.
- Institute of Reproductive and Child Health/Key Laboratory of Reproductive Health, National Health Commission of the People's Republic of China, Beijing, China.
| | - Zhenbiao Tian
- Beijing Red Cross Emergency Rescue Center, Beijing, China
| | - Hong Chen
- Center for Cardiovascular Translational Research, Peking University People's Hospital Beijing, Beijing, China
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Blakeman JR, Prasun MA, Kim M. Predictors of acute coronary syndrome symptom knowledge, attitudes, and beliefs in adults without self-reported heart disease. Heart Lung 2023; 60:102-107. [PMID: 36947932 DOI: 10.1016/j.hrtlng.2023.03.006] [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: 12/14/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND The time of symptom onset to the time an individual decides to seek care is the most significant contributor to total treatment delay. OBJECTIVES To explore predictors of ACS symptom knowledge, attitudes, and beliefs in adults without diagnosed heart disease. METHODS We used a cross-sectional, descriptive, and correlational design, employing an online survey including the ACS Response Index and the avoidance subscale of the Coping Strategy Indicator. We leveraged social media platforms and a university email list-serv to enroll participants. Stepwise hierarchical linear regressions were used. RESULTS We analyzed responses from 981 participants, with a mean age of 35.2 years (SD 16.5) and 75% female. The regression analyses yielded models that explained 14%, 23%, and 25% of the variance for knowledge, beliefs, and attitudes, respectively. Ethnicity, race, exposure to ACS symptom information (in the media or by teaching), and perceived health were the predictors of ACS symptom knowledge, attitudes, and beliefs with the largest effect, though others were statistically significant. CONCLUSIONS The findings underscore the importance of community education to raise awareness of ACS symptoms while considering social determinants of health. Future research and clinician interventions for ACS symptom knowledge, attitudes and beliefs should be expanded with a focus on ethnicity and gender.
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Affiliation(s)
- John R Blakeman
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790-5810, USA.
| | - Marilyn A Prasun
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790-5810, USA
| | - MyoungJin Kim
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790-5810, USA
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Asghari E, Gholizadeh L, Kazami L, Taban Sadeghi M, Separham A, Khezerloy-aghdam N. Symptom recognition and treatment-seeking behaviors in women experiencing acute coronary syndrome for the first time: a qualitative study. BMC Cardiovasc Disord 2022; 22:508. [PMID: 36443668 PMCID: PMC9703419 DOI: 10.1186/s12872-022-02892-3] [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: 12/20/2021] [Accepted: 10/10/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Women are more likely to delay medical help-seeking for ACS symptoms. Understanding patients' experience of the symptoms and their response is essential in improving help-seeking behaviors and timely diagnosis and treatment for ACS. This study aimed to explore women's experience of ACS, their response to the symptoms, and treatment-seeking decisions. METHODS This qualitative descriptive study was conducted in a tertiary referral specialized heart hospital affiliated with Tabriz University of Medical Sciences, Iran. Participants included 39 women who had experienced ACS for the first time. RESULTS Four main themes emerged from the analysis of interview transcripts: (1) the onset of symptoms, (2) the types of symptoms, (3) response to symptoms and (4) arriving at the hospital. These themes and associated sub-themes explained women's experience of ACS symptoms, their response to the symptoms, and decision to seek medical help. CONCLUSIONS This study identified and discussed factors contributing to the prehospital delay in women and their decision-making to seek medical care for ACS symptoms. The results are consistent with previous research indicating that ACS symptoms in women are somewhat different from men, and women tend to underestimate their symptoms and attribute them to non-cardiac causes. Women should be supported to develop awareness and understanding of ACS symptoms and appreciate the importance of early treatment-seeking in the disease outcomes.
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Affiliation(s)
- Elnaz Asghari
- grid.412888.f0000 0001 2174 8913Faculty of Nursing and Midwifery, Tabriz University of Medical Science, South Shariati St., Tabriz, 51368 East Azerbaijan Iran
| | - Leila Gholizadeh
- grid.117476.20000 0004 1936 7611Faculty of Health, University of Technology Sydney, 15 Broadway, Sydney, NSW 2007 Australia
| | - Leila Kazami
- grid.412888.f0000 0001 2174 8913Shahid Madani Hospital, Tabriz University of Medical Science, Tabriz, Iran
| | - Mohammadreza Taban Sadeghi
- grid.412888.f0000 0001 2174 8913Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Ahmad Separham
- grid.412888.f0000 0001 2174 8913Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
| | - Naser Khezerloy-aghdam
- grid.412888.f0000 0001 2174 8913Cardiovascular Research Center, Tabriz University of Medical Science, Tabriz, Iran
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Xiang L, Yoon S, Low AHL, Leung YY, Fong W, Lau TC, Koh DR, Thumboo J. Approaches to improving symptom appraisal: a systematic literature review. BMJ Open 2022; 12:e064521. [PMID: 35998970 PMCID: PMC9403152 DOI: 10.1136/bmjopen-2022-064521] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Accepted: 07/11/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Poor symptom appraisal (detection, interpretation and response to symptoms) plays a major role in prolonged prediagnosis interval in various health conditions. Theories and models have been proposed to study the symptom appraisal process but how they could be employed to improve symptom appraisal remains unclear. We therefore aimed to review approaches to improving symptom appraisal in the literature and to develop a theoretical framework that could guide the development of approaches to improving symptom appraisal among individuals in the general population. DESIGN Systematic review. DATA SOURCES Medline, Web of Science, PsycINFO, Embase, CINAHL and Scopus were searched from inception to 30 March 2021. ELIGIBILITY CRITERIA We included original articles in English in which approaches to improve the detection, interpretation or response to symptoms for symptomatic individuals were described. We excluded articles in which approaches were developed to improve symptom appraisal among healthcare professionals. DATA EXTRACTION AND SYNTHESIS A predefined data extraction form was used to extract the development, characteristics and evaluation of approaches to improving symptom appraisal. This formed the basis for the narrative synthesis. RESULTS Of 19 046 publications identified from the literature search, 112 were selected for full-text review and 29 approaches comprising provision of knowledge of symptoms/signs and additional components (eg, symptom self-examination and comparison) for symptom appraisal were included in the synthesis. Less than half (41.4%) of these approaches were developed based on theories/models. Interestingly, despite the variety of theories/models adopted in developing these approaches, the components of these approaches were similar. CONCLUSION Symptom appraisal is an essential process in a patient's journey that can be targeted to facilitate early diagnosis but is largely unstudied. Building on the literature, we proposed a theoretical framework and approaches to improving symptom appraisal. This could facilitate early identification of a variety of health conditions in the general population. TRIAL REGISTRATION NUMBER CRD42021279500.
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Affiliation(s)
- Ling Xiang
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Sungwon Yoon
- Health Services and Systems Research, Duke-NUS Medical School, Singapore
| | - Andrea H L Low
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Warren Fong
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Duke-NUS Medical School, Singapore
| | - Tang Ching Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore
| | - Dow Rhoon Koh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Medicine, National University Hospital, Singapore
| | - Julian Thumboo
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Duke-NUS Medical School, Singapore
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