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Hussain MM, Baharuddin KA, Fauzi MH, Abu Bakar MA, Ziyan A, Ahmed AZ, Sunil M. Factors associated with prehospital delay in acute myocardial infarction in Maldives. Int J Emerg Med 2023; 16:31. [PMID: 37122000 PMCID: PMC10149151 DOI: 10.1186/s12245-023-00503-2] [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: 01/20/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is the top cause of death in Maldives. Our study aims to determine the prehospital delay and its associated factors in AMI patients in Maldives. METHODS A cross-sectional study was conducted with 127 patients, divided into early (≤ 6 h) and delayed (> 6 h) presenters to the hospital. The data collection for the study was carried out by interviewing AMI patients, focusing on their socio-demographic characteristics, coronary artery disease risk factors, clinical symptoms, situational factors, and behavioral and cognitive responses to symptoms. RESULTS The median onset-to-door time was 230 (IQR 420) minutes. The mean age of AMI patients was 50.9 (SD ± 12.9) years old, and 39.4% of them had delayed presentation to the hospital. Smokers (adj OR = 0.3; 95% CI: 0.1, 0.9; P = 0.047) and those with previous episodes of chest pain or AMI (adj OR = 0.2; 95% CI: 0.03, 0.91; P = 0.038) were significant factors for early presentation to the hospital, while denial of symptoms (adj OR = 29.3; 95% CI: 1.6, 547.2; P = 0.024) and lack of knowledge (adj OR = 7.2; 95% CI: 1.77, 29.43; P = 0.006) led to a delayed decision to seek treatment. Situational factors such as onset at the workplace (adj OR = 5.8; 95% CI: 1.24, 26.83; P = 0.025) had lower odds of delay, whereas referral cases (adj OR = 7.7; 95% CI: 1.9, 30.94; P = 0.004) and use of sea ambulance (adj OR = 11.1; 95% CI: 2.8, 43.8; P = 0.001) were prone to delay in presentation to the hospital. CONCLUSION Sea ambulance, referral cases, lack of knowledge, and denial of symptoms are significant factors associated with prehospital delay among patients with AMI. Public awareness about the benefits of early presentation and improvement of the means of transportation between islands is suggested to improve emergency cardiac care in the country.
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Affiliation(s)
- Madheeh Mohamed Hussain
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Kamarul Aryffin Baharuddin
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Mohd Hashairi Fauzi
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Mimi Azliha Abu Bakar
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Ahmed Ziyan
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Aminath Zeyba Ahmed
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Mohamed Sunil
- National Cardiac Centre, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
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Jin BT, Palleti R, Shi S, Ng AY, Quinn JV, Rajpurkar P, Kim D. Transfer learning enables prediction of myocardial injury from continuous single-lead electrocardiography. J Am Med Inform Assoc 2022; 29:1908-1918. [PMID: 35994003 PMCID: PMC9552286 DOI: 10.1093/jamia/ocac135] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 07/26/2022] [Accepted: 08/03/2022] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Chest pain is common, and current risk-stratification methods, requiring 12-lead electrocardiograms (ECGs) and serial biomarker assays, are static and restricted to highly resourced settings. Our objective was to predict myocardial injury using continuous single-lead ECG waveforms similar to those obtained from wearable devices and to evaluate the potential of transfer learning from labeled 12-lead ECGs to improve these predictions. METHODS We studied 10 874 Emergency Department (ED) patients who received continuous ECG monitoring and troponin testing from 2020 to 2021. We defined myocardial injury as newly elevated troponin in patients with chest pain or shortness of breath. We developed deep learning models of myocardial injury using continuous lead II ECG from bedside monitors as well as conventional 12-lead ECGs from triage. We pretrained single-lead models on a pre-existing corpus of labeled 12-lead ECGs. We compared model predictions to those of ED physicians. RESULTS A transfer learning strategy, whereby models for continuous single-lead ECGs were first pretrained on 12-lead ECGs from a separate cohort, predicted myocardial injury as accurately as models using patients' own 12-lead ECGs: area under the receiver operating characteristic curve 0.760 (95% confidence interval [CI], 0.721-0.799) and area under the precision-recall curve 0.321 (95% CI, 0.251-0.397). Models demonstrated a high negative predictive value for myocardial injury among patients with chest pain or shortness of breath, exceeding the predictive performance of ED physicians, while attending to known stigmata of myocardial injury. CONCLUSIONS Deep learning models pretrained on labeled 12-lead ECGs can predict myocardial injury from noisy, continuous monitor data early in a patient's presentation. The utility of continuous single-lead ECG in the risk stratification of chest pain has implications for wearable devices and preclinical settings, where external validation of the approach is needed.
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Affiliation(s)
- Boyang Tom Jin
- Department of Computer Science, Stanford University, Palo Alto, California, USA
| | - Raj Palleti
- Department of Computer Science, Stanford University, Palo Alto, California, USA
| | - Siyu Shi
- Department of Medicine, Stanford University, Palo Alto, California, USA
| | - Andrew Y Ng
- Department of Computer Science, Stanford University, Palo Alto, California, USA
| | - James V Quinn
- Department of Emergency Medicine, Stanford University, Palo Alto, California, USA
| | - Pranav Rajpurkar
- Department of Biomedical Informatics, Harvard University, Boston, Massachusetts, USA
| | - David Kim
- Department of Emergency Medicine, Stanford University, Palo Alto, California, USA
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Wang F, Zhang Z. Effect of seamless and coherent nursing mode before and after emergency treatment on nursing treatment of patients with acute chest pain. Minerva Med 2022; 113:902-904. [PMID: 32407055 DOI: 10.23736/s0026-4806.20.06624-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Affiliation(s)
- Fang Wang
- Department of Emergency, The First People's Hospital of Lianyungang, Lianyungang, Jiangsu, China
| | - Zhaoxia Zhang
- Department of Nursing, Tongchuan People's Hospital, Tongchuan, Shaanxi, China -
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Dawson LP, Smith K, Cullen L, Nehme Z, Lefkovits J, Taylor AJ, Stub D. Care Models for Acute Chest Pain That Improve Outcomes and Efficiency. J Am Coll Cardiol 2022; 79:2333-2348. [DOI: 10.1016/j.jacc.2022.03.380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/30/2022] [Accepted: 03/30/2022] [Indexed: 10/18/2022]
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Hayajneh AA, Rababa M, Al-Rawashedeh S. Time to Seek Care and Hospital Length of Stay Among Older Adults With Acute Coronary Syndrome During the COVID-19 Pandemic. Clin Nurs Res 2021; 31:364-375. [PMID: 34412541 DOI: 10.1177/10547738211040167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The prevalence of prehospital delay is high among older adults with acute coronary syndrome (ACS). The current study aimed to examine the associated factors of prehospital delay among patients with ACS during the COVID-19 pandemic. This cross-sectional study was conducted on a convenience sample of 300 older adults with ACS admitted to the emergency department in Jordan. Data were collected from June 1 to September 1, 2020. Bivariate and multivariate analyses were used to explore the predictors of prehospital delay. Being widowed, educational level, pain intensity, the gradual onset of ACS symptoms, symptoms lasting for more than 30 minutes, patients' feeling anxious about their ACS symptoms, patients' perceiving their symptoms to be particularly dangerous, history of myocardial infarction (MI), and mode of transportation were associated with the time taken before seeking emergency care. Significant predictors of time to seek help were chief complaint of chest pain or palpitations, abrupt onset of symptoms, the associated symptom of vertigo, and a higher number of chronic illnesses; they explained about 17.9% of the variance in the time to seek care. The average time to seek care among patients with ACS during the COVID-19 pandemic was found to be longer than the average time reported by studies conducted prior the pandemic. Improved understanding of the associations between prehospital delay is crucial for optimal ACS patient outcomes under the impacts of the COVID-19 pandemic.
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Affiliation(s)
- Audai A Hayajneh
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Mohammad Rababa
- Adult Health Nursing Department, Faculty of Nursing, Jordan University of Science and Technology, Irbid, Jordan
| | - Sami Al-Rawashedeh
- Department of Community and Mental Health, Faculty of Nursing, The Hashemite University, Zarqa, Jordan
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Alghamdi A, Howard L, Reynard C, Moss P, Jarman H, Mackway-Jones K, Carley S, Body R. Enhanced triage for patients with suspected cardiac chest pain: the History and Electrocardiogram-only Manchester Acute Coronary Syndromes decision aid. Eur J Emerg Med 2020; 26:356-361. [PMID: 30289775 PMCID: PMC6728057 DOI: 10.1097/mej.0000000000000575] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Supplemental Digital Content is available in the text. Several decision aids can ‘rule in’ and ‘rule out’ acute coronary syndromes (ACS) in the Emergency Department (ED) but all require measurement of blood biomarkers. A decision aid that does not require biomarker measurement could enhance risk stratification at triage and could be used in the prehospital environment. We aimed to derive and validate the History and ECG-only Manchester ACS (HE-MACS) decision aid using only the history, physical examination and ECG.
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Affiliation(s)
- Abdulrhman Alghamdi
- Cardioavascular Science Research Group, Division of Cardiovascular Sciences, The University of Manchester.,Emergency Medical Services Department, College of Applied Medical Sciences, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Laura Howard
- Postgraduate Medical School, Manchester Metropolitan University
| | - Charles Reynard
- Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Philip Moss
- Emergency Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Heather Jarman
- Emergency Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Kevin Mackway-Jones
- Postgraduate Medical School, Manchester Metropolitan University.,Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Simon Carley
- Postgraduate Medical School, Manchester Metropolitan University.,Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
| | - Richard Body
- Cardioavascular Science Research Group, Division of Cardiovascular Sciences, The University of Manchester.,Postgraduate Medical School, Manchester Metropolitan University.,Emergency Department, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester
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Abstract
Introduction: Incidence of chest pain and discomfort varies in general population between 2 % and 5 %. Total prehospital delay involves two components: the time it takes for patients to recognise their symptoms as severe and seek medical attention, ie the decision-making time, and the time from seeking help to hospital admission, ie the transport time. Scope of the study was to analyse time loss in patients with chest pain hesitating to contact healthcare services, as well as distribution of acute myocardial infarction (AMI) and angina pectoris (AP) among them. Methods: Retrospective analysis of medical records of physicians working at the emergency medical services (EMS) Department of the City of Belgrade, Serbia, from 20 April 2006 to 22 July 2013 on a total of 5,310 completed field interventions. When placing a call to the EMS, 10.43 % of patients cited chest pain as a major symptom. After deducting all those ones who denied having the symptom on examination thereafter and those for whom there were no data, 349 patients remained, ie 6.57 % of the total number of calls available for analysis. Results: The average time between the onset of chest pain and the decision to call the EMS was 11.97 h, median 2 h and mode 1 h. Patient's minimum prehospital delay was 2 min and the maximum was 20 days. Most patients who experienced chest pain or discomfort waited less than an hour before calling the EMS. Most commonly diagnoses made for a symptom of chest pain were AMI and AP, ie AMI with 12.32 % of the total diagnoses, as well as the elevated arterial pressure. There were more female patients, with no difference found among the age groups. Conclusion: For the majority of patients with chest pain and discomfort presented in this paper the decision-making time was up to one hour, with cardiovascular causes being the at the top of the list.
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Lim SC, Rahman A, Yaacob NM. Pre-Hospital Factors Influencing Time of Arrival at Emergency Departments for Patients with Acute ST-Elevation Myocardial Infarction. Malays J Med Sci 2019; 26:87-98. [PMID: 30914896 PMCID: PMC6419865 DOI: 10.21315/mjms2019.26.1.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 12/26/2018] [Indexed: 11/21/2022] Open
Abstract
Background Pre-hospital delay is currently a major factor limiting early reperfusion among ST-elevation myocardial infarction (STEMI) patients worldwide. This study aims to determine pre-hospital factors affecting symptom-to-door time among STEMI patients in Malaysia. Methods This cross-sectional study included 222 STEMI patients admitted to two tertiary hospitals in Malaysia. By determining symptom-to-door time, the study population was categorised into two definitive treatment seeking groups: early (≤ 3 h) and delayed (> 3 h). Data was collected focusing on socio-demographical data, risk factors and comorbidities, clinical presentation, situational factors and action taken by patients. Results The mean age of our patients was 58.0 (SD = 11.9) years old, and the population consisted of 186 (83.8%) males and 36 (16.2%) females. Our study found that the median symptom-to-door time was 130.5 (IQR 240) min, with 64% of subjects arriving early and 36% arriving late. Pre-hospital delays were found to be significant among females (adj OR = 2.42; 95% CI: 1.02, 5.76; P = 0.046), patients with recurrence of similar clinical presentations (adj OR = 2.74; 95% CI: 1.37, 5.46; P = 0.004), patients experiencing atypical symptoms (adj OR = 2.64; 95% CI: 1.11, 6.31; P = 0.029) and patients who chose to have their first medical contact (FMC) for their symptoms with a general practitioner (adj OR = 2.80; 95% CI: 1.20, 6.56; P = 0.018). However, patients with hyperlipidaemia (adj OR = 0.46; 95% CI: 0.23, 0.93; P = 0.030), self-perceived cardiac symptoms (adj OR = 0.36; 95% CI: 0.17, 0.73; P = 0.005) and symptoms that began in public places (adj OR = 0.21; 95% CI: 0.06, 0.69; P = 0.010) tended to seek treatment earlier. Conclusion The symptom-to-door time among the Malaysian population is shorter in comparison to other developing countries. Nevertheless, identified, modifiable pre-hospital factors can be addressed to further shorten symptom-to-door time among STEMI patients.
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Affiliation(s)
- See Choo Lim
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan
| | - Andey Rahman
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan
| | - Najib Majdi Yaacob
- Unit of Biostatistics and Research Methodology, School of Medical Sciences, Universiti Sains Malaysia, 16150 Kubang Kerian, Kelantan
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