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Jin J, Yang H, Guo Z, L V X, Jiang X, Ding C. Relationships of illness perception, symptoms response and social support with acute myocardial infarction patients' prehospital delay in rural China: protocol for a cross-sectional study. BMJ Open 2023; 13:e073010. [PMID: 37438062 DOI: 10.1136/bmjopen-2023-073010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION The timely treatment of acute myocardial infarction (AMI) patients is of utmost importance, and yet, there remains a significant disparity between urban and rural areas in China due to the unequal distribution of medical resources. The manifestation of symptoms and psychosocial factors play a crucial role in shaping medical decisions for AMI patients. It is well established that minimising prehospital delay (PHD) is crucial for the successful implementation of recanalisation therapy and reducing mortality in out-of-hospital settings. However, there remains a paucity of studies investigating the correlation between illness perception, symptom response, social support, and PHD in AMI patients. AIM The aim of this study was to analyse the relationship pathways between symptom response, illness perception, social support and PHD time in patients with AMI in rural areas of China. METHODS A primary care-based cross-sectional study was designed to investigate the inpatients initially diagnosed with AMI in the emergency department of three tertiary care hospitals in three counties in northern Zhejiang Province by convenience sampling method from January 2023 to December 2023. A minimum of 286 patients will be enrolled (voluntary response sample). Each participant will complete a paper-based questionnaire to gather research outcomes. Statistical analyses will be performed using logistic regression and structural equation model with PHD as main outcome parameter. DISCUSSION This is the first study of the factors influencing PHD in AMI in rural China using structural equation model. Our study will address this gap in the available research. The implementation and findings of this study may provide a reliable basis for reducing PHD in AMI patients in rural areas and establish a relevant theoretical foundation for the implementation of targeted interventions and risk prevention measures in primary care hospitals.
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Affiliation(s)
- Jingfen Jin
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
| | - Haifeng Yang
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
| | - Zhiting Guo
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Xuebing L V
- Department of Emergency, Changxing County People's Hospital, Changxing, China
| | - Xiuju Jiang
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
| | - Chuanqi Ding
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
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Shahmohamadi E, Sedaghat M, Rahmani A, Larti F, Geraiely B. "Recognition of heart attack symptoms and treatment-seeking behaviors: a multi-center survey in Tehran, Iran". BMC Public Health 2023; 23:875. [PMID: 37173689 PMCID: PMC10176795 DOI: 10.1186/s12889-023-15826-1] [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: 09/15/2022] [Accepted: 05/05/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND In acute myocardial infarction (AMI), timely recognition of symptoms and early hospital presentation positively affect patient morbidity and mortality. Due to the high burden of ischemic heart disease in Iran, this study aimed to identify factors affecting the level of knowledge, responses at the time of AMI onset, and sources of health information among the Iranian population. METHOD This cross-sectional study was conducted in three tertiary hospitals in Tehran, Iran. An expert-validated questionnaire was used to obtain data. A total of 400 individuals were enrolled. RESULT Among the respondents, 285 people(71.3%) considered "chest pain or discomfort," and 251 (62.7%) regarded "pain or discomfort in the arm or shoulder" as MI symptoms. Approximately 288 (72.0%) respondents had poor knowledge of the AMI symptoms. Knowledge of symptoms was higher among those with higher levels of education, those with medical-associated jobs, and those who resided in the capital areas. Major risk factors identified by the participants were: anxiety (340)(85.0%), obesity (327)(81.8%), an unhealthy diet (325)(81.3%), and the presence of high LDL levels (258)(64.5%) and Diabetes Mellitus (164)(41.0%) were less appreciated. Calling an ambulance (286)(71.5%) was the most common treatment-seeking behavior in the case of a suspected heart attack. CONCLUSION It is vital to educate the general population about AMI symptoms, particularly those with comorbidities at the greatest risk for an AMI episode.
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Affiliation(s)
- Elnaz Shahmohamadi
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Mojtaba Sedaghat
- Department of Community Medicine, Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Arash Rahmani
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Farnoosh Larti
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, 1419733141, Iran
| | - Babak Geraiely
- Department of Cardiology, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, 1419733141, Iran.
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Cao J, Sun P, Zhang L, Chen X, Gui W, Ou A, Chen K, Ma L. Effects of acceptance and commitment therapy on self-management skills and psychological resilience of young and middle-aged patients underwent percutaneous transluminal coronary intervention for primary myocardial infarction: a pilot study. Trials 2022; 23:32. [PMID: 35022058 PMCID: PMC8756672 DOI: 10.1186/s13063-021-05923-0] [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: 04/21/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Background Acceptance and commitment therapy (ACT) is an intervention focusing on altering how patients relate to their thoughts. This study aimed to investigate the effects of ACT on self-management ability and psychological resilience of young and middle-aged patients undergoing percutaneous transluminal coronary intervention (PCI) for primary myocardial infarction (MI). Methods This pilot study included 98 young and middle-aged patients who underwent PCI for primary MI using a convenient sampling method. The patients were divided into a control group and an ACT group using the random number table method. The patients in the control group received routine nursing, while those in the ACT group received routine nursing combined with ACT. Results The psychological resilience and self-management ability scores were significantly higher in the ACT group than in the control group 3 months after the intervention (P < 0.001 and < 0.05, respectively). In addition, compared to the baseline scores of psychological resilience and self-management ability, these scores were significantly higher in the ACT group at 3 months post-intervention (P < 0.001 and < 0.05, respectively). Conclusion ACT could enhance the psychological resilience and self-efficacy and improve the self-management ability of young and middle-aged patients who underwent PCI for primary MI. Trial registration China Clinical Trial Center ChiCTR2000029775. Registered on 13 February 2020. Registration title:Study on the popularization and application of rotational atherectomy for the treatment of severely calcified coronary lesions.
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Affiliation(s)
- Jiaoyu Cao
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Panpan Sun
- Department of Cardiovascular Surgery, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Lixiang Zhang
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Xia Chen
- Department of Nursing, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Wenjuan Gui
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Anping Ou
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Kaibing Chen
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China
| | - Likun Ma
- Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China (Anhui Provincial Hospital), Hefei, China.
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Zhou T, Li X, Lu Y, Murugiah K, Bai X, Hu S, Gao Y, Masoudi FA, Krumholz HM, Li J. Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015. Open Heart 2021; 8:openhrt-2021-001666. [PMID: 34599073 PMCID: PMC8488733 DOI: 10.1136/openhrt-2021-001666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Access to acute cardiovascular care has improved and health services capacity has increased over the past decades. We assessed national changes in (1) patient characteristics, (2) in-hospital management and (3) patient outcomes among patients presenting with ST segment elevation myocardial infarction (STEMI) in 2011–2015 in China. Methods In a nationally representative sample of hospitals in China, we created two random cohorts of patients in 2011 and 2015 separately. We weighted our findings to estimate nationally representative numbers and assessed changes from 2011 to 2015. Data were abstracted from medical charts centrally using standardised definitions. Results While the proportion of patients with STEMI among all patients with acute myocardial infarction decreased over time from 82.5% (95% CI 81.7 to 83.3) in 2011 to 68.5% (95% CI 67.7 to 69.3) in 2015 (p<0.0001), the weighted national estimate of patients with STEMI increased from 210 000 to 380 000. The rate of reperfusion eligibility among patients with STEMI decreased from 49.3% (95% CI 48.1 to 50.5) to 42.2% (95% CI 41.1 to 43.4) in 2015 (p<0.0001); ineligibility was principally driven by larger proportions with prehospital delay exceeding 12 hours (67.4%–76.7%, p<0.0001). Among eligible patients, the proportion receiving reperfusion therapies increased from 54% (95% CI 52.3 to 55.7) to 59.7% (95% CI 57.9 to 61.4) (p<0.0001). Crude and risk-adjusted rates of in-hospital death did not differ significantly between 2011 and 2015. Conclusions In this most recent nationally representative study of STEMI in China, the use of acute reperfusion increased, but no significant improvement occurred in outcomes. There is a need to continue efforts to prevent cardiovascular diseases, to monitor changes in in-hospital treatments and outcomes, and to reduce prehospital delay.
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Affiliation(s)
- Tianna Zhou
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China .,Central China Subcenter of the National Center for Cardiovascular Diseases, Zhengzhou, People's Republic of China
| | - Yuan Lu
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Xueke Bai
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Shuang Hu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Frederick A Masoudi
- Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA.,Research and Analytics, MO, Ascension Health, St. Louis, Missouri, USA
| | | | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
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The Number of Patients with Acute Myocardial Infarction Decreased and Door-to-Balloon Time Delayed in COVID-19. Cardiol Res Pract 2021; 2021:6673313. [PMID: 33791126 PMCID: PMC7996045 DOI: 10.1155/2021/6673313] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/21/2021] [Accepted: 02/20/2021] [Indexed: 12/19/2022] Open
Abstract
Background At present, COVID-19 is sweeping the world, and all countries are actively responding. During the COVID-19 epidemic, the treatment of patients with acute myocardial infarction (AMI) may be affected. Methods We reviewed data of patients with AMI from January 23 to April 23, 2020 (2020), and January 23 to April 23, 2019 (2019), who were admitted to two hospitals from Southern China. We collected clinical characteristics, comorbidities, treatment, prognosis, and key time segments to analyze. Results The total number of patients that had been diagnosed with AMI in the two hospitals was 218 in 2020 and 260 in 2019. The number of AMI patients that were admitted to hospitals per day decreased in 2020. The percentage of patients with AMI who refused hospitalization in 2020 was significantly higher than that in 2019 (5.0% vs 1.5%, p=0.028). There is no statistical difference in symptoms of the first medical contact (S2FMC) time between 2020 and 2019 (p=0.552). Door-to-balloon (D2B) time of ST-elevation myocardial infarction (STEMI) patients who were treated with a primary percutaneous coronary intervention (pPCI) in 2020 was 79 (63.75-105.25) mins, while D2B time in 2019 was 57.5 (41.5-76.5) mins, which was statistically different from the two groups. Conclusions COVID-19 had an impact on the number of AMI patients who were admitted to hospitals and the time of treatment. During the COVID-19 epidemic, the number of AMI patients that were admitted to hospitals per day was decreased, while the percentage of AMI patients that refused therapy in these two hospitals increased, and the D2B time of STEMI patients was also delayed.
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Lee C, Chow CM, Yan AT, Moe GW, Tu JV, Chu JY. Awareness of Warning Symptoms of Heart Disease and Stroke: Results of a Follow-up Study of the Chinese Canadian Cardiovascular Health Project. CJC Open 2021; 3:741-750. [PMID: 34169253 PMCID: PMC8209403 DOI: 10.1016/j.cjco.2021.01.014] [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: 12/20/2020] [Accepted: 01/24/2021] [Indexed: 11/17/2022] Open
Abstract
Background Our original pilot study in 2008 demonstrated a poor degree of awareness of heart disease and stroke among Chinese Canadians, warranting an updated survey of their knowledge. We sought to determine the current degree of knowledge of cardiovascular disease, including stroke, among ethnic Chinese residents of Canada. Methods A 35-question online survey was conducted in the fall of 2017 among 1001 Chinese Canadians (aged ≥ 18 years) in the greater Toronto area (n = 501) and Vancouver (n = 500). Knowledge of heart disease and stroke, such as signs and symptoms of stroke and heart attack, health habits, and initial response to a cardiovascular emergency were assessed. Results A total of 52.0% of the respondents were female, and 46.3% were aged <45 years. A total of 40.1% spoke Cantonese, and 23.7% spoke Mandarin; 79.5% were immigrants, and 31% had lived in Canada < 10 years. A total of 85% identified at least one heart attack symptom, and 80% identified at least one stroke symptom; 86.2% indicated that they would call 911 if experiencing a heart attack or stroke. Internet use was positively associated with the ability to identify a greater number of heart attack and stroke symptoms, compared to the number among non–Internet users (P < 0.001). Women were 14% more likely to overlook gender as a risk factor for cardiovascular disease (CVD). Conclusions This study found that in 2017, compared to 2008, awareness of symptoms of heart disease and stroke improved among Chinese Canadians residing in Toronto and Vancouver.
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Affiliation(s)
- Calvin Lee
- School of Medicine, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Chi-Ming Chow
- Division of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Andrew T. Yan
- Division of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Gordon W. Moe
- Division of Cardiology, St Michael’s Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Jack V. Tu
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Joseph Y. Chu
- Division of Neurology, Toronto Western Hospital-UHN, University of Toronto, Toronto, Ontario, Canada
- Corresponding author: Dr Joseph Y. Chu, Queensway Professional Centre, 312-190 Sherway Drive, Toronto, Ontario M9C 5N2, Canada. Tel.: +1-416-626-0740; fax: +1-416-626-0635.
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Abstract
OBJECTIVE Stroke and ischaemic heart disease have become the leading causes of death in China. We evaluated recognition of stroke and heart attack symptoms and stroke treatment-seeking behaviour in a large representative sample of the Chinese adult population and explored characteristics associated with recognition rates. DESIGN Cross-sectional survey. SETTING Household interviews. PARTICIPANT 3051 Chinese adults aged between 18 and 69 (50.7% female) were interviewed between January and March 2019. PRIMARY AND SECONDARY OUTCOME MEASURES Primary measures include recognitions of stroke and heart attack symptoms and stroke treatment-seeking behaviour. Secondary measures include numeracy level, sociodemographics and prior history of cardiovascular diseases and high blood pressure. RESULTS Participants on average recognised 5.2 out of 14 stroke symptoms and 2.6 out of 6 heart attack symptoms. In the presence of stroke symptoms, three quarters of participants would take immediate action and call an ambulance, yet the second most common action was to advise the person to see a doctor (59%) rather than to consult a doctor immediately (34%). Recognition of atypical heartattack symptoms, such as nausea and feeling of anxiety, was poor. Symptom recognition rates were higher in females, people with a personal or family/friend history of cardiovascular events, those with higher numeracy scores, and for stroke symptoms, participants with high (versus low) education level. Furthermore, symptom recognition rate was negatively correlated with burden of cardiovascular diseases across the four economic regions of China. CONCLUSION Recognition of stroke and heart-attack symptoms was moderate and there remains a gap between recognising symptoms and taking immediate action. Interventions focusing on simple symptom detection tools and on building numerical competencies may help reduce the burden of cardiovascular diseases in China.
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Affiliation(s)
- Shenghua Luan
- CAS Key Laboratory of Behavioral Science, Chinese Academy of Sciences, Beijing, China
- Department of Psychology, University of the Chinese Academy of Sciences, Beijing, China
| | - Yujia Yang
- Department of Psychology, University of the Chinese Academy of Sciences, Beijing, China
| | - Yuqi Huang
- Department of Psychology, University of the Chinese Academy of Sciences, Beijing, China
| | - Michelle McDowell
- Harding Center for Risk Literacy, Max-Planck-Institute for Human Development, Berlin, Germany
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Park KS. Predictors of anticipated coping behavior at myocardial infarction symptom onset among a nationwide sample of Korean adults. Epidemiol Health 2021; 43:e2021006. [PMID: 33445822 PMCID: PMC8060522 DOI: 10.4178/epih.e2021006] [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: 10/21/2020] [Accepted: 12/06/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES This cross-sectional study based on the health belief model investigated predictors of anticipated coping behavior at myocardial infarction (MI) symptom onset using secondary data from the 2017 Korea Community Health Survey. METHODS Modifying variables (socioeconomic, health knowledge, perceived threat) were selected as independent variables and anticipated coping behavior at MI symptom onset as the dependent variable. Calling 911 was classified as the correct anticipated coping behavior, while visiting a hospital or an oriental hospital, calling family, and others were classified as incorrect. RESULTS Of 227,740 participants, 83.2% reported correct anticipated coping behaviors. The likelihood of calling 911 was low if participants experienced atypical symptoms (jaw, neck, back, arm, and shoulder pain), even if they were aware of those symptoms. However, 69.9% of participants who were aware of typical symptoms (chest pain) stated that they would call-911. Sex, age, hypertension, dyslipidemia, obesity, and awareness of MI symptoms affected the correct anticipated coping behavior. CONCLUSIONS Correct coping abilities among the general public are vitally important for early treatment of MI patients and reduction of hospitalization time. Members of the general public in their 20s and 30s, 60 years of age or older, with cardiovascular risk factors (male sex, hypertension, dyslipidemia, and obesity), and who are not aware of MI symptoms should be educated about the typical and atypical symptoms of MI. Emergency medical services should be called without delay if needed, and public relations activities should be carried out to raise awareness that anyone can use emergency medical services.
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Yin X, He Y, Zhang J, Song F, Liu J, Sun G, Liang Y, Ye J, Hu Y, Song M, Chen C, Xu Q, Tan N, Chen J, Liu Y, Liu H, Tian M. Patient-level and system-level barriers associated with treatment delays for ST elevation myocardial infarction in China. Heart 2020; 106:1477-1482. [PMID: 32580976 DOI: 10.1136/heartjnl-2020-316621] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 05/10/2020] [Accepted: 05/17/2020] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE This study aims to understand the current ST elevated myocardial infarction (STEMI) treatment process in Guangdong Province and explore patient-level and system-level barriers associated with delay in STEMI treatment, so as to provide recommendations for improvement. METHODS This is a qualitative study. Data were collected using semistructured, face-to-face individual interviews from April 2018 to January 2019. Participants included patients with STEMI, cardiologists and nurses from hospitals, emergency department doctors, primary healthcare providers, local health governors, and coordinators at the emergency medical system (EMS). An inductive thematic analysis was adopted to generate overarching themes and subthemes for potential causes of STEMI treatment delay. The WHO framework for people-centred integrated health services was used to frame recommendations for improving the health system. RESULTS Thirty-two participants were interviewed. Patient-level barriers included poor knowledge in recognising STEMI symptoms and not calling EMS when symptoms occurred. Limited capacity of health professionals in hospitals below the tertiary level and lack of coordination between hospitals of different levels were identified as the main system-level barriers. Five recommendations were provided: (1) enhance public health education; (2) strengthen primary healthcare workforce; (3) increase EMS capacity; (4) establish an integrated care model; and (5) harness government's responsibilities. CONCLUSIONS Barriers associated with delay in STEMI treatment were identified at both patient and system levels. The results of this study provide a useful evidence base for future intervention development to improve the quality of STEMI treatment and patient outcomes in China and other countries in a similar situation.
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Affiliation(s)
- Xuejun Yin
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Yibo He
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jing Zhang
- School of Public Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Feier Song
- Department of Emergency and Critical Care Medicine, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jin Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Guoli Sun
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yan Liang
- Department of Cardiology, Maoming People's Hospital, Maoming, China
| | - Jianfeng Ye
- Department of Cardiology, Dongguan TCM Hospital, Dongguan, China
| | - Yunzhao Hu
- Department of Cardiology, The First People's Hospital of Shunde, Shunde, China
| | - Mingcai Song
- Department of Cardiology, Guangzhou Panyu Central Hospital, Guangzhou, Guangdong, China
| | - Cong Chen
- Department of Cardiology, Maoming People's Hospital, Maoming, China
| | - Qingbo Xu
- Department of Cardiology, Maoming People's Hospital, Maoming, China
| | - Ning Tan
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Jiyan Chen
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Yong Liu
- Department of Cardiology, Guangdong Provincial Key Laboratory of Coronary Heart Disease, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Maoyi Tian
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
- The George Institute for Global Health, Beijing, China
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Park KS. Factors affecting awareness of myocardial infarction symptoms among the general public in Korea. Epidemiol Health 2020; 42:e2020032. [PMID: 32512667 PMCID: PMC7340619 DOI: 10.4178/epih.e2020032] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Accepted: 04/23/2020] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES We aimed to determine the level of awareness of myocardial infarction (MI) symptoms among the general public in Korea and identify factors affecting awareness of MI symptoms using data from the 2017 Korea Community Health Survey (KCHS). METHODS This is a cross-sectional study using KCHS data. Based on five questions about MI symptoms, participants were divided into an awareness group (replied ‘yes’ to all five questions) and an unawareness group (replied ‘no’ or ‘not sure’ to at least one of five questions) for analysis. RESULTS Of a total of 228,281 participants, 42.4% were aware of MI symptoms. There was a high level of awareness of chest pain and shortness of breath, but a low level of awareness of gastrointestinal symptoms and pain in the arm, shoulder, jaw, neck, and back. While women had a higher level of overall awareness relative to men, they showed a lower level of awareness regarding chest pain and discomfort. The factors affecting awareness of MI symptoms were gender, age, education level, occupation, smoking, drinking, physical inactivity, and cardiovascular disease risk factors. CONCLUSIONS In order to enhance awareness of MI symptoms among the general population, appropriate education and promotion efforts must be implemented based on gender, age, education level, and occupation. Moreover, active efforts by the government, educational institutions, and medical institutions are necessary to improve awareness of both typical and atypical MI symptoms. Furthermore, health policies to promote reduced smoking and drinking and increased physical activity, as well as continuous monitoring and management of individuals with cardiovascular disease risk factors, are required.
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Zhang L, Liu J, Geng T. Ginkgetin aglycone attenuates the apoptosis and inflammation response through nuclear factor-kB signaling pathway in ischemic-reperfusion injury. J Cell Biochem 2019; 120:8078-8085. [PMID: 30582212 DOI: 10.1002/jcb.28086] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 10/29/2018] [Indexed: 01/24/2023]
Abstract
AIMS Acute myocardial infarction (AMI) is one of the most threaten disease in the world. Ginkgetin aglycone (GA) was a new kind of Ginkgo biloba, involved in various diseases, including kidney injury and acute pancreatitis. However, the function of GA in AMI remains unknown. The aim of the study was to investigate the characteristics and function of GA in ischemic-reperfusion injury. METHODS H2 O 2 - and CoCl 2 -treated H9C2 cells were used to analyze the function of GA in vitro. Caspase 3, interleukin-6 (IL-6), and tumor necrosis factor-α were detected to evaluate the apoptosis and inflammation response. Rat AMI was performed to elucidate the function in vivo. RESULTS We found that GA could reduce the apoptosis and improved cell survival of H2 O 2 -treated H9C2 cardiomyocytes and CoCl 2 -treated H9C2 cells. GA attenuated CoCl 2 -induced inflammatory response and the level of cleaved caspase 33, suggesting that GA could alleviate the cell apoptosis. GA improved the cardiac function and attenuated the inflammatory cell infiltration in vivo. We also found that nuclear factor-kB signaling pathway, which was activated under hypoxia environment, was also suppressed in the GA-treated group. CONCLUSION We verified the function and mechanism of GA and provide evidence that GA may play a vital role in ischemic-reperfusion injury, and understanding the precise role of GA will undoubtedly shed new light on the clinical treatment.
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Affiliation(s)
- Lei Zhang
- Department of Emergency, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jiangang Liu
- Department of Cardiovascular, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tao Geng
- Healthcare Ward, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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Qiu C, Wu X. The Effect of Medical Insurance on Outpatient Visits by the Elderly: An Empirical Study with China Health and Retirement Longitudinal Study Data. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:175-187. [PMID: 30411304 DOI: 10.1007/s40258-018-0443-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
BACKGROUND As the largest developing country in the world, China is still on its way towards building an adequate system of health insurance through continuous reforms. For the elderly in China, an effective medical security system might be especially helpful. OBJECTIVE This study investigates the effect of medical insurance on outpatient visits by elderly Chinese in order to identify effective policies to improve the Chinese medical security system. METHODS Based on data taken from the China Health and Retirement Longitudinal Study, eleven candidate models were analyzed, among which a finite mixture negative binomial model with two components was chosen as the theoretical foundation for an analysis of the effect of medical insurance on outpatient visits by elderly Chinese. RESULTS The significant variables were found to be basic medical insurance (BMI), sex, surveyed area, education level, health status, economic area, income level, and the number of living children for the elderly aged 60-69 years; BMI, age, health status, number of household members, and income level for the elderly aged 70-79 years; and BMI, age, sex, and the presence of chronic disease for the elderly aged 80 years and above. CONCLUSION Enrollment in BMI was found to be significantly associated with an increased number of outpatient visits, whereas supplementary medical insurance membership did not have a significant effect. The effects of BMI enrollment also differed by scheme and age. For those with a high rate of outpatient medical services utilization, the enhancing effect of BMI on the number of outpatient visits was not significant, so new medical insurance policies should be provided to the elderly population in China.
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Affiliation(s)
- Chunjuan Qiu
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science, East China Normal University, Ministry of Education, Shanghai, China.
| | - Xianyi Wu
- Key Laboratory of Advanced Theory and Application in Statistics and Data Science, East China Normal University, Ministry of Education, Shanghai, China
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Fu R, Song CX, Dou KF, Yang JG, Xu HY, Gao XJ, Liu QQ, Xu H, Yang YJ. Differences in symptoms and pre-hospital delay among acute myocardial infarction patients according to ST-segment elevation on electrocardiogram: an analysis of China Acute Myocardial Infarction (CAMI) registry. Chin Med J (Engl) 2019; 132:519-524. [PMID: 30807351 PMCID: PMC6416090 DOI: 10.1097/cm9.0000000000000122] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. METHODS We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. RESULTS Compared with patients with STEMI (N = 16,315), those with NSTEMI (N = 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849-2.107). CONCLUSIONS Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction. TRIAL REGISTRATION www.clinicaltrials.gov (No. NCT01874691).
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Affiliation(s)
- Rui Fu
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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