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Pelter MM. Hospital-Based Electrocardiographic Monitoring: The Good, the Not So Good, and Untapped Potential. Am J Crit Care 2024; 33:247-259. [PMID: 38945816 DOI: 10.4037/ajcc2024781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/02/2024]
Abstract
Continuous electrocardiographic (ECG) monitoring was first introduced into hospitals in the 1960s, initially into critical care, as bedside monitors, and eventually into step-down units with telemetry capabilities. Although the initial use was rather simplistic (ie, heart rate and rhythm assessment), the capabilities of these devices and associated physiologic (vital sign) monitors have expanded considerably. Current bedside monitors now include sophisticated ECG software designed to identify myocardial ischemia (ie, ST-segment monitoring), QT-interval prolongation, and a myriad of other cardiac arrhythmia types. Physiologic monitoring has had similar advances from noninvasive assessment of core vital signs (blood pressure, respiratory rate, oxygen saturation) to invasive monitoring including arterial blood pressure, temperature, central venous pressure, intracranial pressure, carbon dioxide, and many others. The benefit of these monitoring devices is that continuous and real-time information is displayed and can be configured to alarm to alert nurses to a change in a patient's condition. I think it is fair to say that critical and high-acuity care nurses see these devices as having a positive impact in patient care. However, this enthusiasm has been somewhat dampened in the past decade by research highlighting the shortcomings and unanticipated consequences of these devices, namely alarm and alert fatigue. In this article, which is associated with the American Association of Critical-Care Nurses' Distinguished Research Lecture, I describe my 36-year journey from a clinical nurse to nurse scientist and the trajectory of my program of research focused primarily on ECG and physiologic monitoring. Specifically, I discuss the good, the not so good, and the untapped potential of these monitoring systems in clinical care. I also describe my experiences with community-based research in patients with acute coronary syndrome and/or heart failure.
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Affiliation(s)
- Michele M Pelter
- Michele M. Pelter is an associate professor, director of the ECG Monitoring Research Lab, and an associate translational scientist, Center for Physiologic Research, Department of Physiological Nursing, School of Nursing, University of California San Francisco
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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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Cimino J, Braun C. Clinical Research in Prehospital Care: Current and Future Challenges. Clin Pract 2023; 13:1266-1285. [PMID: 37887090 PMCID: PMC10605888 DOI: 10.3390/clinpract13050114] [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: 08/21/2023] [Revised: 10/08/2023] [Accepted: 10/19/2023] [Indexed: 10/28/2023] Open
Abstract
Prehospital care plays a critical role in improving patient outcomes, particularly in cases of time-sensitive emergencies such as trauma, cardiac failure, stroke, bleeding, breathing difficulties, systemic infections, etc. In recent years, there has been a growing interest in clinical research in prehospital care, and several challenges and opportunities have emerged. There is an urgent need to adapt clinical research methodology to a context of prehospital care. At the same time, there are many barriers in prehospital research due to the complex context, posing unique challenges for research, development, and evaluation. Among these, this review allows the highlighting of limited resources and infrastructure, ethical and regulatory considerations, time constraints, privacy, safety concerns, data collection and analysis, selection of a homogeneous study group, etc. The analysis of the literature also highlights solutions such as strong collaboration between emergency medical services (EMS) and hospital care, use of (mobile) health technologies and artificial intelligence, use of standardized protocols and guidelines, etc. Overall, the purpose of this narrative review is to examine the current state of clinical research in prehospital care and identify gaps in knowledge, including the challenges and opportunities for future research.
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Affiliation(s)
- Jonathan Cimino
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, 44 Rue d’Anvers, 1130 Luxembourg, Luxembourg
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg
| | - Claude Braun
- Clinical Research Unit, Fondation Hôpitaux Robert Schuman, 44 Rue d’Anvers, 1130 Luxembourg, Luxembourg
- Hôpitaux Robert Schuman, 9 Rue Edward Steichen, 2540 Luxembourg, Luxembourg
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Bessonov IS, Sapozhnikov SS, Shadrin AA, Kashtanov MG, Popov SV. Effect of the "door-to-balloon" time on the results of treatment of patients with ST-segment elevation myocardial infarction, depending on the duration of the pre-hospital delay. KARDIOLOGIIA 2023; 63:28-36. [PMID: 37470731 DOI: 10.18087/cardio.2023.6.n2245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 09/08/2022] [Accepted: 10/28/2022] [Indexed: 07/21/2023]
Abstract
Aim To analyze the effect of the door-to-balloon time on treatment outcomes in patients with acute ST-segment elevation myocardial infarction (STEMI) depending on the duration of pre-hospital delay.Material ad methods The study used data of the hospital registry of percutaneous coronary interventions (PCI) in STEMI from 2006 through 2017. The analysis included 1333 patients. All patients were divided into two groups. The first group included 574 (43.1%) patients with the time from the pain syndrome onset to admission was ≤120 min. The second group consisted of 759 (56.9 %) patients with the time of pre-hospital delay exceeding 120 min. Results of the treatment were analyzed for each group depending on the door-to-balloon time, ≤60 min or >60 min.Results In the group of patients with the prehospital delay less than 120 min and the door-to-balloon time ≤60 min vs. patients with the door-to-balloon time >60 min, the following was observed: decreased in-hospital mortality (1.3 % vs. 6.8 %, p=0.001), reduced incidence of major adverse cardiac effects (МАСЕ) (3.2 % vs. 8.3 %, p=0.008), and reduced incidence of the no-reflow phenomenon (3.9 % vs. 9.4 %, p=0.007). Also, immediate angiographic success of PCI was more frequently achieved in these patents (94.5 % vs. 87.5 %, p=0.003). In addition, in the group with the prehospital delay ≤120 min and the door-to-balloon time ≤60 min, a higher ejection fraction was noted at discharge from the hospital (48 [43; 51] % vs. 46 [42; 51] %, р=0.038). Comparison of treatment outcomes between the groups with different door-to-balloon time (≤60 min or >60 min) and a prehospital delay >120 min did not show any significant intergroup differences. According to a multivariate analysis, the door-to-balloon time ≤60 min did not predict in-hospital mortality. There was a strong correlation between the time of prehospital delay and the total time of myocardial ischemia (r=0.87; р<0.001) while the correlation between the door-to-balloon time and the total time of myocardial ischemia was moderate (r=0.41; р<0.001). At the same time, there was no correlation between the time of prehospital delay and the door-to-balloon time.Conclusion In STEMI patients with a prehospital delay less than 120 min from the pain syndrome onset, a decrease in the door-to-balloon time was associated with better outcome of the hospital treatment. When the duration of prehospital delay was more than 120 min, a decrease in door-to-balloon time did not influence the treatment outcome. The time of prehospital delay strongly correlated with the total time of myocardial ischemia.
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Affiliation(s)
- I S Bessonov
- Tyumen Cardiological Scientific Center, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - S S Sapozhnikov
- Tyumen Cardiological Scientific Center, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - A A Shadrin
- Tyumen Cardiological Scientific Center, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - M G Kashtanov
- Tyumen Cardiological Scientific Center, Tomsk National Research Medical Center of the Russian Academy of Sciences
| | - S V Popov
- Research Institute of Cardiology, Tomsk National Research Medical Center of the Russian Academy of Sciences
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Davis LL, McCoy TP, Riegel B, McKinley S, Doering LV, Moser DK. Association of Symptoms and Mode of Transportation to Emergency Department in Patients With Acute Coronary Syndrome. Dimens Crit Care Nurs 2023; 42:95-103. [PMID: 36720034 PMCID: PMC9897491 DOI: 10.1097/dcc.0000000000000566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS) with symptoms matching their expectations of a heart attack are more likely to use emergency medical services (EMS) than not. OBJECTIVE To determine whether presenting symptom clusters are associated with EMS use in ACS patients and if EMS use or symptom clusters are associated with prehospital delay. METHODS This secondary analysis used data from the PROMOTION trial, a randomized clinical trial that enrolled 3522 subjects with a history of or at risk for ACS from 5 sites in the United States, Australia, and New Zealand. Subjects were randomized to usual care or an educational intervention to reduce prehospital delay. During the 2-year follow-up, subjects admitted for ACS were asked about symptoms, time of symptom onset, and mode of transportation to the hospital. Symptoms were grouped into classic ACS, pain symptoms, and stress symptoms clusters. RESULTS Of 3522 subjects enrolled, 331 sought care for ACS during follow-up; 278 had transportation mode documented; 121 (44%) arrived via EMS. Classic ACS plus pain symptoms (adjusted odds ratio [AOR], 2.66; P = .011), classic ACS plus stress symptoms (AOR, 2.61; P = .007), and classic ACS plus both pain and stress symptoms (AOR, 3.90; P = .012) were associated with higher odds of EMS use versus classic ACS symptoms alone. Emergency medical services use resulted in a 68.5-minute shorter median delay (P = .002) versus non-EMS use. Symptom clusters were not predictive of delay time in the adjusted model (P = .952). DISCUSSION Although chest symptoms were the most prevalent symptoms for most (85%), the combination of classic ACS symptoms with other symptom clusters was associated with higher EMS use. Further research is needed to determine whether a combination of symptom clusters helps patients correctly interpret ACS symptoms to better understand how symptom clusters influence EMS use.
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Li PWC, Yu DSF, Yan BP, Wong CW, Yue SCS, Chan CMC. Effects of a Narrative-Based Psychoeducational Intervention to Prepare Patients for Responding to Acute Myocardial Infarction: A Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2239208. [PMID: 36306128 PMCID: PMC9617174 DOI: 10.1001/jamanetworkopen.2022.39208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Despite decades of educational efforts, patients' prolonged delays in seeking care for symptoms of acute myocardial infarction (AMI) remain the greatest obstacle to successful management of the condition. OBJECTIVE To compare the effects of a narrative-based psychoeducational intervention with a didactic educative approach on AMI survivors' intention to seek care for AMI symptoms and on AMI knowledge. DESIGN, SETTING, AND PARTICIPANTS A multisite randomized clinical trial recruited community-dwelling patients aged 18 years or older with a history of AMI from 4 hospitals in Hong Kong from January 1, 2018, to January 22, 2021, and followed up participants for 1 year. INTERVENTIONS An 8-week narrative-based psychoeducational intervention aimed to create a vivid cognitive experience of complex decision-making and modeled desirable behavioral changes through nurse-led, interactive video sessions using model patients. The control group received 4 nurse-led sessions comprising education about AMI and care seeking delivered using a didactic approach. MAIN OUTCOMES AND MEASURES The primary outcome was the behavioral intention between the 2 groups, reflected by participants' attitudes and beliefs about care seeking for AMI measured using the Acute Coronary Syndrome Response Index-Chinese version. The secondary outcome was AMI knowledge. RESULTS Six hundred and eight participants (mean [SD] age, 67.2 [8.3] years; 469 [77.1%] male) were randomized to either the narrative-based psychoeducation group (n = 304) or the didactic education group (n = 304). The psychoeducational intervention group reported greater positive changes than the control group in their attitudes (β = -1.053 [95% CI, -1.714 to -0.391]; P < .001) and beliefs (β = -0.686 [95% CI, -1.354 to -0.180]; P = .04) toward care seeking at the 3-month follow-up, and the difference was sustained at 12 months for both attitudes (β = -0.797 [95% CI, -1.477 to -0.117]; P = .02) and beliefs (β = -0.692 [95% CI, -1.309 to -0.012]; P = .047). There were no significant differences in AMI knowledge between the 2 study groups at the 3-month and 12-month time points. CONCLUSIONS AND RELEVANCE The results of this randomized clinical trial found that a novel approach of narrative-based psychoeducation was effective in improving patients' behavioral intention to seek care for AMI symptoms. Longer-term follow-up to evaluate actual care-seeking behavior and clinical outcomes in patients with AMI is warranted to determine the sustained effects of this intervention. TRIAL REGISTRATION ChiCTR Identifier: ChiCTR-IIC-17010576.
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Affiliation(s)
- Polly W. C. Li
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Doris S. F. Yu
- School of Nursing, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong
| | - Bryan P. Yan
- Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - C. W. Wong
- Department of Medicine and Geriatrics, Pok Oi Hospital, Hong Kong
| | - Sunny C. S. Yue
- Department of Medicine and Geriatrics, United Christian Hospital, Hong Kong
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Shi W, Ghisi GLM, Zhang L, Hyun K, Pakosh M, Gallagher R. Systematic review, meta‐analysis and meta‐regression to determine the effects of patient education on health behaviour change in adults diagnosed with coronary heart disease. J Clin Nurs 2022. [DOI: 10.1111/jocn.16519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 08/03/2022] [Accepted: 08/17/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Wendan Shi
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Gabriela L. M. Ghisi
- Cardiovascular Prevention and Rehabilitation Program, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Ling Zhang
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
| | - Karice Hyun
- School of Health Sciences, Faculty of Medicine and Health University of Sydney Sydney New South Wales Australia
| | - Maureen Pakosh
- Library & Information Services, Toronto Rehabilitation Institute University Health Network Toronto Ontario Canada
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
- Charles Perkins Centre, Faculty of Medicine and Health The University of Sydney Sydney New South Wales Australia
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8
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The relationship between symptom onset-to-needle time and ischemic outcomes in patients with acute myocardial infarction treated with primary PCI: Observations from Prague-18 Study. J Cardiol 2021; 79:626-633. [PMID: 34924237 DOI: 10.1016/j.jjcc.2021.11.015] [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] [Received: 07/29/2021] [Revised: 10/21/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Based on previous studies with clopidogrel, the time between acute myocardial infarction (AMI) symptoms onset and primary percutaneous coronary intervention (PCI) was proven as important prognostic factor. Our aim was to assess the relationship between symptoms onset to needle time (SNT) and procedural results and the occurrence of ischemic endpoints in primary angioplasty patients treated with potent P2Y12 inhibitors. METHODS A total of 1,131 out of 1,230 patients randomized to the Prague-18 study (prasugrel vs. ticagrelor in primary PCI) were divided into a high and a low-risk group. The effect of defined SNT on patients' ischemic endpoints and prognosis by their risk status at admission was tested. RESULTS The median SNT was 3.2 hours. Longer SNTs resulted in a more frequent incidence of TIMI flow <3 post PCI (p=0.015). There were significant differences in the occurrence of the combined ischemic endpoint among the compared SNT groups at 30 days (p=0.032), and 1 year (p=0.011), with the highest incidence in the ≤1 h SNT group of patients. "Latecomers" (SNT>4 hs) in the high-risk group experienced more reinfarction within 1 year [OR (95% CI) 3.23 (1.09-9.62) p=0.035]; no difference was found in the low-risk group. CONCLUSIONS In the era of intense antithrombotic medication, stratification of MI patients undergoing primary angioplasty, based on initial ischemic risk assessment affected prognosis more than symptom onset to needle time. Longer time delay was significantly related to increased incidence of ischemic events and all-cause mortality only in patients with high ischemic risk.
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9
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Stehli J, Dinh D, Dagan M, Duffy SJ, Brennan A, Smith K, Andrew E, Nehme Z, Reid CM, Lefkovits J, Stub D, Zaman S. Sex Differences in Prehospital Delays in Patients With ST-Segment-Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention. J Am Heart Assoc 2021; 10:e019938. [PMID: 34155902 PMCID: PMC8403281 DOI: 10.1161/jaha.120.019938] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Women with ST‐segment–elevation myocardial infarction experience delays in reperfusion compared with men with little data on each time component from symptom onset to reperfusion. This study analyzed sex discrepancies in patient delays, prehospital system delays, and hospital delays. Methods and Results Consecutive patients with ST‐segment–elevation myocardial infarction treated with percutaneous coronary intervention across 30 hospitals in the Victorian Cardiac Outcomes Registry (2013–2018) were analyzed. Data from the Ambulance Victoria Data warehouse were used to perform linkage to the Victorian Cardiac Outcomes Registry for all patients transported via emergency medical services (EMS). The primary end point was EMS call‐to‐door time (prehospital system delay). Secondary end points included symptom‐to‐EMS call time (patient delay), door‐to‐device time (hospital delay), 30‐day mortality, major adverse cardiovascular events, and major bleeding. End points were analyzed according to sex and adjusted for age, comorbidities, cardiogenic shock, cardiac arrest, and symptom onset time. A total of 6330 (21% women) patients with ST‐segment–elevation myocardial infarction were transported by EMS. Compared with men, women had longer adjusted geometric mean symptom‐to‐EMS call times (47.0 versus 44.0 minutes; P<0.001), EMS call‐to‐door times (58.1 versus 55.7 minutes; P<0.001), and door‐to‐device times (58.5 versus 54.9 minutes; P=0.006). Compared with men, women had higher 30‐day mortality (odds ratio [OR], 1.38; 95% CI, 1.06–1.79; P=0.02) and major bleeding (OR, 1.54; 95% CI, 1.08–2.20; P=0.02). Conclusions Female patients with ST‐segment–elevation myocardial infarction experienced excess delays in patient delays, prehospital system delays, and hospital delays, even after adjustment for confounders. Prehospital system and hospital delays resulted in an adjusted excess delay of 10 minutes compared with men.
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Affiliation(s)
- Julia Stehli
- School of Clinical Sciences at Monash Health Monash Cardiovascular Research Centre Monash University Melbourne Australia
| | - Diem Dinh
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Misha Dagan
- Department of General Medicine The Alfred Hospital Melbourne Australia
| | - Stephen J Duffy
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia.,Department of Cardiology The Alfred Hospital Melbourne Australia.,Baker Heart and Diabetes Institute Melbourne Australia
| | - Angela Brennan
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia
| | - Karen Smith
- Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Emily Andrew
- Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Ziad Nehme
- Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,Department of Epidemiology and Preventive Medicine Monash University Melbourne Australia
| | - Christopher M Reid
- Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,School of Public Health Curtin University Perth Australia
| | - Jeffrey Lefkovits
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia.,Department of Cardiology Royal Melbourne Hospital Melbourne Australia
| | - Dion Stub
- Centre of Cardiovascular Research and Education in Therapeutics School of Public Health and Preventive Medicine Monash University Melbourne Australia.,Department of Cardiology The Alfred Hospital Melbourne Australia.,Centre for Research and Evaluation Ambulance Victoria Melbourne Australia.,Baker Heart and Diabetes Institute Melbourne Australia
| | - Sarah Zaman
- School of Clinical Sciences at Monash Health Monash Cardiovascular Research Centre Monash University Melbourne Australia.,Department of Cardiology Westmead Hospital Sydney Australia.,Westmead Applied Research Centre University of Sydney Australia
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Sun C, Dyer S, Salvia J, Segal L, Levi R. Worse Cardiac Arrest Outcomes During The COVID-19 Pandemic In Boston Can Be Attributed To Patient Reluctance To Seek Care. Health Aff (Millwood) 2021; 40:886-895. [PMID: 34038193 DOI: 10.1377/hlthaff.2021.00250] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Delays in seeking emergency care stemming from patient reluctance may explain the rise in cases of out-of-hospital cardiac arrest and associated poor health outcomes during the COVID-19 pandemic. In this study we used emergency medical services (EMS) call data from the Boston, Massachusetts, area to describe the association between patients' reluctance to call EMS for cardiac-related care and both excess out-of-hospital cardiac arrest incidence and related outcomes during the pandemic. During the initial COVID-19 wave, cardiac-related EMS calls decreased (-27.2 percent), calls with hospital transportation refusal increased (+32.5 percent), and out-of-hospital cardiac arrest incidence increased (+35.5 percent) compared with historical baselines. After the initial wave, although cardiac-related calls remained lower (-17.2 percent), out-of-hospital cardiac arrest incidence remained elevated (+24.8 percent) despite fewer COVID-19 infections and relaxed public health advisories. Throughout Boston's fourteen neighborhoods, out-of-hospital cardiac arrest incidence was significantly associated with decreased cardiac-related calls, but not with COVID-19 infection rates. These findings suggest that patients were reluctant to obtain emergency care. Efforts are needed to ensure that patients seek timely care both during and after the pandemic to reduce potentially avoidable excess cardiovascular disease deaths.
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Affiliation(s)
- Christopher Sun
- Christopher Sun is a postdoctoral fellow at the Sloan School of Management, Massachusetts Institute of Technology, in Cambridge, Massachusetts, and Massachusetts General Hospital, in Boston, Massachusetts
| | - Sophia Dyer
- Sophia Dyer is the medical director of Boston Emergency Medical Services (EMS), in Boston, Massachusetts
| | - James Salvia
- James Salvia is a deputy superintendent of Boston EMS
| | - Laura Segal
- Laura Segal is the chief of staff of Boston EMS
| | - Retsef Levi
- Retsef Levi is the J. Spencer Standish (1945) Professor of Operations Management at the Sloan School of Management, Massachusetts Institute of Technology
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11
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Bessonov IS, Kuznetsov VA, Gorbatenko EA, Dyakova AO, Sapozhnikov SS. Influence of Total Ischemic Time on Clinical Outcomes in Patients with ST-Segment Elevation Myocardial Infarction. ACTA ACUST UNITED AC 2021; 61:40-46. [PMID: 33734047 DOI: 10.18087/cardio.2021.2.n1314] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 11/11/2020] [Accepted: 11/24/2020] [Indexed: 11/18/2022]
Abstract
Aim To evaluate the effect of the total time of myocardial ischemia on results of the treatment of patients with ST segment elevation acute myocardial infarction (STEMI) who underwent percutaneous coronary interventions (PCI).Material and methods This study used data from a hospital register for PCI in STEMI from 2006 through 2017. 1649 patients were included. Group 1 consisted of 604 (36.6 %) patients with a total time of myocardial ischemia not exceeding 1880 min; group 2 included 531 (32.2 %) patients with a duration of myocardial ischemia from 180 to 360 min; and group 3 included 514 (31.2 %) patients with a duration of myocardial ischemia longer than 360 min.Results Mortality was lower in group 1 (2.3 %) than in groups 2 and 3 (6.2 and 7.2 %, respectively; p1-2=0.001; p1-3<0.001; p2-3=0.520). The incidence of major cardiac complications ("adverse cardiac events", MACE) was lower in group 1 (4.1 %) than in groups 2 and 3 (7.3 and 9.5 %, respectively, p1-2=0.020; p1-3<0.001; p2-3=0.200). The incidence of no-reflow phenomenon was higher in group 3 (9.7 %) than in groups 2 and 3 (4.5 and 5.3 %, respectively (p1-2=0.539; p1-3=0.001; p2-3=0.005). The major factors associated with the increased total time of myocardial ischemia >180 min were age (odd ratio, OR, 1.01 at 95 % confidence interval, CI, 1.0 to 1.02; р=0.044), female gender (OR, 1.64 at 95 % CI 1.26 to 2.13; р<0.001), chronic kidney disease (OR 1.82 at 95 % CI 1.21 to 2.74; р=0.004). Performing prehospital thrombolysis was associated with a decrease in the total time of myocardial ischemia (OR 0.4 at 95 % CI 0.31 to 0.51; р<0.001). A strong direct correlation was observed between the total time of myocardial ischemia and the time from the onset of pain syndrome to hospitalization (r=0.759; р<0.001).Conclusion The total time of myocardial ischemia >180 min was associated with increased mortality and development of MACE. The total time of myocardial ischemia > 360 min was associated with increased incidence of the no-reflow phenomenon. The major predictors for the time of myocardial ischemia >180 min included age, female gender, and chronic kidney disease. The use of pharmacoinvasive strategy was associated with an increased number of patients with a total duration of myocardial ischemia <180 min. The contribution of the time of prehospital delay to the total time of myocardial ischemia was greater than the contribution of the "door-to-balloon" time. The time of prehospital delay showed a strong direct correlation with the total time of myocardial ischemia.
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Affiliation(s)
- I S Bessonov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - V A Kuznetsov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - E A Gorbatenko
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - A O Dyakova
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
| | - S S Sapozhnikov
- Tyumen Cardiology Research Center, Tomsk National Research Medical Center, Russian Academy of Science, Tomsk
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Vitori TK, Frazier SK, Biddle MJ, Mudd-Martin G, Pelter MM, Dracup K, Moser DK. Hostility predicts mortality but not recurrent acute coronary syndrome. Eur J Cardiovasc Nurs 2021; 20:132–137. [PMID: 33611360 DOI: 10.1177/1474515120950913] [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] [Received: 08/23/2019] [Accepted: 07/28/2020] [Indexed: 11/17/2022]
Abstract
BACKGROUND Hostility is associated with greater risk for cardiac disease, cardiac events and dysrhythmias. Investigators have reported equivocal findings regarding the association of hostility with acute coronary syndrome (ACS) recurrence and mortality. Given mixed results on the relationship between hostility and cardiovascular outcomes, further research is critical. AIMS The aim of our study was to determine whether hostility was a predictor of ACS recurrence and mortality. METHODS We performed a secondary analysis of data (N = 2321) from a large randomized clinical trial of an intervention designed to reduce pre-hospital delay among patients who were experiencing ACS. Hostility was measured at baseline with the Multiple Adjective Affect Checklist (MAACL) and patients were followed for 24 months for evaluation of ACS recurrence and all-cause mortality. We used Cox proportional hazards modeling to determine whether hostility was predictive of time to ACS recurrence or all-cause mortality. RESULTS The majority of patients were married (73%), Caucasian (97%), men (68%), and had a mean age of 67 ± 11 years. Fifty-seven percent of participants scored as hostile based on the established MAACL cut point (mean score = 7.56 ± 3.8). Hostility was an independent predictor of all-cause mortality (p = < 0.039), but was not a predictor of ACS recurrence (p = 0.792). CONCLUSION Hostility is common in patients with ACS and its relationship to clinical outcomes is important to the design of future interventions to improve long-term ACS mortality.
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Caltabellotta T, Magne J, Salerno B, Pradel V, Petitcolin PB, Auzemery G, Virot P, Aboyans V. Characteristics associated with patient delay during the management of ST-segment elevated myocardial infarction, and the influence of awareness campaigns. Arch Cardiovasc Dis 2020; 114:305-315. [PMID: 33272857 DOI: 10.1016/j.acvd.2020.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Revised: 07/03/2020] [Accepted: 09/22/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The delay between the occurrence of symptoms and the call seeking medical assistance is an important component of the pain-to-balloon delay in patients with ST-segment elevation myocardial infarction (STEMI). Factors affecting this "patient delay" have been poorly studied, and campaigns to raise emergency call awareness have barely been evaluated. AIMS To evaluate the factors related to patient delay, and the effects of public awareness campaigns undertaken in our region. METHODS Data from the regional registry of STEMI in Limousin, France, were analysed, and we performed a survey to assess medical history, clinical signs, context, socioeconomic situation and perception and behaviour of the patient. "Late callers" (i.e. third tertile,>154minutes) were compared with "early callers" (i.e. first and second tertiles,≤154minutes) using univariate and multivariable statistical methods. The influence of public awareness campaigns was studied by comparing the patient delays before and after a regional campaign. RESULTS Among 481 patients, the median patient delay was 87minutes. "Late callers" were older (odds ratio [OR] 1.02 per year, 95% confidence interval [CI] 1.00 to 1.03), more often had symptom onset between 00:00 and 05:59 a.m. (OR 1.86, 95% CI 1.10 to 3.12) and more often sought assistance from a general practitioner (OR 2.58, 95% CI 1.66 to 4.04) or attended the emergency room (OR 4.10, 95% CI 2.04 to 8.32). Sweats and considering the situation to be severe were factors associated with a reduced delay. After awareness campaigns, there was no change in patient delay, but the proportion of patients calling the Emergency Medical Services increased from 55% to 62% (P<0.001). CONCLUSIONS Patient delay is multifactorial. The impact of previous campaigns is mixed. Psychological and behavioural aspects are determinant, and should be taken into consideration to develop awareness messages that target specific groups.
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Affiliation(s)
- Thibaut Caltabellotta
- Department of Medicine, Monts-et-Barrages Hospital, 87400 Saint-Léonard de Noblat, France
| | - Julien Magne
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France
| | - Baptiste Salerno
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | - Valerie Pradel
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | | | - Gilles Auzemery
- Agence Régionale de Santé-Nouvelle-Aquitaine, 33000 Bordeaux, France
| | - Patrice Virot
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren University Hospital, 2, Martin-Luther-King avenue, 87042 Limoges, France; INSERM U1094 & IRD, Limoges University, 87025 Limoges, France.
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Liu H, Wang W, Chen H, Li Z, Feng S, Yuan Y. Can WeChat group-based intervention reduce reperfusion time in patients with ST-segment myocardial infarction? A controlled before and after study. J Telemed Telecare 2020; 26:627-637. [PMID: 31238784 DOI: 10.1177/1357633x19856473] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Pre-hospital identification of acute ST-elevation myocardial infarction and activation of the catheterization laboratory can reduce first medical contact to wire-crossing times. We conducted a study on providing 24-hour tele-electrocardiography services via the WeChat group application, aiming to reduce the time taken for diagnosis and treatment of ST-elevation myocardial infarction. METHODS A controlled before and after study was conducted on 140 ST-elevation myocardial infarction patients who were initially seen in non-percutaneous coronary intervention-capable hospital and transferred for primary percutaneous coronary intervention at our percutaneous coronary intervention centre from 1 February to 31 October 2018. The WeChat group had 70 patients with pre-hospital electrocardiography transmission via WeChat and the control group had 70 patients who did not transfer pre-hospital electrocardiography. The reperfusion time of the two groups was compared to evaluate the effect of the WeChat group intervention. RESULTS In the WeChat group versus the control group, the median symptom onset to first medical contact time was similar (129 vs 150 min, p > 0.05), but the median first medical contact to wire, door to wire and first medical contact to catheterization laboratory activity were significantly shorter (132 vs 171 minutes, p < 0.001; 60 vs 95 minutes, p < 0.001; 29 vs 74 minutes, p < 0.001, respectively). CONCLUSIONS Pre-hospital electrocardiography transfer via a WeChat group resulted in earlier reperfusion of ST-elevation myocardial infarction patients who were transferred from the non-percutaneous coronary intervention centre.
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Affiliation(s)
- Hui Liu
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, China
| | - Wei Wang
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, China
| | - Haojia Chen
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, China
| | - Zhi Li
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, China
| | - Shushuang Feng
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, China
| | - Yonghong Yuan
- Department of Cardiology, The Second Affiliated Hospital of Shantou University Medical College, China
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Tizón-Marcos H, Vaquerizo B, Marrugat J, Ariza A, Carrillo X, Muñoz JF, Cárdenas M, García-Picart J, Rojas SG, Tomás-Querol C, Massotti M, Lidón RM, Jiménez J, Martí-Almor J, Farré N, Pérez-Fernández S, Curós A, Mauri Ferré J. Complicaciones y mortalidad a 30 días y al año en pacientes con primer IAMCEST tratados en la red Codi IAM en 2010-2016: análisis del efecto del género. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.05.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Wang MW, Cheng YR, Zheng Y, Chen J, Yu P, Zhang Z, Gan WT, Wu MJ, Ren KH, Zhang F, Chen YL, Bao JZ, Feng ZH, Zhang XW. The impact of Community intervention on the time from Symptom onset to first medical contact with acute coronary syndrome. PATIENT EDUCATION AND COUNSELING 2020; 103:1581-1586. [PMID: 32147306 DOI: 10.1016/j.pec.2020.02.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 02/27/2020] [Accepted: 02/28/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Patient delay in the recognition of and response to the symptoms of acute coronary syndrome (ACS) is a worldwide problem. A community education program about chest pain was implemented in China, and was aimed at providing better community intervention. In this study, the impact of this program on the time of symptom onset to the first medical contact (SO-to-FMC) in ACS patients was investigated, as was the incidence of major adverse cardiac and cerebrovascular events (MACCE) in these patients. METHODS A total of 10 local communities were included in this study. A 9-month intensive community education program about chest pain was conducted in these communities. The data on the demographics, mode of transportation, procedures, clinical outcomes, and discharge diagnoses of all ACS patients in these communities were collected. RESULTS The study communities had a combined population of 361,609, and all community population sizes ranged from 12,823 to 66,127. The average SO-to-FMC time of the control period was 510 min, whereas, following community intervention, the average SO-to-FMC time was 256 min (P < 0.001). Furthermore, comparative analyses revealed that, following discharge from the hospital, the 1.5-year MACCE-free survival rate was higher in the community intervention group than in the control group (95.0 % vs. 90.5 %, P = 0.025), and the 1.5-year mortality rate was lower in the community intervention group than in the control group (3.3 % vs. 6.3 %, P = 0.03). CONCLUSIONS AND PRACTICAL IMPLICATIONS The Hangzhou Chest Pain Science Education Project(HCPSEP) was found to reduce the SO-to-FMC time and improve the outcome of ACS patients. This indicates that a scientific, educational program on chest pain can be effective in improving the knowledge and alertness of the local residents about chest pain. This type of program may be recognized and carried out in other regions.
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Affiliation(s)
- Ming-Wei Wang
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | | | - Yong Zheng
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | - Juan Chen
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | - Ping Yu
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | - Zhi Zhang
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | - Wen-Tao Gan
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | - Min-Juan Wu
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | - Kai-Han Ren
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | - Fang Zhang
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | - Yu-Lin Chen
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China
| | | | - Zhan-Hui Feng
- Affiliated Hospital of Guizhou Medical University, Department of Neurology, Guiyang, China.
| | - Xing-Wei Zhang
- Affiliated Hospital of Hangzhou Normal University, Department of Cardioogy, Hangzhou, China.
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Tizón-Marcos H, Vaquerizo B, Marrugat J, Ariza A, Carrillo X, Muñoz JF, Cárdenas M, García-Picart J, Rojas SG, Tomás-Querol C, Massotti M, Lidón RM, Jiménez J, Martí-Almor J, Farré N, Pérez-Fernández S, Curós A, Mauri Ferré J. Differences in 30-day complications and 1-year mortality by sex in patients with a first STEMI managed by the Codi IAM network between 2010 and 2016. ACTA ACUST UNITED AC 2020; 74:674-681. [PMID: 32660910 DOI: 10.1016/j.rec.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 05/19/2020] [Indexed: 11/16/2022]
Abstract
INTRODUCTION AND OBJECTIVES ST-segment elevation myocardial infarction (STEMI) emergency care networks aim to increase reperfusion rates and reduce ischemic times. The influence of sex on prognosis is still being debated. Our objective was to analyze prognosis according to sex after a first STEMI. METHODS This multicenter cohort study enrolled first STEMI patients from 2010 to 2016 to determine the influence of sex after adjustment for revascularization delays, age, and comorbidities. End points were 30-day mortality, the 30-day composite of mortality, ventricular fibrillation, pulmonary edema, or cardiogenic shock, and 1-year all-cause mortality. RESULTS From 2010 to 2016, 14 690 patients were included; 24% were women. The median [interquartile range] time from electrocardiogram to artery opening decreased throughout the study period in both sexes (119 minutes [85-160] vs 109 minutes [80-153] in 2010, 102 minutes [81-133] vs 96 minutes [74-124] in 2016, both P=.001). The rates of primary PCI within 120 minutes increased in the same period (50.4% vs 57.9% and 67.1% vs 72.1%, respectively; both P=.001). After adjustment for confounders, female sex was not associated with 30-day complications (OR, 1.06; 95%CI, 0.91-1.22). However, female 30-day survivors had a lower adjusted 1-year mortality than their male counterparts (HR,0.76; 95%CI, 0.61-0.95). CONCLUSIONS Compared with men, women with a first STEMI had similar 30-day mortality and complication rates but significantly lower 1-year mortality after adjustment for age and severity.
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Affiliation(s)
- Helena Tizón-Marcos
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain.
| | - Beatriz Vaquerizo
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Jaume Marrugat
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Grupo de Trabajo en Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain
| | - Albert Ariza
- Servicio de Cardiología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Xavier Carrillo
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain
| | - Juan-Francisco Muñoz
- Servicio de Cardiología, Hospital Universitari Mútua de Terrassa, Terrassa, Barcelona, Spain
| | - Mérida Cárdenas
- Servicio de Cardiología, Hospital Universitari Dr. Josep Trueta, Girona, Spain
| | - Joan García-Picart
- Servicio de Cardiología, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | | | - Carlos Tomás-Querol
- Servicio de Cardiología, Hospital Universitari Arnau de Vilanova, Lleida, Spain
| | - Mònica Massotti
- Servicio de Cardiología, Hospital Clínic i Provincial, Barcelona, Spain
| | - Rosa-Maria Lidón
- Servicio de Cardiología, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain
| | - Josep Jiménez
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Julio Martí-Almor
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Núria Farré
- Servicio de Cardiología, Hospital del Mar, Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain; Facultat de Medicina, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain
| | - Sílvia Pérez-Fernández
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares, Grupo de Trabajo en Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médica (IMIM), Barcelona, Spain
| | - Antoni Curós
- Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Josepa Mauri Ferré
- Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain; Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
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Hoschar S, Albarqouni L, Ladwig KH. A systematic review of educational interventions aiming to reduce prehospital delay in patients with acute coronary syndrome. Open Heart 2020; 7:e001175. [PMID: 32201586 PMCID: PMC7066622 DOI: 10.1136/openhrt-2019-001175] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 10/30/2019] [Accepted: 10/31/2019] [Indexed: 11/03/2022] Open
Abstract
Interventions aiming at reducing prehospital delay (PHD) in patients with acute coronary syndrome (ACS) have yielded inconsistent findings. Therefore, we aimed to systematically review studies which investigated the impact of educational interventions on reducing PHD in patients with ACS. We searched four electronic databases (Cumulative Index to Nursing and Allied Health Literature, MEDLINE, Embase, Cochrane) from inception throughout December 2016 for studies that reported the impact of either mass-media or personalised intervention on PHD. Reporting quality was assessed with the Template for Intervention Description and Replication checklist for interventional trials. Two reviewers screened 12 184 abstracts and performed full-text screening on 86 articles, leading to 34 articles which met our inclusion criteria. We found 18 educational interventions with a total of 180 914 participants (range: n=100-125 161) and a median of 1342 participants. Among these educational interventions, 13 campaigns employed a mass-media approach and five a personalised approach. Ten studies yielded no significant effects on the primary outcome while the remaining interventions reported a significant reduction with a decrease between 17 and 324 min (median reduction: 40 min, n=5). The success was partly driven by an increase in emergency medical services use. Two studies reported an increase in acute myocardial infarction knowledge. We observed no superiority of the personalised over the mass-media approach. Although methodological shortcomings and the heterogeneity of included interventions still do not allow definite recommendations for future campaigns, it becomes evident that either mass media or personalised interventions can be successful in reducing PHD, especially those who address behavioural consequences and psychological barriers (eg, denial) and provide practical action plan considerations as part of their campaign messages. CRD42017055684 (PROSPERO registration number).
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Affiliation(s)
- Sophia Hoschar
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum, München, German Research Center for Environmental Health, Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Loai Albarqouni
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum, München, German Research Center for Environmental Health, Neuherberg, Germany.,Institute for Evidence Based Healthcare, Bond University, Gold Coast, Queensland, Australia
| | - Karl-Heinz Ladwig
- Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Munich, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
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Ivanovic MD, Miletic M, Subotic I, Boljevic D. Signal Quality in Reconstructed 12-Lead Ambulatory ECGs Recorded Using 3-Lead Device. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2020; 2019:5481-5487. [PMID: 31947096 DOI: 10.1109/embc.2019.8857251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Acute myocardial infraction (AMI) is a leading cause of death in the developed countries. Survival of patients having acute coronary syndrome (ACS) dramatically depends on treatment delay. Hence, a technology that would enable ECG recording immediately after ACS symptom occurrence may significantly decrease AMI mortality. In this study we investigate the signal quality of reconstructed 12-lead ECGs by using 3-lead handheld device with dry electrode in realistic ambulatory conditions. For each subject enrolled in the study an individual transformation matrix was calculated during the calibration procedure, and used for 12-lead reconstruction whenever that subject sends a recording from a handheld device. To evaluate fidelity of 12-lead reconstructions, 3 performance metrics were defined. The results show that the reconstruction error is largest on QRS complex and smallest on ST segment for all 3 metrics. This indicates that the reconstruction of the ST segment, which carries the most important information for ischemia detection, is reconstructed with the highest quality.
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Martin LK, Lewis VJ, Clark D, Murphy MC, Edvardsson D, Stub D, Farouque O. Frontline barriers to effective paramedic and emergency nursing STEMI management: clinician perspectives. Australas Emerg Care 2019; 23:126-136. [PMID: 31843496 DOI: 10.1016/j.auec.2019.12.001] [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: 07/15/2019] [Revised: 12/01/2019] [Accepted: 12/01/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Factors that hinder the pivotal role frontline clinicians play in STEMI management are under-reported. We aimed to explore perceived barriers to effective STEMI management by addressing the following questions: 1. What are the most commonly occurring barriers to timely STEMI management for paramedics and emergency nurses? 2. Are there differences in barriers experienced by paramedics and emergency nurses? 3. Are there differences in barriers experienced by frontline clinicians in rural and metropolitan settings? METHODS A 79-item online survey was offered to paramedics and emergency nurses. Descriptive statistics and exploratory factor analysis identified the most frequently experienced types of barriers. Professional groups and geographical locations were compared. RESULTS There were 333 respondents. Response rates for paramedics was 10% and 9% for members of an emergency nursing association. Most commonly occurring barriers across all respondents were: 'lack of skills development'; 'lack of feedback'; 'untimely support'; 'distance to scene/hospital facilities'; 'hospital-related delays'. Statistically significant differences were found by professional group and geographical location. CONCLUSION Barriers to timely management were present, but not frequently experienced. Survey responses indicate a need for improved continuing professional development opportunity, clearer feedback mechanisms, streamlined facilitation of STEMI processes in hospitals, and enhanced access to expert advice/resources for all frontline clinicians.
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Affiliation(s)
- Lorelle K Martin
- La Trobe University, School of Nursing and Midwifery, Melbourne, Australia; Austin Health, Department of Cardiology, Heidelberg, Melbourne, Australia.
| | - Virginia J Lewis
- La Trobe University, School of Nursing and Midwifery, Melbourne, Australia
| | - David Clark
- Austin Health, Department of Cardiology, Heidelberg, Melbourne, Australia; University of Melbourne, School of Medicine, Melbourne, Australia
| | - Maria C Murphy
- La Trobe University, School of Nursing and Midwifery, Melbourne, Australia
| | - David Edvardsson
- La Trobe University, School of Nursing and Midwifery, Melbourne, Australia
| | - Dion Stub
- Ambulance Victoria, Melbourne, Australia; Monash University, Department Epidemiology Preventative Medicine, Melbourne, Australia
| | - Omar Farouque
- Austin Health, Department of Cardiology, Heidelberg, Melbourne, Australia; University of Melbourne, School of Medicine, Melbourne, Australia
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Mahajan S, Valero-Elizondo J, Khera R, Desai NR, Blankstein R, Blaha MJ, Virani SS, Kash BA, Zoghbi WA, Krumholz HM, Nasir K. Variation and Disparities in Awareness of Myocardial Infarction Symptoms Among Adults in the United States. JAMA Netw Open 2019; 2:e1917885. [PMID: 31851350 PMCID: PMC6991230 DOI: 10.1001/jamanetworkopen.2019.17885] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Prompt recognition of myocardial infarction symptoms is critical for timely access to lifesaving emergency cardiac care. However, patients with myocardial infarction continue to have a delayed presentation to the hospital. OBJECTIVE To understand the variation and disparities in awareness of myocardial infarction symptoms among adults in the United States. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study used data from the 2017 National Health Interview Survey among adult residents of the United States, assessing awareness of the 5 following common myocardial infarction symptoms among different sociodemographic subgroups: (1) chest pain or discomfort, (2) shortness of breath, (3) pain or discomfort in arms or shoulders, (4) feeling weak, lightheaded, or faint, and (5) jaw, neck, or back pain. The response to a perceived myocardial infarction (ie, calling emergency medical services vs other) was also assessed. MAIN OUTCOMES AND MEASURES Prevalence and characteristics of individuals who were unaware of myocardial infarction symptoms and/or chose not to call emergency medical services in response to these symptoms. RESULTS Among 25 271 individuals (13 820 women [51.6%; 95% CI, 50.8%-52.4%]; 17 910 non-Hispanic white individuals [69.9%; 95% CI, 68.2%-71.6%]; and 21 826 individuals [82.7%; 95% CI, 81.5%-83.8%] born in the United States), 23 383 (91.8%; 95% CI, 91.0%-92.6%) considered chest pain or discomfort a symptom of myocardial infarction; 22 158 (87.0%; 95% CI, 86.1%-87.8%) considered shortness of breath a symptom; 22 064 (85.7%; 95% CI, 84.8%-86.5%) considered pain or discomfort in arm a symptom; 19 760 (77.0%; 95% CI, 76.1%-77.9%) considered feeling weak, lightheaded, or faint a symptom; and 16 567 (62.6%; 95% CI, 61.6%-63.7%) considered jaw, neck, or back pain a symptom. Overall, 14 075 adults (53.0%; 95% CI, 51.9%-54.1%) were aware of all 5 symptoms, whereas 4698 (20.3%; 95% CI, 19.4%-21.3%) were not aware of the 3 most common symptoms and 1295 (5.8%; 95% CI, 5.2%-6.4%) were not aware of any symptoms. Not being aware of any symptoms was associated with male sex (odds ratio [OR], 1.23; 95% CI, 1.05-1.44; P = .01), Hispanic ethnicity (OR, 1.89; 95% CI, 1.47-2.43; P < .001), not having been born in the United States (OR, 1.85; 95% CI, 1.47-2.33; P < .001), and having a lower education level (OR, 1.31; 95% CI, 1.09-1.58; P = .004). Among 294 non-Hispanic black or Hispanic individuals who were not born in the United States, belonged to the low-income or lowest-income subgroup, were uninsured, and had a lower education level, 61 (17.9%; 95% CI, 13.3%-23.6%) were not aware of any symptoms. This group had 6-fold higher odds of not being aware of any symptoms (OR, 6.34; 95% CI, 3.92-10.26; P < .001) compared with individuals without these characteristics. Overall, 1130 individuals (4.5%; 95% CI, 4.0%-5.0%) chose a different response than calling emergency medical services in response to a myocardial infarction. CONCLUSIONS AND RELEVANCE Many adults in the United States remain unaware of the symptoms of and appropriate response to a myocardial infarction. In this study, several sociodemographic subgroups were associated with a higher risk of not being aware. They may benefit the most from targeted public health initiatives.
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Affiliation(s)
- Shiwani Mahajan
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Javier Valero-Elizondo
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - Rohan Khera
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas
| | - Nihar R Desai
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Ron Blankstein
- Cardiovascular Imaging Program, Cardiovascular Division and Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for Prevention of Cardiovascular Disease, Baltimore, Maryland
| | - Salim S Virani
- Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas
- Section of Cardiology, Baylor College of Medicine, Houston, Texas
| | - Bita A Kash
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
| | - William A Zoghbi
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, Connecticut
- Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, Connecticut
- Department of Health Policy and Management, Yale School of Public Health, New Haven, Connecticut
| | - Khurram Nasir
- Division of Cardiovascular Prevention and Wellness, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas
- Center for Outcomes Research, Houston Methodist Research Institute, Houston, Texas
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Tongpeth J, Du H, Barry T, Clark RA. Effectiveness of an Avatar application for teaching heart attack recognition and response: A pragmatic randomized control trial. J Adv Nurs 2019; 76:297-311. [DOI: 10.1111/jan.14210] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 07/22/2019] [Accepted: 08/30/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Jintana Tongpeth
- Prachomklao College of Nursing Praboromrajchanok Institute Ministry of Public Health Muang Phetchaburi Thailand
| | - Huiyun Du
- College of Nursing & Health Sciences Flinders University Adelaide SA Australia
| | - Tracey Barry
- College of Nursing & Health Sciences Flinders University Adelaide SA Australia
| | - Robyn A. Clark
- College of Nursing & Health Sciences Flinders University Adelaide SA Australia
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Dehghan-Nayeri N, Shali M, Vaezi A, Navabi N, Ghaffari F. Cardiac patients' beliefs about their illness and treatment: A sequential exploratory mixed methods design. Med J Islam Repub Iran 2019; 33:98. [PMID: 31696092 PMCID: PMC6825381 DOI: 10.34171/mjiri.33.98] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Cardiac patients’ beliefs about illness and treatment can disturb their treatment process, treatment regimen adherence, and daily activities. Exploring these beliefs by the use of appropriate, valid, and accurate scales can be helpful in false beliefs reforming by nurses and finally, result in life quality promotion. Therefore, this study is conducted to design and psychometry a questionnaire probing about cardiac patients’ beliefs about illness and treatment. Methods: The sequential combination exploratory mixed methods design was used to develop the questionnaire format, which involved two sections: the quantitative and qualitative step. The qualitative step included probing the role of cultural beliefs about illness and treatment in two steps, including the literature and related tools review and fieldwork (semi-structured interviews with cardiac patients). Seventeen studies were checked in the literature review. Twenty-two cardiac patients were selected and interviewed by purposive sampling. The interviews continued up to the data saturation. The data analysis was conducted in both steps using conventional content analysis and textual content analysis. The quantitative step was a methodology study accomplished in two parts. The questionnaire items were formed using the data and items pool in the first part while the psychometric properties of the questionnaire were checked using face, content and construct validity and the reliability was probed using internal consistency and stability in the second part. The data were transferred into SPSS software program, version 18.0 for Windows (α<0.05). Results: 319 codes were extracted from the analyzing phase which formed 6 categories including prognosis, prevention, contexts, treatment efficiency, mentality and lifestyle as well as 9 sub-categories including understanding the danger, attitude toward disease, attitude toward treatment, society’s culture, feeling hopeless, treatment regimen ignorance, self-curing, trying to survive and physical outcomes. The items pool was formed using literature reviews and interviews. A 30-itemed questionnaire was formed after the psychometric process. The Kaiser-Meyer-Olkin (KMO) index and the Bartlett’s test of sphericity showed good results. Six components from the exploratory content analysis including prognosis, prevention, contexts, treatment efficiency, mentality, and lifestyle gained 51.7% variance totally. The interclass correlation coefficient was 0.83 in responding to the items for two times. Conclusion: This study developed a questionnaire about cardiac patients’ beliefs regarding their illness and treatment. It can be used for the educational, research, and treatment purposes as a questionnaire with short, easy, and grammatically simple items that have appropriate validity and reliability. Using this scale can be helpful in evaluating clients’ beliefs and recognize their educational needs.
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Affiliation(s)
- Nahid Dehghan-Nayeri
- School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahboubeh Shali
- School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Atefeh Vaezi
- School of Nursing and Midwifery, Zanjan University of Medical Sciences, Zanjan, Iran
| | - Nasrin Navabi
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
| | - Fatemeh Ghaffari
- Nursing Care Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran
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24
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Nymark C, Henriksson P, Mattiasson AC, Saboonchi F, Kiessling A. Inability to act was associated with an extended delay prior to care-seeking, in patients with an acute myocardial infarction. Eur J Cardiovasc Nurs 2019; 18:512-520. [PMID: 31132880 DOI: 10.1177/1474515119844654] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND The out-of-hospital mortality in patients with acute myocardial infarction remains unchanged in contrast to a decrease in inhospital mortality. Interventions aiming to shorten patient delay have been largely unsuccessful. A deeper understanding is apparently needed on patients' appraisal prior to care-seeking. AIM To investigate whether appraisal processes influence patient delay, and if the questionnaire 'Patients' appraisal, emotions and action tendencies preceding care seeking in acute myocardial infarction' (PA-AMI) could discriminate between patients with prolonged care-seeking and those with a short delay. METHODS A cross-sectional study including 326 acute myocardial infarction patients filling out the validated questionnaire PA-AMI. The impact of subscales on delay was analysed by projection to latent structures regression. Discrimination opportunities between patients with short and long delays were analysed by projection to latent structures discriminant analysis. RESULTS The subscales 'perceived inability to act' and 'symptom appraisal' had a major impact on patient delay (P<0.0001). 'Perceived inability to act' had its main influence in patients with a delay exceeding 12 hours, and 'symptom appraisal' had its main influence in patients with a delay shorter than one hour. CONCLUSION Appraisal processes influence patient delay. Acute myocardial infarction patients with a prolonged delay were, besides a low perceived symptom severity and urgency to seek medical care, characterised by a perceived loss of control and ability to act. Therefore, future interventions aimed at decreasing delay should pay attention to appraisal processes, and perceived inability to act may be a sign of a health threat and therefore a signal to seek medical care.
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Affiliation(s)
- Carolin Nymark
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
| | - Peter Henriksson
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
| | | | - Fredrik Saboonchi
- 3 Karolinska Institutet, Department of Clinical Neuroscience, Sweden.,4 The Red Cross University College, Stockholm, Sweden
| | - Anna Kiessling
- 1 Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Sweden
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25
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Farquharson B, Abhyankar P, Smith K, Dombrowski SU, Treweek S, Dougall N, Williams B, Johnston M. Reducing delay in patients with acute coronary syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions. Open Heart 2019; 6:e000975. [PMID: 30997136 PMCID: PMC6443141 DOI: 10.1136/openhrt-2018-000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background Time to treatment in many conditions, particularly acute coronary syndrome, is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay. Objective To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical. Methods The data sources were Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Study eligibility criteria include intervention evaluations (randomised controlled trials, controlled clinical trials and cohort studies) involving adults (aged >18 years) and including an outcome measure of patient delay up to August 2016. Study appraisal and synthesis methods include screening potential studies using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies. Results From 39 studies (200 538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified, plus 5 additional techniques, with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, three of four studies that included two or more BCTs, in addition to the two most commonly used additional techniques, reported a significant reduction in delay. Conclusions Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions, although in relation to patient delay particularly additional use of BCTs might be helpful. Trial registration number CRD42014013106.
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Affiliation(s)
| | - Purva Abhyankar
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Karen Smith
- NHS Tayside School of Nursing & Midwifery, University of Dundee, Dundee, UK
| | | | - Shaun Treweek
- Health Sciences Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Brian Williams
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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26
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McNair PW, Bilchick KC, Keeley EC. Very late presentation in ST elevation myocardial infarction: Predictors and long-term mortality. IJC HEART & VASCULATURE 2019; 22:156-159. [PMID: 30828600 PMCID: PMC6383163 DOI: 10.1016/j.ijcha.2019.02.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/03/2019] [Indexed: 01/17/2023]
Abstract
Background Despite improvements in ST elevation myocardial infarction (STEMI) care, total ischemic time remains long in patients who present late. Our goal was to identify predictors of very late presentation (≥12 h) of STEMI and determine long-term mortality. Methods We retrospectively examined consecutive patients admitted with STEMI to our institution using the ACTION Registry™. Time of symptom onset to first medical contact (FMC) was calculated and categorized as <12 h or ≥12 h. Predictors of very late presentation were determined. Results Compared to patients who presented <12 h (n = 365), those who presented ≥12 h (n = 49) after symptom onset were more likely women, diabetics, and those with prior coronary revascularization. In addition, patients who presented ≥12 h had worse ventricular function, were less likely to report chest pain, and were less likely to be transported by ambulance and to undergo coronary angiography. Late presenters had higher rates of heart failure, longer hospitalizations, and were less likely to be discharged home. Diabetes, female sex, and absence of chest pain were strong predictors of late presentation. Long-term survival was significantly lower in late presenters (73% vs. 93%, p = 0.007). Conclusions Female sex, diabetes, and absence of chest pain are strong predictors of presentation delay, and long-term mortality is significantly increased in those presenting very late. A proportion of patients with acute myocardial infarction present late after symptom onset. Women, diabetics and patients who do not experience typical chest pain are more likely to present late. Patients with myocardial infarction who present late have increased mortality at one year.
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Affiliation(s)
- Patrick W McNair
- Department of Medicine, Division of Cardiology, University of Virginia, Charlottesville, VA, United States of America
| | - Kenneth C Bilchick
- Department of Medicine, Division of Cardiology, University of Virginia, Charlottesville, VA, United States of America
| | - Ellen C Keeley
- Department of Medicine, Division of Cardiovascular Medicine, University of Florida, Gainesville, FL, United States of America
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27
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Li YH, Chiu YW, Cheng JJ, Hsieh IC, Lo PH, Lei MH, Ueng KC, Chiang FT, Sung SH, Kuo JY, Chen CP, Lai WT, Lee WL, Chen JH. Changing Practice Pattern of Acute Coronary Syndromes in Taiwan from 2008 to 2015. ACTA CARDIOLOGICA SINICA 2019; 35:1-10. [PMID: 30713394 PMCID: PMC6342842 DOI: 10.6515/acs.201901_35(1).20180716b] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 07/16/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients with acute coronary syndrome (ACS), including ST segment elevation myocardial infarction (STEMI) and non-ST segment elevation (NSTE)-ACS have a significant risk of morbidity and mortality. This study evaluated the practice patterns of ACS care in Taiwan from 2005 to 2018. METHODS Data from two nationwide ACS registries (2008-2010 and 2012-2015) were used. ACS patients who received percutaneous coronary interventions (PCIs) during admission were compared between the two registries. RESULTS In STEMI, the door-to-balloon time for primary PCI decreased by 25 min from a median of 96 to 71 min (p < 0.0001) from the first to second registry. More complex PCI procedures and drug-eluting stents were used for ACS. However, the onset-to-door time was still long for both STEMI and NSTE-ACS. The D2B time for NSTE-ACS was long, especially in the elderly and female patients. Although the prescription rate of secondary preventive medications for ACS increased, it was still relatively low compared with Western data, especially in NSTE-ACS. CONCLUSIONS The registry data showed that ACS care quality has improved in Taiwan. However, areas including onset-to-door time and use of secondary preventive medications still need further improvements.
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Affiliation(s)
- Yi-Heng Li
- National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan
| | - Yu-Wei Chiu
- Far Eastern Memorial Hospital, New Taipei City
| | | | - I-Chang Hsieh
- Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taoyuan
| | - Ping-Han Lo
- China Medical University Hospital and College of Medicine, Taichung
| | | | | | - Fu-Tien Chiang
- National Taiwan University Hospital and Fu-Jen Catholic University Hospital
| | - Shih-Hsien Sung
- Taipei Veterans General Hospital and National Yang Ming University
| | | | | | - Wen-Ter Lai
- Kaohsiung Medical University Hospital, Kaohsiung City
| | | | - Jyh-Hong Chen
- College of Medicine, China Medical University, Taichung, Taiwan
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Sriha Belguith A, Beltaief K, Msolli MA, Bouida W, Abroug H, Ben Fredj M, Zemni I, Grissa MH, Boubaker H, Hsairi M, Nouira S. Management of acute coronary syndrome in emergency departments: a cross sectional multicenter study (Tunisia). BMC Emerg Med 2018; 18:50. [PMID: 30509187 PMCID: PMC6276213 DOI: 10.1186/s12873-018-0201-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2018] [Accepted: 11/15/2018] [Indexed: 01/25/2023] Open
Abstract
Background We aimed to describe diagnosed acute coronary syndrome (ACS) and its care management and outcomes in emergency departments (EDs) and to determine related cardiovascular risk factors (CVRFs). Methods We conducted a cross sectional multicenter study that included 1173 adults admitted to EDs for acute chest pain (ACP) in 2015 at 14 sites in Tunisia. Data included patients’ baseline characteristics, diagnosis, treatment and output. Results ACS represented 49.7% of non-traumatic chest pain [95% CI: 46.7–52.6]; 74.2% of ACS cases were unstable angina/non-ST-segment-elevation myocardial infarction (UA/NSTEMI). Males represented 67.4% of patients with ACS (p < 0.001). The median age was 60 years (IQR 52–70). Emergency medical service transportation was used in 11.9% of cases. The median duration between chest pain onset and ED arrival was two hours (Inter quartile ranges (IQR) 2–4 h). The age-standardized prevalence rate was 69.9/100,000 PY; the rate was 96.24 in men and 43.7 in women. In the multivariable analysis, CVRFs related to ST segment elevation myocardial infarction were age correlated to sex and active smoking. CVRFs related to UA/NSTEMI were age correlated to sex, familial and personal vascular history and type 2 diabetes. We reported 27 cases of major adverse cardiovascular events (20.0%) in patients with STEMI and 36 in patients with UA/NSTEMI (9.1%). Conclusion Half of the patients consulting EDs with ACP had ACS. Emergency medical service transportation calls were rare. Management delays were acceptable. The risk of developing an UA/NSTEMI was equal to the number of CVRFs + 1. To improve patient outcomes, it is necessary to increase adherence to international management guidelines.
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Affiliation(s)
- Asma Sriha Belguith
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia.
| | - Kaouthar Beltaief
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | | | - Wahid Bouida
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | - Hela Abroug
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | - Manel Ben Fredj
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | - Imen Zemni
- Epidemiology and Preventive Medicine Department, University Hospital of Monastir, Monastir, Tunisia
| | | | - Hamdi Boubaker
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
| | | | | | - Samir Nouira
- Research Laboratory (LR12SP18), University of Monastir, Monastir, Tunisia
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An Educational and Skill-Building Intervention to Improve Symptom Recognition and Interpretation in Women With Acute Coronary Syndrome: A Pilot Study. Dimens Crit Care Nurs 2018; 38:29-37. [PMID: 30499790 DOI: 10.1097/dcc.0000000000000329] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The type of symptoms that a woman experiences during an acute coronary syndrome (ACS) event influences symptom recognition and interpretation. Women who experience intense, abrupt symptoms are more likely to correctly attribute symptoms to a cardiac etiology and seek care faster than women with less intense, intermittent symptoms. OBJECTIVE A single-group pretest-posttest design was used to evaluate the feasibility and acceptability of a nurse-delivered education and skill-building intervention designed to improve symptom recognition and interpretation in women with recurrent ACS symptoms. METHODS Women hospitalized for an ACS event received an individualized education and skill-building intervention that was conceptually framed by the investigator's previous research. Three in-person sessions were followed by 2 telephone sessions for reinforcement. Outcomes and acceptability were evaluated at close-out (approximately 2 months after the index event). RESULTS All but 2 women approached agreed to participate. Of the 10 women enrolled, 9 completed all study sessions within an average of 55 days. Mean knowledge scores increased by 7.4% measured by the ACS Response Index. Attitudes toward symptom recognition and help seeking increased by 2.4, whereas beliefs toward expectations and actions increased by 3.2. The women were pleased with the intervention (satisfaction scores averaging 1.4 on a 4-point Likert scale, with 1 as "strongly agree" and 4 as "strongly disagree"). All women who completed the study would recommend it to others. CONCLUSION The nurse-delivered intervention was feasible and acceptable to women in the study. Results support further testing and refinement of the intervention in a longitudinal randomized control study to determine efficacy and sustainability.
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Li PW, Yu DS. A modeling-based narrative intervention to promote timely care-seeking in patients with acute myocardial infarction: A pilot randomized controlled trial and feasibility analysis. Eur J Cardiovasc Nurs 2018; 18:215-223. [PMID: 30371101 DOI: 10.1177/1474515118810126] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Prolonged delay in seeking medical attention for acute myocardial infarction persists as a global phenomenon, which limits effective disease management. The effects of previous mass-media campaigns and psycho-educations have been minimal. AIMS This study aimed to develop a modeling-based narrative intervention, and to examine its feasibility and preliminary effects on care-seeking behavioral intention in Chinese acute myocardial infarction patients. METHODS The modeling-based narrative intervention was developed by integrating updated research evidence and participants' perspectives. Ten patients were invited to co-design the intervention. The narrative approach was adopted to engage patients in a mental rehearsal of the decision-making process through a virtual acute myocardial infarction attack experience. A pilot randomized controlled trial was adopted to examine the feasibility and preliminary effects of this intervention. RESULTS A total of 67 participants were randomly allocated to receive either the modeling-based narrative intervention ( n=34) or didactic education ( n=33). The intervention was feasible and well-accepted by the participants as evidenced by high attendance and participant satisfaction. They considered the intervention as informative and interesting. The majority of the participants in the intervention group expressed that they enjoyed the intervention. Although the preliminary data showed non-significant between-group differences, a more prominent improving trend for acute myocardial infarction knowledge, care-seeking attitudes and beliefs in the intervention group were evident. CONCLUSIONS This study is the first of its kind to adopt a novel narrative approach to optimize care-seeking behaviors among patients with acute myocardial infarction. The preliminary findings showed that this approach was highly feasible and accepted by patients.
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Affiliation(s)
- Polly Wc Li
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Doris Sf Yu
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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31
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Andersson PO, Lawesson SS, Karlsson JE, Nilsson S, Thylén I. Characteristics of patients with acute myocardial infarction contacting primary healthcare before hospitalisation: a cross-sectional study. BMC FAMILY PRACTICE 2018; 19:167. [PMID: 30305077 PMCID: PMC6180517 DOI: 10.1186/s12875-018-0849-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/10/2017] [Accepted: 09/17/2018] [Indexed: 12/02/2022]
Abstract
Background The characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients. Methods This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014. Results A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66±11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (p<0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58). Conclusions Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.
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Affiliation(s)
- Per O Andersson
- Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden. .,Ljungsbro Health Care Centre, Evastigen 9, 590 71 Ljungsbro, Ljungsbro, Sweden.
| | - Sofia Sederholm Lawesson
- Department of Cardiology and department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Jan-Erik Karlsson
- Department of Internal Medicine, Region Jönköping County, Jönköping, and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Staffan Nilsson
- Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ingela Thylén
- Department of Cardiology and department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Sederholm Lawesson S, Isaksson RM, Ericsson M, Ängerud K, Thylén I. Gender disparities in first medical contact and delay in ST-elevation myocardial infarction: a prospective multicentre Swedish survey study. BMJ Open 2018; 8:e020211. [PMID: 29724738 PMCID: PMC5942442 DOI: 10.1136/bmjopen-2017-020211] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 03/09/2018] [Accepted: 03/15/2018] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES Compare gender disparities in ST-elevation myocardial infarction (STEMI) regarding first medical contact (FMC) and prehospital delay times and explore factors associated with prehospital delay in men and women separately. DESIGN Cross-sectional study based on medical records and a validated questionnaire. Eligible patients were enrolled within 24 hours after admittance to hospital. SETTING Patients were included from November 2012 to January 2014 from five Swedish hospitals with catheterisation facilities 24/7. PARTICIPANTS 340 men and 109 women aged between 31 and 95 years completed the survey. MAIN OUTCOME MEASURES FMC were divided into five possible contacts: primary healthcare centre by phone or directly, national advisory nurse by phone, emergency medical services (EMS) and emergency room directly. Two parts of prehospital delay times were studied: time from symptom onset to FMC and time from symptom onset to diagnostic ECG. RESULTS Women more often called an advisory nurse as FMC (28% vs 18%, p=0.02). They had a longer delay until FMC, 90 (IQR 39-221) vs 66 (28-161) min, p=0.04 and until ECG, 146 (68-316) vs 103 (61-221) min, p=0.03. Men went to hospital because of believing they were stricken by an MI to a higher extent than women did (25% vs 15%, p=0.04) and were more often recommended to call EMS by bystanders (38% vs 22%, p<0.01). Hesitating about going to hospital and experiencing pain in the stomach/back/shoulders were factors associated with longer delays in women. Believing the symptoms would disappear or interpreting them as nothing serious were corresponding factors in men. In both genders bystanders acting by contacting EMS explained shorter prehospital delays. CONCLUSIONS In STEMI, women differed from men in FMC and they had longer delays. This was partly due to atypical symptoms and a longer decision time. Bystanders acted more promptly when men than when women fell ill. Public knowledge of MI symptoms, and how to act properly, still seems insufficient.
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Affiliation(s)
- Sofia Sederholm Lawesson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Department of Medicine, Stanford Prevention Research Center, CA, United States
| | - Rose-Marie Isaksson
- Department of Research, Norrbotten County Council, Luleå, Sweden
- Division of Nursing Sciences, Department of Medicine and Health Sciences, Linköping University, Linköping, Sweden
| | - Maria Ericsson
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Karin Ängerud
- Department of Nursing, Umeå University, Umeå, Sweden
- Cardiology, Heart Centre, Umeå University, Umeå, Sweden
| | - Ingela Thylén
- Department of Cardiology and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Yonemoto N, Kada A, Yokoyama H, Nonogi H. Public awareness of the need to call emergency medical services following the onset of acute myocardial infarction and associated factors in Japan. J Int Med Res 2018; 46:1747-1755. [PMID: 29490526 PMCID: PMC5991256 DOI: 10.1177/0300060518757639] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objectives Early recognition of acute myocardial infarction (AMI) and early activation of emergency medical services (EMS) are essential to reduce delays in patient care. We investigated public awareness of the need to call EMS at onset of AMI and evaluated associated factors. Methods In January 2008, a nationwide population-based survey using quota sampling was conducted in Japan. The primary outcome measure was responsiveness to promptly calling EMS at AMI onset, subdivided by on-time (daytime) and off-time (nights and holidays) hours. Results In total, 1200 participants were surveyed. Their mean age was 46.3 years (standard deviation, 17.4), and 50.3% (n=604) were women. A total of 11.6% (n=139) answered that they would call EMS during on-time hours, and 27.5% (n=330) stated that they would call during off-time hours. Multivariable analysis showed that the participants’ age, female sex, education level, and self-confidence regarding their understanding of AMI were significant associated factors. The associated factors were almost identical during the off-time hours; only sex was no longer significant. Conclusions Public awareness of the need to call EMS at AMI onset in Japan was low. Previous intervention studies that were not effective may not have targeted groups with significant risk factors.
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Affiliation(s)
- Naohiro Yonemoto
- 1 Department of Biostatistics, Kyoto University School of Public Health, Kyoto, Japan
| | - Akiko Kada
- 2 Department of Clinical Trial and Research, National Hospital Organization Nagoya Medical Center, Nagoya, Japan
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Ma J, Wang J, Zheng W, Zheng J, Wang H, Wang G, Zhang H, Xu F, Chen Y. Usage of ambulance transport and influencing factors in acute coronary syndrome: a cross-sectional study at a tertiary centre in China. BMJ Open 2017; 7:e015809. [PMID: 28827246 PMCID: PMC5629702 DOI: 10.1136/bmjopen-2016-015809] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVES The aim of this study was to explore the choice of transportation mode to hospital in patients with acute coronary syndrome (ACS) and to determine the factors influencing the use of ambulance. DESIGN, SETTING AND PARTICIPANTS This cross-sectional study was conducted in a tertiary and teaching hospital in China. The study was carried out between 24 August 2015 and 24 July 2016. A total of 828 patients with ACS presented at the emergency department (ED) were included. The study population was dichotomised according to their primary mode of transport (ambulance or self-transport) to hospital. Social demographics, cardiovascular history, risk factors, prehospital medications, clinical characteristics and symptom characteristics were collected. Multivariable logistic regression was used to examine the factors associated with ambulance use. RESULTS We found that only 179 (21.6%) patients with ACS chose taking ambulance to hospital. Factors associated with ambulance use were single (OR 1.66, 95% CI 1.07 to 2.57), taking Suxiaojiuxin pills (OR 1.91, 1.31 to 2.80) or nitrates (OR 2.91, 1.70 to 4.99) before going to hospital, diagnosed as ST-elevation myocardial infarction (STEMI) (OR 2.43, 1.45 to 4.05), with persistent symptoms (OR 1.95, 1.33 to 2.86) and symptoms accompanied with vomiting (OR 2.35, 1.19 to 4.62). The patients who had symptoms precipitated or aggravated by exercise (OR 0.37, 0.14 to 0.98) tended to choose self-transport. CONCLUSION The usage of ambulance in patients with ACS presenting to the ED was low in China. Factors like single, taking Suxiaojiuxin pills or nitrates before going to hospital, diagnosed as STEMI, accompanied with vomiting and persistent symptoms were independently associated with ambulance use. Future education programmes should focus on these factors and increase people's knowledge on ACS and the benefits of ambulance use.
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Affiliation(s)
- Jingjing Ma
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Jiali Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Wen Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Jiaqi Zheng
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Hao Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Guangmei Wang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - He Zhang
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Feng Xu
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
| | - Yuguo Chen
- Department of Emergency, Qilu Hospital, Shandong University, Jinan, China
- Chest Pain Centre, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Emergency and Critical Care Medicine of Shandong Province, Qilu Hospital, Shandong University, Jinan, China
- Key Laboratory of Cardiovascular Remodeling & Function Research, Chinese Ministry of Education & Chinese Ministry of Public Health, Qilu Hospital, Shandong University, Jinan, China
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Anderson L, Brown JP, Clark AM, Dalal H, Rossau HK, Bridges C, Taylor RS. Patient education in the management of coronary heart disease. Cochrane Database Syst Rev 2017; 6:CD008895. [PMID: 28658719 PMCID: PMC6481392 DOI: 10.1002/14651858.cd008895.pub3] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Coronary heart disease (CHD) is the single most common cause of death globally. However, with falling CHD mortality rates, an increasing number of people live with CHD and may need support to manage their symptoms and improve prognosis. Cardiac rehabilitation is a complex multifaceted intervention which aims to improve the health outcomes of people with CHD. Cardiac rehabilitation consists of three core modalities: education, exercise training and psychological support. This is an update of a Cochrane systematic review previously published in 2011, which aims to investigate the specific impact of the educational component of cardiac rehabilitation. OBJECTIVES 1. To assess the effects of patient education delivered as part of cardiac rehabilitation, compared with usual care on mortality, morbidity, health-related quality of life (HRQoL) and healthcare costs in patients with CHD.2. To explore the potential study level predictors of the effects of patient education in patients with CHD (e.g. individual versus group intervention, timing with respect to index cardiac event). SEARCH METHODS We updated searches from the previous Cochrane review, by searching the Cochrane Central Register of Controlled Trials (CENTRAL) (Cochrane Library, Issue 6, 2016), MEDLINE (Ovid), Embase (Ovid), PsycINFO (Ovid) and CINAHL (EBSCO) in June 2016. Three trials registries, previous systematic reviews and reference lists of included studies were also searched. No language restrictions were applied. SELECTION CRITERIA 1. Randomised controlled trials (RCTs) where the primary interventional intent was education delivered as part of cardiac rehabilitation.2. Studies with a minimum of six-months follow-up and published in 1990 or later.3. Adults with a diagnosis of CHD. DATA COLLECTION AND ANALYSIS Two review authors independently screened all identified references for inclusion based on the above inclusion criteria. One author extracted study characteristics from the included trials and assessed their risk of bias; a second review author checked data. Two independent reviewers extracted outcome data onto a standardised collection form. For dichotomous variables, risk ratios and 95% confidence intervals (CI) were derived for each outcome. Heterogeneity amongst included studies was explored qualitatively and quantitatively. Where appropriate and possible, results from included studies were combined for each outcome to give an overall estimate of treatment effect. Given the degree of clinical heterogeneity seen in participant selection, interventions and comparators across studies, we decided it was appropriate to pool studies using random-effects modelling. We planned to undertake subgroup analysis and stratified meta-analysis, sensitivity analysis and meta-regression to examine potential treatment effect modifiers. We used the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to evaluate the quality of the evidence and the GRADE profiler (GRADEpro GDT) to create summary of findings tables. MAIN RESULTS This updated review included a total of 22 trials which randomised 76,864 people with CHD to an education intervention or a 'no education' comparator. Nine new trials (8215 people) were included for this update. We judged most included studies as low risk of bias across most domains. Educational 'dose' ranged from one 40 minute face-to-face session plus a 15 minute follow-up call, to a four-week residential stay with 11 months of follow-up sessions. Control groups received usual medical care, typically consisting of referral to an outpatient cardiologist, primary care physician, or both.We found evidence of no difference in effect of education-based interventions on total mortality (13 studies, 10,075 participants; 189/5187 (3.6%) versus 222/4888 (4.6%); random effects risk ratio (RR) 0.80, 95% CI 0.60 to 1.05; moderate quality evidence). Individual causes of mortality were reported rarely, and we were unable to report separate results for cardiovascular mortality or non-cardiovascular mortality. There was evidence of no difference in effect of education-based interventions on fatal and/or non fatal myocardial infarction (MI) (2 studies, 209 participants; 7/107 (6.5%) versus 12/102 (11.8%); random effects RR 0.63, 95% CI 0.26 to 1.48; very low quality of evidence). However, there was some evidence of a reduction with education in fatal and/or non-fatal cardiovascular events (2 studies, 310 studies; 21/152 (13.8%) versus 61/158 (38.6%); random effects RR 0.36, 95% CI 0.23 to 0.56; low quality evidence). There was evidence of no difference in effect of education on the rate of total revascularisations (3 studies, 456 participants; 5/228 (2.2%) versus 8/228 (3.5%); random effects RR 0.58, 95% CI 0.19 to 1.71; very low quality evidence) or hospitalisations (5 studies, 14,849 participants; 656/10048 (6.5%) versus 381/4801 (7.9%); random effects RR 0.93, 95% CI 0.71 to 1.21; very low quality evidence). There was evidence of no difference between groups for all cause withdrawal (17 studies, 10,972 participants; 525/5632 (9.3%) versus 493/5340 (9.2%); random effects RR 1.04, 95% CI 0.88 to 1.22; low quality evidence). Although some health-related quality of life (HRQoL) domain scores were higher with education, there was no consistent evidence of superiority across all domains. AUTHORS' CONCLUSIONS We found no reduction in total mortality, in people who received education delivered as part of cardiac rehabilitation, compared to people in control groups (moderate quality evidence). There were no improvements in fatal or non fatal MI, total revascularisations or hospitalisations, with education. There was some evidence of a reduction in fatal and/or non-fatal cardiovascular events with education, but this was based on only two studies. There was also some evidence to suggest that education-based interventions may improve HRQoL. Our findings are supportive of current national and international clinical guidelines that cardiac rehabilitation for people with CHD should be comprehensive and include educational interventions together with exercise and psychological therapy. Further definitive research into education interventions for people with CHD is needed.
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Affiliation(s)
- Lindsey Anderson
- Institute of Health Research, University of Exeter Medical School, Veysey Building, Salmon Pool Lane, Exeter, UK, EX2 4SG
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Cartledge S, Finn J, Straney L, Ngu P, Stub D, Patsamanis H, Shaw J, Bray J. The barriers associated with emergency medical service use for acute coronary syndrome: the awareness and influence of an Australian public mass media campaign. Emerg Med J 2017; 34:466-471. [PMID: 28289037 DOI: 10.1136/emermed-2016-206396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 02/03/2017] [Accepted: 02/15/2017] [Indexed: 11/04/2022]
Abstract
BACKGROUND Emergency medical services (EMS) transport to hospital is recommended in acute coronary syndrome (ACS) guidelines, but only half of patients with ACS currently use EMS. The recent Australian Warning Signs campaign conducted by the Heart Foundation addressed some of the known barriers against using EMS. Our aim was to examine the influence of awareness of the campaign on these barriers in patients with ACS. METHODS Interviews were conducted with patients admitted to an Australian tertiary hospital between July 2013 and April 2014 with a diagnosis of ACS. Patient selection criteria included: aged 35-75 years, competent to provide consent, English speaking, not in residential care and medically stable. Multivariable logistic regression was used to examine factors associated with EMS use. RESULTS Only 54% of the 199 patients with ACS interviewed used EMS for transport to hospital. Overall 64% of patients recalled seeing the campaign advertising, but this was not associated with increased EMS use (52.0%vs56.9%, p=0.49) or in the barriers against using EMS. A large proportion of patients (43%) using other transport thought it would be faster. Factors associated with EMS use for ACS were: age >65 years, ST-elevation myocardial infarction, a sudden onset of pain and experiencing vomiting. CONCLUSION In medically stable patients with ACS, awareness of the Australian Warning Signs campaign was not associated with increased use of EMS or a change in the barriers for EMS use. Future education strategies could emphasise the clinical role that EMS provide in ACS.
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Affiliation(s)
- Susie Cartledge
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Phillip Ngu
- Alfred Health, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Victoria, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia.,Baker IDI Heart and Diabetes Institute, Victoria, Australia.,Western Health, Victoria, Australia
| | | | - James Shaw
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia.,Alfred Health, Victoria, Australia.,School of Nursing, Midwifery and Paramedicine, Curtin University, Bentley, Western Australia, Australia
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Lavery T, Greenslade JH, Parsonage WA, Hawkins T, Dalton E, Hammett C, Cullen L. Factors influencing choice of pre-hospital transportation of patients with potential acute coronary syndrome: An observational study. Emerg Med Australas 2017; 29:210-216. [PMID: 28122419 DOI: 10.1111/1742-6723.12735] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Revised: 08/25/2016] [Accepted: 10/11/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To determine factors associated with ambulance use in patients with confirmed and potential acute coronary syndrome presenting to the ED. METHODS A convenience sample of patients (n = 247) presenting to the ED from April 2014 to January 2015 with suspected acute coronary syndrome were included in the study. Data on mode of transport and patient demographics were collected from the Emergency Department Information System database. Clinical data were collected from chart records and information systems. A questionnaire assessed reasons for using a chosen method of transport, symptom timing and characteristics, acute coronary syndrome knowledge, and awareness of the National Heart Foundation Early Warning Symptoms campaign. RESULTS Approximately half the patients (49.4%) assessed with symptoms of potential acute coronary syndrome used ambulance transport to the ED. Patients who arrived by ambulance were older than those not arriving by ambulance (mean 56.7 years vs 51.7 years, P = 0.01). Risk factors were not associated with ambulance use. Dizziness (P < 0.01), sweating (P = 0.03), nausea (P = 0.03) and vomiting (P = 0.04) were associated with increased ambulance use. Mean systolic blood pressure was lower in the ambulance group (136 mmHg, standard deviation [SD] = 19.8) than in the non-ambulance group (143 mmHg, SD = 25.9). Awareness of the National Heart Foundation Heart Attack Warning Signs campaign was not associated with ambulance use. CONCLUSIONS Patients with possible ischaemic symptoms who are at a high risk of cardiac disease do not utilise ambulance services more than low risk patients. In general, transport to hospital using ambulance services by patients with symptoms of possible acute coronary syndrome is low despite community campaigns.
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Affiliation(s)
- Tim Lavery
- Toowoomba Rural Clinical School, The University of Queensland, Brisbane, Queensland, Australia
| | - Jaimi H Greenslade
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - William A Parsonage
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia.,Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Tracey Hawkins
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Emily Dalton
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Christopher Hammett
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Department of Cardiology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Louise Cullen
- Department of Emergency Medicine, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,School of Public Health, Queensland University of Technology, Brisbane, Queensland, Australia
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Wechkunanukul K, Grantham H, Clark RA. Global review of delay time in seeking medical care for chest pain: An integrative literature review. Aust Crit Care 2017; 30:13-20. [DOI: 10.1016/j.aucc.2016.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 01/09/2023] Open
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Nielsen CGA, Laut KG, Jensen LO, Ravkilde J, Terkelsen CJ, Kristensen SD. Patient delay in patients with ST-elevation myocardial infarction: Time patterns and predictors for a prolonged delay. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 6:583-591. [DOI: 10.1177/2048872616676570] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Kristina G Laut
- Department of Cardiology, Aarhus University Hospital, Denmark
| | | | - Jan Ravkilde
- Department of Cardiology, Aalborg University Hospital, Denmark
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Congruence of the Medical Record and Subject Interview on Time of Symptom Onset in Patients Diagnosed With Acute Coronary Syndrome. Dimens Crit Care Nurs 2016; 35:332-338. [PMID: 27749436 DOI: 10.1097/dcc.0000000000000207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Past research has shown discrepancies between the time of symptom onset for patients with acute coronary syndrome (ACS) as documented in the medical record (MR) and patients' recall of the time assessed through subject interviews done later by researchers. PURPOSE The aim of this study is to determine if there were differences between the time of symptom onset documented in the MR and subject interview taking into consideration sex, age group, and recall period for patients admitted to the emergency department for symptoms suggestive of ACS. METHODS A secondary analysis was conducted on data from the PROMOTION (Patient Response to Myocardial Infarction Following a Teaching Intervention Offered by Nurses) trial, a multicenter randomized clinical trial to reduce patient prehospital delay to treatment in ACS. RESULTS Of the 3522 subjects with CAD enrolled into the trial, 3087 subjects completed 2-year follow-up. Of these, 331 subjects sought treatment in the emergency department for ACS symptoms and 276 patients (83%) had complete information on the time of symptom onset from both sources. Of the 276 patients, 25 (9%) had differing times more than 48 hours and were thus excluded. The median difference between the 2 sources was 45.0 minutes. When both times were examined, there were no significant differences in time by sex (P = .720) or by age group (P = .188). The median number of days between the interview and the date of symptom onset was 29.5 days. There was a significant correlation between differences in the time of symptom onset and the length of recall period (rs = 0.148, P = .023). In multivariable modeling, a longer recall period was associated with greater median differences in the symptom onset time (b = 13.2, P = .023). CONCLUSION These results suggest that the time of symptom onset obtained at the time of the index event and documented in the MR is not interchangeable with data obtained later by research staff, especially if the interview is not conducted near the time of the index event.
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Alexithymia affects the time from symptom onset to calling the emergency system in STEMI patients referred for primary PCI. Int J Cardiol 2016; 219:428-32. [DOI: 10.1016/j.ijcard.2016.06.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2016] [Accepted: 06/12/2016] [Indexed: 11/23/2022]
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Regional systems-of-care for primary percutaneous coronary intervention in ST-elevation myocardial infarction. Coron Artery Dis 2016; 26:713-22. [PMID: 26230884 DOI: 10.1097/mca.0000000000000290] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
ST-elevation myocardial infarction (STEMI) is a critical, time-dependent condition requiring immediate reperfusion of the coronary arteries to minimize mortality and morbidity. The preferred method of revascularization is a primary percutaneous coronary intervention (PCI) if this can be performed in a timely manner. This requires an effective and well-organized setup from symptom onset to revascularization. Such regional networks for the diagnosis and treatment of STEMI patients have been proven to be very effective in achieving the treatment goals stipulated by the international guidelines. Several trials have provided evidence that prehospital ECG recording and early diagnosis combined with direct referral to a primary PCI center reduces treatment delay considerably. In-hospital awareness with early notification of the PCI operator and technicians and admission directly to the catheterization laboratory also reduces time to treatment. There is solid evidence that the reduction in treatment delay achieved by dedicated STEMI networks is associated with a lower mortality and morbidity. Regional STEMI networks are now implemented in many countries with highly varying geographical challenges and healthcare systems, allowing patients everywhere to receive optimal treatment with primary PCI.
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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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Makam RP, Erskine N, Yarzebski J, Lessard D, Lau J, Allison J, Gore JM, Gurwitz J, McManus DD, Goldberg RJ. Decade Long Trends (2001-2011) in Duration of Pre-Hospital Delay Among Elderly Patients Hospitalized for an Acute Myocardial Infarction. J Am Heart Assoc 2016; 5:e002664. [PMID: 27101833 PMCID: PMC4843528 DOI: 10.1161/jaha.115.002664] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Early intervention with medical and/or coronary revascularization treatment approaches remains the cornerstone of the management of patients hospitalized with acute myocardial infarction (AMI). However, several patient groups, especially the elderly, are known to delay seeking prompt medical care after onset of AMI-associated symptoms. Current trends, and factors associated with prolonged prehospital delay among elderly patients hospitalized with AMI, are incompletely understood. METHODS AND RESULTS Data from a population-based study of patients hospitalized at all 11 medical centers in central Massachusetts with a confirmed AMI on a biennial basis between 2001 and 2011 were analyzed. Information about duration of prehospital delay after onset of acute coronary symptoms was abstracted from hospital medical records. In patients 65 years and older, the overall median duration of prehospital delay was 2.0 hours, with corresponding median delays of 2.0, 2.1, and 2.0 hours in those aged 65 to 74 years, 75 to 84 years, and in patients 85 years and older, respectively. There were no significant changes over time in median delay times in each of the age strata examined in both crude and multivariable adjusted analyses. A limited number of patient characteristics were associated with prolonged delay in this patient population. CONCLUSIONS The results of this community-wide study demonstrate that delay in seeking prompt medical care continues to be a significant problem among elderly patients hospitalized with AMI. The lack of improvement in the timeliness of patients' care-seeking behavior during the years under study remains of considerable clinical and public health concern.
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Affiliation(s)
- Raghavendra P Makam
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Nathaniel Erskine
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jorge Yarzebski
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Darleen Lessard
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jason Lau
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Jeroan Allison
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
| | - Joel M Gore
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | | | - David D McManus
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA
| | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA
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McSweeney JC, Rosenfeld AG, Abel WM, Braun LT, Burke LE, Daugherty SL, Fletcher GF, Gulati M, Mehta LS, Pettey C, Reckelhoff JF. Preventing and Experiencing Ischemic Heart Disease as a Woman: State of the Science: A Scientific Statement From the American Heart Association. Circulation 2016; 133:1302-31. [PMID: 26927362 PMCID: PMC5154387 DOI: 10.1161/cir.0000000000000381] [Citation(s) in RCA: 176] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Impact of pre-hospital electrocardiogram teletransmission on time delays in ST segment elevation myocardial infarction patients: a single-centre experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2015; 11:212-7. [PMID: 26677362 PMCID: PMC4631736 DOI: 10.5114/pwki.2015.54016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Revised: 11/12/2014] [Accepted: 03/16/2015] [Indexed: 12/05/2022] Open
Abstract
Introduction Delay in diagnosis and treatment has a great influence on morbidity and mortality of ST-segment elevation myocardial infarction (STEMI) patients. Every 30 min of delay in reperfusion is associated with an 8% increase in mortality. ECG teletransmission was proved to effectively shorten time delays in STEMI treatment. In 2012 an ECG teletransmission program was introduced in the Lower Silesia region. Aim To assess the frequency of ECG teletransmission in STEMI patients and its influence on time delays. Material and methods We conducted a retrospective analysis of all patients admitted to our hospital with STEMI in 2013. Time delays, treatment and clinical characteristics of patients with and without teletransmission performed were compared. Results The study included 137 patients, of whom 49 (36%) had teletransmission performed. Direct transport to a percutaneous coronary intervention (PCI)-capable hospital was more frequent in patients with ECG teletransmission performed (88% vs. 63%, p = 0.002). In patients with teletransmission pain-emergency room time and total ischemic time were shorter (respectively 125 (91–184) min vs. 201 (113–339) min, p = 0.001 and 159 (136–244) min vs. 259 (170–389) min, p < 0.001). There were no differences in in-hospital delay, patients’ characteristics, or applied therapy. Conclusions The percentage of STEMI patients who had ECG teletransmission performed was low. Patients with ECG teletransmission had a shorter total ischemic time and lower percentage of indirect transport to a PCI-capable hospital.
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Tra J, van der Wulp I, de Bruijne MC, Wagner C. Exploring the treatment delay in the care of patients with ST-elevation myocardial infarction undergoing acute percutaneous coronary intervention: a cross-sectional study. BMC Health Serv Res 2015; 15:340. [PMID: 26292969 PMCID: PMC4546199 DOI: 10.1186/s12913-015-0993-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Accepted: 08/10/2015] [Indexed: 01/14/2023] Open
Abstract
Background A short delay between diagnosis and treatment for patients diagnosed with ST-elevation myocardial infarction (STEMI) is vital to prevent cardiac damage and mortality. The objective of this study was to explore the treatment delay and associated factors in the management of patients diagnosed with STEMI going for percutaneous coronary intervention (PCI). Methods In a cross-sectional multicenter study, the treatment delay (time between first electrocardiogram and start of PCI procedure) of STEMI patients in seven PCI centers in the Netherlands was measured. Data were analyzed by means of multivariable generalized linear models, accounting for a non-normally distributed outcome and clustering of patients within centers. Results In total, 1017 patient charts were included. The majority of the patients (78.7 %) were treated within the guideline recommended time target of 90 min. Overall, the median treatment delay was 64 min (interquartile range 47–82). A significantly prolonged delay was found among patients of whom their first electrocardiogram was performed at a general practitioner’s practice (+23.9 min; 95 % confidence interval 9.9–40.8) or in-hospital (+9.5 min; 95 % confidence interval 2.5–17.3), patients requiring interhospital transfer (+14.6 min; 95 % confidence interval 7.6–22.4) or presenting with acute heart failure on admission (+17.6 min; 95 % confidence interval 7.9–28.7). Conclusions Despite a short median delay between first electrocardiogram and PCI, the time targets are occasionally exceeded for patients diagnosed with STEMI. To further improve the process of care, PCI centers should focus on improving regional STEMI care networks, involving general practitioners, emergency departments and referring hospitals.
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Affiliation(s)
- Joppe Tra
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Ineke van der Wulp
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Martine C de Bruijne
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands.
| | - Cordula Wagner
- Department of Public and Occupational Health, EMGO+ / VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands. .,The Netherlands Institute of Health Services Research (NIVEL), Otterstraat 118, 3513 CR, Utrecht, The Netherlands.
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Coventry LL, Bremner AP, Williams TA, Celenza A. The effect of presenting symptoms and patient characteristics on prehospital delay in MI patients presenting to emergency department by ambulance: a cohort study. Heart Lung Circ 2015; 24:943-50. [PMID: 25922230 DOI: 10.1016/j.hlc.2015.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is little recent information about prehospital delay time for Australian patients with myocardial infarction (MI). OBJECTIVES This study: (1) describes prehospital delay time for patients with MI; (2) identifies variables and presenting symptoms which contribute to the delay. METHODS This retrospective cohort study identified patients with an Emergency Department (ED) discharge diagnosis of MI, transported by ambulance to one of the seven Perth metropolitan EDs, between January 2008 and October 2009. Prehospital delay times were analysed using linear regression models. Non-numeric (word descriptions) of delay time were categorised. RESULTS Of 1,633 patients, symptom onset-time was available for 1,003. For 829 patients with a numeric onset-time, median delay was 2.2hours; decreased delay was associated with age <70 years, presenting with chest pain, and diaphoresis. Increased delay was associated with being with a primary health care provider, and if the patient was at home and if the person who called the ambulance was anyone other than the spouse. For 174 patients with non-numeric onset-times, 37% patients delayed one to three days and 110 (64.0%) patients described their symptoms as intermittent and/or of gradual onset. CONCLUSION Given that prehospital delay times remain longer than is optimal, public awareness of MI symptoms should be enhanced in order to decrease prehospital delay.
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Affiliation(s)
- Linda L Coventry
- School of Population Health, The University of Western Australia, Perth, WA, 6009; Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, WA, 6009; Faculty of Health, Engineering and Science, School of Nursing and Midwifery, Edith Cowan University, Perth, WA, 6027.
| | - Alexandra P Bremner
- School of Population Health, The University of Western Australia, Perth, WA, 6009.
| | - Teresa A Williams
- Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, WA, 6009; St John Ambulance, Western Australia, Perth, WA, 6984; Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing and Midwifery, Curtin University, Perth, WA, 6845.
| | - Antonio Celenza
- Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, WA, 6009.
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Mooney M, O'Brien F, McKee G, O'Donnell S, Moser D. Ambulance use in acute coronary syndrome in Ireland: A cross-sectional study. Eur J Cardiovasc Nurs 2015; 15:345-54. [PMID: 25805100 DOI: 10.1177/1474515115579134] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Accepted: 03/06/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND As myocardial salvage is time dependent, prompt emergency department attendance is imperative in the presence of unresolved acute coronary syndrome symptoms. Although ambulance use is the recommended mode of transport during an acute coronary syndrome event, people regularly have misperceptions about its role. Consequently, many fail to use this service when warranted. AIM To evaluate factors associated with ambulance usage among patients admitted to emergency departments with acute coronary syndrome symptoms in Ireland. METHODS Patients (N=1947) diagnosed with acute coronary syndrome were recruited across five hospitals. The ACS Response Index was used to identify mode of transport to access the emergency department, symptom context and experience and the rationale for non-ambulance use. Using logistic regression, predictors of ambulance use were identified. RESULTS Only 40.1% of the sample used an ambulance. The primary reason for non-ambulance use was the perception that it was unwarranted (31%). A further 23.8% thought another mode of transportation would be faster. Independent predictors of ambulance usage differed among the three sub-diagnoses of acute coronary syndrome. For each group, visiting the general practitioner with symptoms was associated with a greater likelihood of not using an ambulance. CONCLUSION The use of ambulance services is not positively embraced by the public. Furthermore, it appears that general practitioners may not always promote its use, particularly in the early stages of acute coronary syndrome symptom onset. The findings from our study suggest that a public education drive is necessary to promote ambulance usage during an acute coronary syndrome event.
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Affiliation(s)
| | | | | | | | - Debra Moser
- College of Nursing, University of Kentucky, Lexington, USA
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Mark L, Dani G, Vendrey R, Ruzsa J, Katona A. Improvement in prehospital time in acute coronary syndrome between 1985 and 2013 in the south-eastern area of Hungary. Wien Klin Wochenschr 2015; 127:218-21. [PMID: 25794562 DOI: 10.1007/s00508-015-0717-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2014] [Accepted: 11/11/2014] [Indexed: 12/28/2022]
Abstract
Acute coronary syndrome (ACS) is a life-threatening condition and the time-period from the onset of symptoms to the patients' arrival into the hospital has crucial importance. The authors investigated retrospectively the patients' decision time (time from the onset of the symptoms to seeking medical help) and the transport time to hospital arrival. In Hungary, it is unique of its kind that the present data can be compared to those obtained in the same area almost three decades ago.One-hundred forty-two patients (106 males and 36 females) were involved in the study, the mean age ± SD was 62.4 ± 11.3 years. The median decision time was 40 min; the median hospital arrival time was 2 h and 13 min. These were significantly shorter than in 1985-1986. These time parameters were influenced neither by gender, age, the number of inhabitants in the patients' city, the patients' education level, the occurrence of any former coronary event in the family and nor by the fact that the type of ACS was myocardial infarction with or without ST segment elevation.During the last two and half decades both the decision and the hospital arrival time decreased significantly (by 39 and 28 %, respectively) probably due to greater knowledge of general practitioners and the better organized ambulance service. Further improvement is needed; this can be expected by consistent education of the patients.
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Affiliation(s)
- Laszlo Mark
- 2nd Department of Internal Medicine-Cardiology, Pandy Kalman Bekes County Hospital, Semmelweis u. 1., P.O. Box 46, 5701, Gyula, Hungary,
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