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Yang J, Zhao Y, Wang J, Ma L, Xu H, Leng W, Wang Y, Wang Y, Wang Z, Gao X, Yang Y. Current status of emergency medical service use in ST-segment elevation myocardial infarction in China: Findings from China Acute Myocardial Infarction (CAMI) Registry. Int J Cardiol 2024; 406:132040. [PMID: 38614365 DOI: 10.1016/j.ijcard.2024.132040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2024] [Revised: 04/01/2024] [Accepted: 04/10/2024] [Indexed: 04/15/2024]
Abstract
BACKGROUND The mortality rate of myocardial infarction in China has increased dramatically in the past three decades. Although emergency medical service (EMS) played a pivotal role for the management of patients with ST-segment elevation myocardial infarction (STEMI), the corresponding data in China are limited. METHODS An observational analysis was performed in 26,305 STEMI patients, who were documented in China acute myocardial infarction (CAMI) Registry and treated in 162 hospitals from January 1st, 2013 to January 31th, 2016. We compared the differences such as demographic factors, social factors, medical history, risk factors, socioeconomic distribution and treatment strategies between EMS transport group and self-transport group. RESULTS Only 4336 patients (16.5%) were transported by EMS. Patients with symptom onset outside, out-of-hospital cardiac arrest and presented to province-level hospital were more likely to use EMS. Besides those factors, low systolic blood pressure, severe dyspnea or syncope, and high Killip class were also positively related to EMS activation. Notably, compared to self-transport, use of EMS was associated with a shorter prehospital delay (median, 180 vs. 245 min, P < 0.0001) but similar door-to-needle time (median, 45 min vs. 52 min, P = 0.1400) and door-to-balloon time (median, 105 min vs. 103 min, P = 0.1834). CONCLUSIONS EMS care for STEMI is greatly underused in China. EMS transport is associated with shorter onset-to-door time and higher rate of reperfusion, but not substantial reduction in treatment delays or mortality rate. Targeted efforts are needed to promote EMS use when chest pain occurs and to set up a unique regionalized STEMI network focusing on integration of prehospital care procedures in China. TRIAL REGISTRATION ClinicalTrials.gov (NCT01874691), retrospectively registered June 11, 2013.
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Affiliation(s)
- Jingang Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yanyan Zhao
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Jianyi Wang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Liyuan Ma
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Haiyan Xu
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Wenxiu Leng
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yang Wang
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Yan Wang
- Department of Cardiology, Xiamen Cardiovascular Hospital Xiamen University, Xia Men, Fujian Province, China
| | - Zhifang Wang
- Department of Cardiology, Xinxiang Central Hospital, Xinxiang, He Nan Province, China
| | - Xiaojin Gao
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yuejin Yang
- Coronary Heart Disease Center, Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Tuminah S, Indrawati L, Riyadina W, Wurisastuti T, Letelay AM, Sitorus N, Putri AS, Isfandari S, Irmansyah I. Number of comorbidities and the risk of delay in seeking treatment for coronary heart disease: a longitudinal study in Bogor City, Indonesia. Osong Public Health Res Perspect 2024; 15:201-211. [PMID: 38988023 PMCID: PMC11237317 DOI: 10.24171/j.phrp.2023.0337] [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: 11/13/2023] [Revised: 04/04/2024] [Accepted: 04/07/2024] [Indexed: 07/12/2024] Open
Abstract
BACKGROUND The aim of this study was to investigate the relationship between the number of patient comorbidities and the delays in seeking treatment for coronary heart disease (CHD). METHODS This longitudinal study utilized secondary data from the Non-Communicable Disease Risk Factor (NCDRF) cohort study conducted in Bogor City. Individuals who participated in the NCDRF cohort study and were diagnosed with CHD within the 6-year study period met the inclusion criteria. Respondents who were not continuously monitored up to the 6th year were excluded. The final sample included data from respondents with CHD who participated in the NCDRF cohort study and were monitored for the full 6-year duration. The final logistic regression analysis was conducted on data collected from 812 participants. RESULTS Among the participants with CHD, 702 out of 812 exhibited a delay in seeking treatment. The risk of a delay in seeking treatment was significantly higher among individuals without comorbidities, with an odds ratio (OR) of 3.5 (95% confidence interval [CI], 1.735-7.036; p<0.001). Among those with a single comorbidity, the risk of delay in seeking treatment was still notable (OR, 2.6; 95% CI, 1.259-5.418; p=0.010) when compared to those with 2 or more comorbidities. These odds were adjusted for age, sex, education level, and health insurance status. CONCLUSION The proportion of patients with CHD who delayed seeking treatment was high, particularly among individuals with no comorbidities. Low levels of comorbidity also appeared to correlate with a greater tendency to delay in seeking treatment.
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Affiliation(s)
- Sulistyowati Tuminah
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
| | - Lely Indrawati
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
| | - Woro Riyadina
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
| | - Tri Wurisastuti
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
| | - Alfons M. Letelay
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
| | - Nikson Sitorus
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
| | - Alifa S. Putri
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
| | - Siti Isfandari
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
| | - Irmansyah Irmansyah
- Research Center for Public Health and Nutrition, Research Organization for Health, National Research and Innovation Agency, Jakarta, Indonesia
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Beza L, Alemayehu B, Addissie A, Azazh A, Gary R. Treatment Seeking Behaviors and Associated Factors among Patients Experiencing Acute Coronary Syndrome Using Health Belief Model in Addis Ababa, Ethiopia. Ethiop J Health Sci 2022; 32:781-790. [PMID: 35950066 PMCID: PMC9341033 DOI: 10.4314/ejhs.v32i4.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute coronary syndrome (ACS) is a life-threatening condition. The mortality rate will be reduced if immediate treatment is provided. Patients' awareness of ACS is limited, so they do not seek help as quite often as they should. The level of treatment seeking behavior and associated factors among ACS patients admitted to three hospitals in Addis Ababa, Ethiopia, were assessed using a health belief model. Methods A cross-sectional study was conducted among 330 ACS patients from November 2019 to December 2020. Sociodemographic and clinical variables data were extracted using pre-tested checklist. The outcome and other variables data were collected using the checklist and structured questionnaire. The data were entered into Epi-data 3.1 and exported to STATA 17.1 for analysis. Descriptive statistics relevant to the variable was performed. A multivariable logistic regression was used to identify factors associated with treatment seeking behavior. Results This study revealed that the mean time from symptom onset to arrival at the emergency unit (EU) was 24 ± 19.5 hours, slightly < half of the participants (n=149, 45.1 %) had adequate treatment seeking behavior. Perceived threat (AOR=1.03,95% CI:1.01–1.06, p=0.002), perceived benefits (AOR=1.09, 95%CI: 1.02–1.0, p≤0.001), self-efficacy (AOR=1.16, 95% CI :1.01- 1.22, p≤0.001), education (AOR=2.2,95%CI:1.31–3.9, p≤0.01) self-autonomy (AOR=3.1,95%CI:1.82–5.4, p<.001) and no depression (AOR=1.9,95%CI:1.1–3.3, p≤0.05) were found to have significantly association with adequate treatment seeking behavior. Conclusion This study indicates, less than half of ACS patients had adequate treatment seeking behavior. Thus, context-specific behavioral interventions, along with public awareness campaigns about ACS, should be implemented.
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Affiliation(s)
- Lemlem Beza
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekele Alemayehu
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Aklilu Azazh
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
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Fan ZY, Yang Y, Yin RY, Tang L, Zhang F. Effect of Health Literacy on Decision Delay in Patients With Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:754321. [PMID: 34917660 PMCID: PMC8669267 DOI: 10.3389/fcvm.2021.754321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Health literacy (HL) is a risk factor for adverse outcomes in patients with cardiovascular disease, and shorter pre-hospital delay time is crucial for successful treatment of acute myocardial infraction (AMI) patients. Most previous studies focused on the influencing factors of pre-hospital delay but ignore the essential contribution of decision delay. Aims: Therefore, the purpose of this study was to explore the effect of HL on decision delay. Methods: Continuously included AMI patients admitted to a grade A class three hospital in Chongqing. HL level was assessed using Brief Health Literacy Screen and categorized as adequate or inadequate. Mann-Whitney U-test and Chi-square test were used to compare the differences between groups, and binary logistic regression was used to analyze the association between HL and decision delay. Results: A total of 217 AMI patients were enrolled in this study, including 166 males (76.5%) and 51 females (23.5%), with the median age was 68 years old; 135 (62.2%) patients had delayed decision-making while 82 (37.8%) did not; 157 (72.7%) patients had inadequate HL and 59 (27.3%) had adequate HL. The total HL score of non-delayed group was higher than that in delayed group (9.22 vs. 7.02, P < 0.000). Conclusion: After adjusting for covariates, HL was significantly negatively associated with decision time. AMI patients with inadequate HL were more likely to delay seeking timely medical care.
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Affiliation(s)
- Zhao-Ya Fan
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yuan Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruo-Yun Yin
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lei Tang
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Fan Zhang
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
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5
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Zhou T, Li X, Lu Y, Murugiah K, Bai X, Hu S, Gao Y, Masoudi FA, Krumholz HM, Li J. Changes in ST segment elevation myocardial infarction hospitalisations in China from 2011 to 2015. Open Heart 2021; 8:openhrt-2021-001666. [PMID: 34599073 PMCID: PMC8488733 DOI: 10.1136/openhrt-2021-001666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 09/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective Access to acute cardiovascular care has improved and health services capacity has increased over the past decades. We assessed national changes in (1) patient characteristics, (2) in-hospital management and (3) patient outcomes among patients presenting with ST segment elevation myocardial infarction (STEMI) in 2011–2015 in China. Methods In a nationally representative sample of hospitals in China, we created two random cohorts of patients in 2011 and 2015 separately. We weighted our findings to estimate nationally representative numbers and assessed changes from 2011 to 2015. Data were abstracted from medical charts centrally using standardised definitions. Results While the proportion of patients with STEMI among all patients with acute myocardial infarction decreased over time from 82.5% (95% CI 81.7 to 83.3) in 2011 to 68.5% (95% CI 67.7 to 69.3) in 2015 (p<0.0001), the weighted national estimate of patients with STEMI increased from 210 000 to 380 000. The rate of reperfusion eligibility among patients with STEMI decreased from 49.3% (95% CI 48.1 to 50.5) to 42.2% (95% CI 41.1 to 43.4) in 2015 (p<0.0001); ineligibility was principally driven by larger proportions with prehospital delay exceeding 12 hours (67.4%–76.7%, p<0.0001). Among eligible patients, the proportion receiving reperfusion therapies increased from 54% (95% CI 52.3 to 55.7) to 59.7% (95% CI 57.9 to 61.4) (p<0.0001). Crude and risk-adjusted rates of in-hospital death did not differ significantly between 2011 and 2015. Conclusions In this most recent nationally representative study of STEMI in China, the use of acute reperfusion increased, but no significant improvement occurred in outcomes. There is a need to continue efforts to prevent cardiovascular diseases, to monitor changes in in-hospital treatments and outcomes, and to reduce prehospital delay.
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Affiliation(s)
- Tianna Zhou
- Yale School of Medicine, New Haven, Connecticut, USA
| | - Xi Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China .,Central China Subcenter of the National Center for Cardiovascular Diseases, Zhengzhou, People's Republic of China
| | - Yuan Lu
- Yale School of Medicine, New Haven, Connecticut, USA
| | | | - Xueke Bai
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Shuang Hu
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Yan Gao
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
| | - Frederick A Masoudi
- Medicine, University of Colorado - Anschutz Medical Campus, Aurora, Colorado, USA.,Research and Analytics, MO, Ascension Health, St. Louis, Missouri, USA
| | | | - Jing Li
- National Clinical Research Center for Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, People's Republic of China
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6
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Zhang Y, Wu S, Pan J, Hoschar S, Wang Z, Tu R, Ladwig KH, Ma W. The impact of the Type D Personality pattern on prehospital delay in patients suffering from acute myocardial infarction. J Thorac Dis 2020; 12:4680-4689. [PMID: 33145041 PMCID: PMC7578491 DOI: 10.21037/jtd-20-1546] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The Type D Personality (TDP) has been specifically linked to acute myocardial infarction (AMI). However, the impact on prehospital delay of AMI patients is unclear. The aim of this study was to assess the relationship between TDP and pre-hospital delay time (PHT) in a Chinese population. Methods A total of 256 AMI patients (47 women and 209 men) were taken from the Multicenter Delay in Patients Experiencing AMI in Shanghai (MEDEA FAR-EAST) study. Sociodemographic and psycho-behavioral characteristics were assessed by bedside interviews and questionnaires. TDP was evaluated according to the Type D Personality Scale (DS14) subdivided in social inhibition (SI) and negative affectivity (NA). Based on a significant interaction analysis of TDP and sex on PHT, all analyses were stratified by sex. Results PHT of female patients with TDP were substantially shorter compared to non-TDP female patients (108 vs. 281 min, P=0.029). In male patients, no effect of TDT on PHT was found. Spearman correlation analysis suggests that NA was negatively correlated with PHT (r=−0.358, P=0.014). Further age-adjusted logistic regression analyses showed that female patients with TDP were generally less likely to prehospital delay compared with non-TDP patients (OR =0.28; 95% CI, 0.08–0.98) and had a lower risk of PHT >360 minutes (OR =0.10; 95% CI, 0.01–0.91). However, statistical significance disappeared after adjustment for psychological factors (anxiety, depression, suboptimal wellbeing, cardiac denial and stress event). Conclusions TDP is associated with less prehospital delay in female patients during AMI—an effect which may be particularly mediated by NA.
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Affiliation(s)
- Youyang Zhang
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Shihao Wu
- Department of Geriatrics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Jiangqi Pan
- Department of Cardiology, Gongli Hospital, Navy Military Medical University, Shanghai, China
| | - Sophia Hoschar
- Institute of Epidemiology, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health (HMGU), Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center-University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Zhen Wang
- Department of General Practice, Jiangning Hospital, Nanjing Medical University, Nanjing, China
| | - Rongxiang Tu
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
| | - Karl-Heinz Ladwig
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Rechts der Isar, Technische Univerität Munich (TUM), Munich, Germany
| | - Wenlin Ma
- Department of Cardiology, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China.,Department of Geriatrics, Shanghai Tongji Hospital, Tongji University School of Medicine, Shanghai, China
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7
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Fu X, Wilson P, Chung WSF. Time-to-reperfusion in patients with acute myocardial infarction and mortality in prehospital emergency care: meta-analysis. BMC Emerg Med 2020; 20:65. [PMID: 32842962 PMCID: PMC7448494 DOI: 10.1186/s12873-020-00356-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 08/03/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND People living in rural areas usually suffer comparatively disadvantaged emergency health care than those living in urban areas, reasons including long transit time due to geographic factors. As for many time critical diseases, it is necessary to obtain treatment as quickly as possible. METHODS Screening of eligible studies were conducted based on inclusion an exclusion criteria. A comprehensive search was conducted by using following database: EMBASE, Medline, Cochrane library and Scopus. Quality assessment tool for observational cohort and cross-sectional study is used for assessing the risk of bias. The time group were defined based on the median or mean transit time among patients. In symptom onset-balloon time, we take 120 min transit time as the standard so patients in included studies are divided into two groups:less than 120 min (group A) and more than 120 min (group B). The collected data were used for quantitative analysis, they were inputted into Review Manager Software (v5.3) to produce summary results. RESULTS Ten studies representing 71,099 patients were included in the meta-analysis. All studies were retrospective and prospective observational studies and RCTs in which patients experienced ST-elevation myocardial infarction (STEMI) and were treated with percutaneous coronary intervention (PCI). Random effects meta-analysis of the point estimate was 0.69 (CI 0.60, 0.79). Heterogeneity between study results was evaluated via examination of the forest plots and quantified by using I2 statistic. Heterogeneity in two stage time was moderate among studies (I2 = 29%, P = 0.23). CONCLUSION The meta-analysis for included studies report less mortality in less than 120 min symptom onset-balloon and door-balloon time than that in more than 120 min. It is necessary to optimize the prehospital system for rapid decision making and logical destination and mode of transport with prehospital notification of the cath lab so that the hospital is ready to optimize door to balloon time.
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Affiliation(s)
- Xing Fu
- Chengdu Center for Disease Control and Prevention, Chengdu, China
| | - Philip Wilson
- University of Aberdeen, Aberdeen, The United Kingdom of Great Britain and Northern Ireland, Aberdeen, UK
| | - Wing Sun Faith Chung
- University of Aberdeen, Aberdeen, The United Kingdom of Great Britain and Northern Ireland, Aberdeen, UK
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8
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Hoschar S, Pan J, Wang Z, Fang X, Tang X, Shi W, Tu R, Xi P, Che W, Wang H, Li Y, Fritzsche K, Liu X, Ladwig KH, Ma W. The MEDEA FAR-EAST Study: Conceptual framework, methods and first findings of a multicenter cross-sectional observational study. BMC Emerg Med 2019; 19:31. [PMID: 31046724 PMCID: PMC6498495 DOI: 10.1186/s12873-019-0240-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2018] [Accepted: 03/14/2019] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND The substantial increase in cardiovascular diseases (CVD) in China over the last three decades warrants comprehensive preventive primary and secondary strategies. Prolonged prehospital delay (PHD) has been identified as a substantial barrier to timely therapeutic interventions for acute myocardial infarction (AMI). Despite worldwide efforts to decrease the patient's decision-making time, minimal change has been achieved so far. Here, we aim to describe the conceptual framework and methods and outline key data of the MEDEA FAR-EAST Study, which aimed to elucidate in-depth barriers contributing to delay in Chinese AMI-patients. METHODS Data sources of this multicenter cross-sectional observational study are a standardized bedside interview, a self-administered tailored questionnaire tool and the patient chart. PHD was defined as the main outcome and triangulated at bedside. Standard operation procedures ensured uniform data collection by trained study personnel. The study was ethically approved by Tongji-Hospital and applied to all participating hospitals. RESULTS Among 379 consecutively screened patients, 296 (78.1%) fulfilled eligibility criteria. A total of 241 (81.4%) AMI-patients were male and 55 (18.6%) female. Mean age was 62.9 years. Prehospital delay time was assessed for 294 (99.3%) patients. Overall median PHD was 151 min with no significant sex difference. Symptom mismatch was present in 200 (69.7%) patients and 106 (39.0%) patients did not attribute their symptoms to cardiac origin. A total of 33 (12.4%) patients suffered from depression, 31 (11.7%) from anxiety and 141 (53.2%) patients employed denial as their major coping style. CONCLUSION This is the first study on prehospital delay with emphasis on psychological variables in Chinese AMI-patients. A comprehensive assessment tool to measure clinical and psychological factors was successfully implemented. Socio-demographic key data proved a good fit into preexisting Chinese literature. Potential barriers including cardiac denial and symptom-mismatch were assessed for the first time in Chinese AMI-patients. The pretested selection of instruments allows future in depth investigations into barriers to delay of Chinese AMI-patients and enables inter-cultural comparisons.
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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 (GmbH), Ingolstädter Landstr 1, 85764, Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Medical Center- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Jiangqi Pan
- Department of Cardiology, Tongji-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Zhen Wang
- Department of Cardiology, Tongji-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Xiaoyan Fang
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr 1, 85764, Neuherberg, Germany.,Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany
| | - Xian'e Tang
- Department of Cardiology, Tongji-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Weiqi Shi
- Department of Cardiology, Tongji-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Rongxiang Tu
- Department of Cardiology, Tongji-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Peng Xi
- Department of Cardiology, Tongji-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Wenliang Che
- Department of Cardiology, Tenth-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Hongbao Wang
- Department of Cardiology, Yangpu-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Yawei Li
- Department of Cardiology, 455-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Kurt Fritzsche
- Department of Psychosomatic Medicine and Psychotherapy, Medical Center- University of Freiburg, Faculty of Medicine, Freiburg, Germany
| | - Xuebo Liu
- Department of Cardiology, Tongji-Hospital, Tongji-University, Shanghai, People's Republic of China
| | - Karl-Heinz Ladwig
- Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health (GmbH), Ingolstädter Landstr 1, 85764, Neuherberg, Germany. .,Department of Psychosomatic Medicine and Psychotherapy, Technical University Munich, Munich, Germany.
| | - Wenlin Ma
- Department of Cardiology, Tongji-Hospital, Tongji-University, Shanghai, People's Republic of China
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9
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Fu R, Song CX, Dou KF, Yang JG, Xu HY, Gao XJ, Liu QQ, Xu H, Yang YJ. Differences in symptoms and pre-hospital delay among acute myocardial infarction patients according to ST-segment elevation on electrocardiogram: an analysis of China Acute Myocardial Infarction (CAMI) registry. Chin Med J (Engl) 2019; 132:519-524. [PMID: 30807351 PMCID: PMC6416090 DOI: 10.1097/cm9.0000000000000122] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Approximately 70% patients with acute myocardial infarction (AMI) presented without ST-segment elevation on electrocardiogram. Patients with non-ST segment elevation myocardial infarction (NSTEMI) often presented with atypical symptoms, which may be related to pre-hospital delay and increased risk of mortality. However, up to date few studies reported detailed symptomatology of NSTEMI, particularly among Asian patients. The objective of this study was to describe and compare symptoms and presenting characteristics of NSTEMI vs. STEMI patients. METHODS We enrolled 21,994 patients diagnosed with AMI from China Acute Myocardial Infarction (CAMI) Registry between January 2013 and September 2014. Patients were divided into 2 groups according to ST-segment elevation: ST-segment elevation (STEMI) group and NSTEMI group. We extracted data on patients' characteristics and detailed symptomatology and compared these variables between two groups. RESULTS Compared with patients with STEMI (N = 16,315), those with NSTEMI (N = 5679) were older, more often females and more often have comorbidities. Patients with NSTEMI were less likely to present with persistent chest pain (54.3% vs. 71.4%), diaphoresis (48.6% vs. 70.0%), radiation pain (26.4% vs. 33.8%), and more likely to have chest distress (42.4% vs. 38.3%) than STEMI patients (all P < 0.0001). Patients with NSTEMI were also had longer time to hospital. In multivariable analysis, NSTEMI was independent predictor of presentation without chest pain (odds ratio: 1.974, 95% confidence interval: 1.849-2.107). CONCLUSIONS Patients with NSTEMI were more likely to present with chest distress and pre-hospital patient delay compared with patients with STEMI. It is necessary for both clinicians and patients to learn more about atypical symptoms of NSTEMI in order to rapidly recognize myocardial infarction. TRIAL REGISTRATION www.clinicaltrials.gov (No. NCT01874691).
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Affiliation(s)
- Rui Fu
- Department of Cardiology, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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10
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Guan W, Venkatesh AK, Bai X, Xuan S, Li J, Li X, Zhang H, Zheng X, Masoudi FA, Spertus JA, Krumholz HM, Jiang L. Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study. EUROPEAN HEART JOURNAL. QUALITY OF CARE & CLINICAL OUTCOMES 2019; 5:63-71. [PMID: 29878087 PMCID: PMC6307335 DOI: 10.1093/ehjqcco/qcy022] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 05/24/2018] [Indexed: 11/12/2022]
Abstract
Aims Few contemporary studies have reported the time between acute myocardial infarction (AMI) symptoms onset and hospital arrival, associated factors, and patient perceptions of AMI symptoms and care seeking. We sought to study these issues using data from China, where AMI hospitalizations are increasing. Methods and results We used data from the China PEACE prospective AMI study of 53 hospitals across 21 provinces in China. Patients were interviewed during index hospitalization for information of symptom onset, and perceived barriers to accessing care. Regression analyses were conducted to explore factors associated with the time between symptom onset and hospital arrival. The final sample included 3434 patients (mean age 61 years). The median time from symptom onset to hospital arrival was 4 h (interquartile range 2–7.5 h). While 94% of patients reported chest pain or chest discomfort, only 43% perceived symptoms as heart-related. In multivariable analyses, time to hospital arrival was longer by 14% and 39% for patients failing to recognize symptoms as cardiac and those with rural medical insurance, respectively (both P < 0.001). Compared with patients with household income over 100 000 RMB, those with income of 10 000–50 000 RMB, and <10 000 RMB had 16% and 23% longer times, respectively (both P = 0.03). Conclusion We reported an average time to hospital arrival of 4 h for AMI in China, with longer time associated with rural medical insurance, failing to recognize symptoms as cardiac, and low household income. Strategies to improve the timeliness of presentation may be essential to improving outcomes for AMI in China. Clinical trial registration https://clinicaltrials.gov/ct2/show/NCT01624909.
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Affiliation(s)
- Wenchi Guan
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China
| | - Arjun K Venkatesh
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, USA
- Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, Ste 260, New Haven, CT, USA
| | - Xueke Bai
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China
| | - Si Xuan
- Department of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, Los Angeles, California, USA
| | - Jing Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China
| | - Xi Li
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China
| | - Haibo Zhang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China
| | - Xin Zheng
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China
| | - Frederick A Masoudi
- Division of Cardiology, University of Colorado Anschutz Medical Campus, Campus Box B132, 12401 East 17th Avenue, Room 522, Aurora, CO, USA
| | - John A Spertus
- Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, 4401 Wornall Road, Kansas City, MO, USA
| | - Harlan M Krumholz
- Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, USA
- Department of Health Policy and Management, Yale University School of Public Health, 60 College Street, New Haven, CT, USA
- Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, SHM I-456, New Haven, CT, USA
| | - Lixin Jiang
- National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China
- Corresponding author. Tel: +86 10 8839 6203, Fax: +86 10 8836 5201,
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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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12
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Nguyen HL, Phan DT, Ha DA, Nguyen QN, Goldberg RJ. Pre-hospital delay in Vietnamese patients hospitalized with a first acute myocardial infarction: A short report. F1000Res 2015; 4:633. [PMID: 29445447 PMCID: PMC5790997 DOI: 10.12688/f1000research.6943.3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2018] [Indexed: 01/10/2023] Open
Abstract
Background: Administration of coronary reperfusion therapy to patients with an acute myocardial infarction (AMI) within the proper timeframe is essential in avoiding clinical complications and death. However, the extent of pre-hospital delay is unexplored in Vietnam. This report aims to describe the duration of pre-hospital delay of Hanoi residents hospitalized with a first AMI at the Vietnam National Heart Institute . Methods: A total of 103 Hanoi residents hospitalized at the largest tertiary care medical center in the city for first AMI, who have information on prehospital delay was included in this report. Results: One third of the study sample was women and mean age was 66 years. The mean and median pre-hospital delay duration were 14.9 hours and 4.8 hours, respectively. The proportion of patients who delayed <6 , 6-<12, and ≥ 12 hours were 45%, 13%, and 42%, respectively. Conclusions: Our data shows that a prolonged pre-hospital delay is often observed in patients with a first AMI in Vietnam. In order to confirm these preliminary descriptive findings, a full-scale investigation of all Hanoi residents hospitalized with first AMI is needed. Increasing public awareness about AMI treatment is vital in encouraging patients to seek medical care timely after experiencing AMI symptoms such that received treatment is most effective.
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Affiliation(s)
- Hoa L Nguyen
- Department of Quantitative Sciences , Baylor Scott & White Health, Dallas, Texas, USA.,Institute of Population, Health and Development, Ha Noi, Vietnam
| | - Dat T Phan
- Viet Nam National Heart Institute, Ha Noi, Vietnam
| | - Duc A Ha
- Ministry of Health, Ha Noi, Vietnam
| | | | - Robert J Goldberg
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Massachusetts, USA
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Sex differences in clinical characteristics, hospital management practices, and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first acute myocardial infarction. PLoS One 2014; 9:e95631. [PMID: 24752383 PMCID: PMC3994106 DOI: 10.1371/journal.pone.0095631] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2014] [Accepted: 03/28/2014] [Indexed: 11/21/2022] Open
Abstract
Background Cardiovascular disease is one of the leading causes of morbidity and mortality in Vietnam. We conducted a pilot study of Hanoi residents hospitalized with acute myocardial infarction (AMI) at the Vietnam National Heart Institute in Hanoi. The objectives of this observational study were to examine sex differences in clinical characteristics, hospital management, in-hospital clinical complications, and mortality in patients hospitalized with an initial AMI. Methods The study population consisted of 302 Hanoi residents hospitalized with a first AMI at the largest tertiary care medical center in Hanoi in 2010. Results The average age of study patients was 66 years and one third were women. Women were older (70 vs. 64 years) and were more likely than men to have had hyperlipidemia previously diagnosed (10% vs. 2%). During hospitalization, women were less likely to have undergone percutaneous coronary intervention (PCI) compared with men (57% vs. 74%), and women were more likely to have developed heart failure compared with men (19% vs. 10%). Women experienced higher in-hospital case-fatality rates (CFRs) than men (13% vs. 4%) and these differences were attenuated after adjustment for age and history of hyperlipidemia (OR: 2.64; 95% CI: 1.01, 6.89), and receipt of PCI during hospitalization (OR: 2.09; 95% CI: 0.77, 5.09). Conclusions Our pilot data suggest that among patients hospitalized with a first AMI in Hanoi, women experienced higher in-hospital CFRs than men. Full-scale surveillance of all Hanoi residents hospitalized with AMI at all Hanoi medical centers is needed to confirm these findings. More targeted and timely educational and treatment approaches for women appear warranted.
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Mackay MH, Ratner PA, Nguyen M, Percy M, Galdas P, Grunau G. Inconsistent measurement of acute coronary syndrome patients' pre-hospital delay in research: a review of the literature. Eur J Cardiovasc Nurs 2014; 13:483-93. [PMID: 24532675 DOI: 10.1177/1474515114524866] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients' treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research. METHODS AND RESULTS We reviewed the English-language literature from 1998-2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing. CONCLUSION We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.
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Affiliation(s)
- Martha H Mackay
- School of Nursing, University of British Columbia, Canada St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | - Michelle Nguyen
- St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | | | - Gilat Grunau
- School of Nursing, University of British Columbia, Canada
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