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Ookeditse O, Ookeditse KK, Motswakadikgwa TR, Masilo G, Bogatsu Y, Lekobe BC, Mosepele M, Schirmer H, Johnsen SH. Age and healthy lifestyle behavior's disparities and similarities on knowledge of myocardial infarction symptoms and risk factors among public and outpatients in a resource-limited setting, cross-sectional study in greater Gaborone, Botswana. BMC Cardiovasc Disord 2024; 24:140. [PMID: 38439021 PMCID: PMC10910839 DOI: 10.1186/s12872-024-03792-4] [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: 09/08/2023] [Accepted: 02/15/2024] [Indexed: 03/06/2024] Open
Abstract
OBJECTIVES In this cross-sectional study from Botswana, we investigated knowledge of myocardial infarction (MI) symptoms and risk factors among the general public and outpatients with MI risk factors based on age and lifestyle behaviors, in addition to assessing associations with sociodemographic and MI risk factors. METHOD Open-ended questionnaires about 8 MI symptoms and 10 risk factors, were administered by research assistants to a representative selection of outpatients (n = 525) and the public (n = 2248). Weight and height were measured in all participants and BMI was calculated. Knowledge scores were compared between the two groups. We examined whether sociodemographic and MI risk factors had impact on the scores. Analyses were further adjusted for lifestyle behavior (smoking status, dietary status and physical activities). RESULTS The valid response rate was 97.9% comprising 97.8% for the public (n = 2199) and 98.1% for outpatients (n = 515). Public respondents (35.2 ± 12.3 years) were younger than outpatients (38.5 ± 12.6 years). The public comprised 56.9% females while outpatients 54.6%. In general, outpatients had higher knowledge of MI symptoms than the public, with mean scores ± SD of 3.49 ± 2.84 vs 2.80 ± 2.54. Outpatients also had higher knowledge score of MI risk factors than the public, with mean scores, 5.33 ± 3.22 vs 3.82 ± 3.07. For MI symptoms, outpatients were more aware than the public for chest pains among all ages, for arm pain/ numbness, neck/ jaw pain radiating to/ from chest, and feeling sick or looking pallor on the skin among those aged 35-49 years. Among both the public and outpatients, lower knowledge of both MI symptoms and risk factors was associated with primary education, not residing/working together, history of hypertension, no history of heart disease/stroke, and obesity. There were similarities and disparities on MI knowledge among respondents with various numbers of healthy lifestyle behaviours. CONCLUSION Results call for urgent educational campaigns on awareness and knowledge of MI and using strategies based on age and lifestyle behavior.
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Affiliation(s)
- Ookeditse Ookeditse
- Department of Physical Medicine and Rehabilitation, Trust Hospital in Vestfold, Kysthospitalet, Division of Neurorehabilitation Medicine, Tønsberg, Norway
- Department of Family Medicine, Larvik County Acute and Emergency Clinic, Larvik, Norway
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | | | | | - Gosiame Masilo
- Department of Family Medicine, Larvik County Acute and Emergency Clinic, Larvik, Norway
- Division of Family Medicine, Nanset Medical Clinic, Larvik, Norway
| | - Yaone Bogatsu
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
| | - Baleufi C Lekobe
- Department of Internal Medicine, Sidilega Private Hospital, Gaborone, Botswana
| | - Mosepele Mosepele
- Faculty of Medicine, University of Botswana, Gaborone, Botswana
- Princess Marina Referral Hospital, Gaborone, Botswana
| | - Henrik Schirmer
- UIT The Arctic University of Norway, Institute of Clinical Medicine, Tromsø, Norway
- Department of Cardiology, Akershus University Hospital, Lørenskog, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Stein H Johnsen
- UIT The Arctic University of Norway, Institute of Clinical Medicine, Tromsø, Norway.
- Department of Neurology, University Hospital of North Norway, Tromsø, Norway.
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Hussain MM, Baharuddin KA, Fauzi MH, Abu Bakar MA, Ziyan A, Ahmed AZ, Sunil M. Factors associated with prehospital delay in acute myocardial infarction in Maldives. Int J Emerg Med 2023; 16:31. [PMID: 37122000 PMCID: PMC10149151 DOI: 10.1186/s12245-023-00503-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2022] [Accepted: 04/02/2023] [Indexed: 05/02/2023] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is the top cause of death in Maldives. Our study aims to determine the prehospital delay and its associated factors in AMI patients in Maldives. METHODS A cross-sectional study was conducted with 127 patients, divided into early (≤ 6 h) and delayed (> 6 h) presenters to the hospital. The data collection for the study was carried out by interviewing AMI patients, focusing on their socio-demographic characteristics, coronary artery disease risk factors, clinical symptoms, situational factors, and behavioral and cognitive responses to symptoms. RESULTS The median onset-to-door time was 230 (IQR 420) minutes. The mean age of AMI patients was 50.9 (SD ± 12.9) years old, and 39.4% of them had delayed presentation to the hospital. Smokers (adj OR = 0.3; 95% CI: 0.1, 0.9; P = 0.047) and those with previous episodes of chest pain or AMI (adj OR = 0.2; 95% CI: 0.03, 0.91; P = 0.038) were significant factors for early presentation to the hospital, while denial of symptoms (adj OR = 29.3; 95% CI: 1.6, 547.2; P = 0.024) and lack of knowledge (adj OR = 7.2; 95% CI: 1.77, 29.43; P = 0.006) led to a delayed decision to seek treatment. Situational factors such as onset at the workplace (adj OR = 5.8; 95% CI: 1.24, 26.83; P = 0.025) had lower odds of delay, whereas referral cases (adj OR = 7.7; 95% CI: 1.9, 30.94; P = 0.004) and use of sea ambulance (adj OR = 11.1; 95% CI: 2.8, 43.8; P = 0.001) were prone to delay in presentation to the hospital. CONCLUSION Sea ambulance, referral cases, lack of knowledge, and denial of symptoms are significant factors associated with prehospital delay among patients with AMI. Public awareness about the benefits of early presentation and improvement of the means of transportation between islands is suggested to improve emergency cardiac care in the country.
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Affiliation(s)
- Madheeh Mohamed Hussain
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Kamarul Aryffin Baharuddin
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia.
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia.
| | - Mohd Hashairi Fauzi
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Mimi Azliha Abu Bakar
- Department of Emergency Medicine, School of Medical Sciences, Universiti Sains Malaysia, Health Campus, 16150 Kubang Kerian, Kelantan, Malaysia
- Hospital Universiti Sains Malaysia, Kubang Kerian, 16150, Kelantan, Malaysia
| | - Ahmed Ziyan
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Aminath Zeyba Ahmed
- Trauma and Emergency Department, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
| | - Mohamed Sunil
- National Cardiac Centre, Indira Gandhi Memorial Hospital, Malé, Republic of Maldives
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Muacevic A, Adler JR. Knowledge and Attitude of General People Towards Symptoms of Heart Attack and the Impact of Delay Time in Riyadh, Saudi Arabia. Cureus 2022; 14:e32758. [PMID: 36561329 PMCID: PMC9767791 DOI: 10.7759/cureus.32758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cardiovascular disease is prevalent worldwide. The goal of this research is to evaluate the knowledge of Riyadh, Saudi Arabia, population about heart attack symptoms and risk factors. METHODOLOGY A one-year cross-sectional study was carried out. The study was conducted on 385 individuals in Riyadh, Saudi Arabia. We used the Acute Coronary Syndrome Response Index, with additional questions added, such as risk factors of heart attack and physical activity time. An anonymous self-administered online questionnaire was used to collect the data. RESULTS We collected data from 440 participants, but only 385 were included in the analysis. Males represented 41.4% of the participants. In terms of participant knowledge of heart attack symptoms, we found that chest pain or pressure was the most common (80.5%), followed by shortness of breath (77%) and weakness and fatigue (72.0%). In addition, 90.2% and 90.7% of the participants knew that smoking and obesity were risk factors for heart attacks. Furthermore, 46% of participants said they "would not be at all certain" of identifying the symptoms and indicators of a heart attack in another person and 45.7% "in themselves." We found that males were more likely than females to have low knowledge (RR: 1.84, 95% CI: 1.24:2.72, P = 0.002). CONCLUSION Our findings suggest that there is a lack of awareness of the heart attack warning signs and symptoms. We propose that future local campaigns focus on increasing awareness and recognition of heart attack symptoms.
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Demisse L, Alemayehu B, Addissie A, Azazh A, Gary R. Knowledge, attitudes and beliefs about acute coronary syndrome among patients diagnosed with acute coronary syndrome, Addis Ababa, Ethiopia. BMC Cardiovasc Disord 2022; 22:444. [PMID: 36241970 PMCID: PMC9563121 DOI: 10.1186/s12872-022-02893-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 10/10/2022] [Indexed: 11/24/2022] Open
Abstract
Background Acute coronary syndrome (ACS) morbidity and mortality are rising in low- and middle-income countries, including Ethiopia. The shift in health-care resources from communicable diseases to chronic conditions has created formidable health-care challenges. Objective The objective of this study was to examine the knowledge, attitudes and beliefs among ACS patients. Methods A cross-sectional design was used to enroll participants admitted to one of 3 emergency units in Addis Ababa, Ethiopia. Knowledge, attitudes and beliefs about ACS was measured using modified ACS response index questionaries. Results Participant’s (N = 330) mean age was 57.9 ± 14.1, majority male (n = 219, 66.36%). Half of the study participants have inadequate Knowledge (n = 147, 44.6%), unfavorable attitudes (n = 152, 46%), and belief (n = 153, 46.4%) about ACS symptoms even after being diagnosed and treated in the emergency unit. The most frequently recognized ACS symptoms were chest discomfort (n = 274, 83%), fatigue (n = 267, 80.9%) and chest pain (n = 266, 80.6%) while Jaw pain (n = 101, 30%) neck pain (n = 146,44.2%), were less often recognized. Nearly two thirds of the participants (n = 214, 65%) would not prefer to use emergency medical services (EMS) to come to the hospital. Factors associated with adequate knowledge were age < 45 (AOR = 2.16, CI (1.1–4.0) p = 0.014), and female sex (AOR = 2.7, CI (1.5–4.4) p = 0.001) and diabetics (AOR = 1.9, (1.18–3.0) p = 0.008). Meanwhile, lack of formal education (AOR = 6.7, CI (3.1–14) p < 0.001) and unemployment (AOR = 2.0, CI (1.1–3.8) p = 0.021) were associated with unfavorable attitude. In addition, lack of social support (AOR = 1.9, (1.17–3.0) p = 0.009) and unfavorable attitude (AOR = 2.1, CI (1.3–3.4) p = 0.001) were significantly associated with unfavorable belief. Conclusion Despite receiving treatment for ACS in an emergency unit, roughly half of participants did not have adequate knowledge, favorable attitude and belief towards ACS. This elucidates there is significant communication gap between the health care providers and patients. The study findings stipulate there is a need to provide health awareness campaigns using different media outlet with special attention to the uneducated and unemployed groups. Furthermore, most participants were less likely to utilize emergency medical service, which should be further investigated and addressed.
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Affiliation(s)
- Lemlem Demisse
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
| | - Bekele Alemayehu
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Aklilu Azazh
- 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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Factors Responsible for Prehospital Delay in Patients with Acute Coronary Syndrome in Bangladesh. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091206. [PMID: 36143884 PMCID: PMC9502759 DOI: 10.3390/medicina58091206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 08/29/2022] [Accepted: 08/30/2022] [Indexed: 11/25/2022]
Abstract
Background: Acute coronary syndrome (ACS) remains a cause of high morbidity and mortality among adults, despite advances in treatment. Treatment modality and outcomes of ACS mainly depend on the time yielded since the onset of symptoms. Prehospital delay is the time between the onset of myocardial ischemia/infarction symptoms and arrival at the hospital, where either pharmacological or interventional revascularization is available. This delay remains unacceptably long in many countries worldwide, including Bangladesh. The current study investigates several sociodemographic characteristics as well as clinical, social, and treatment-seeking behaviors, with an aim to uncover the factors responsible for the decision time to get medical help and home-to-hospital delay. Materials and Methods: A prospective cross-sectional study was conducted between July 2019 and June 2020 in 21 district hospitals and 6 medical college hospitals where cardiac care facilities were available. The population selected for this study was patients with ACS who visited the studied hospitals during the study period. Following confirmation of ACS, a semi-structured data sheet was used to collect the patient data and was subsequently analyzed. Results: This study evaluated 678 ACS patients from 30 districts. The majority of the patients were male (81.9%), married (98.2%), rural residents (79.2), middle-aged (40–60 years of age) (55.8%), low-income holders (89.4%), and overweight (56.9%). It was found that 37.5% of the patients received their first medical care after 12 h of first symptom presentation. The study found that the patients’ age, residence, education, and employment status were significant factors associated with prehospital delay. The patients with previous myocardial infarction (MI) and chest pain arrived significantly earlier at the hospital following ACS onset. Location of symptom onset, first medical contact with a private physician, distance from symptom onset location to location of first medical contact, the decision about hospitalization, ignorance of symptoms, and mode of transportation were significantly associated with prehospital delay. Conclusions: Several factors of prehospital delay of the ACS patients in Bangladesh have been described in this study. The findings of this study may help the national health management system identify the factors related to treatment delay in ACS and thus reduce ACS-related morbidity and mortality.
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Factors Affecting Delayed Hospital Arrival of Patients with Acute Myocardial Infarction in Kinmen. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031323. [PMID: 35162347 PMCID: PMC8834892 DOI: 10.3390/ijerph19031323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 01/21/2022] [Accepted: 01/22/2022] [Indexed: 12/04/2022]
Abstract
This study explores factors related to delayed emergency medical treatment for acute myocardial infarction patients on Kinmen Island. A cross-sectional study was performed in the only hospital in Kinmen Island. The study group consisted of 116 patients diagnosed with acute myocardial infarction (AMI, ICD-10 codes: 121.9) from November 2015 to May 2019. The binary logistic regression analyses were performed for the inferential statistical analysis. The mean age of the study group was 63.0 ± 14.5 years, 39.7% of the patients arrived at the emergency medicine longer than 6 h after the onset of symptoms. The related factors for delayed arrival the hospital emergency medicine department were female sex, age over 65 years, less than nine years’ education, and Killip Class, but only Killip Class reached the significant difference of statistics (OR = 3.616, 95% C.I. = 1.574 to 8.310, p = 0.002), and patients with delayed arrival times (>6 h) were found to have a higher percentage of Killip Class ≥ II. Therefore, it is essential to remind the physicians to proceed with risk stratification for acute coronary syndrome patients. In addition, health authorities should provide effective programs to increase awareness of the symptoms and timely treatment of acute myocardial infraction to the general public, especially the elderly.
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Chowdhury IZ, Amin MN, Chowdhury MZ, Rahman SM, Ahmed M, Cader FA. Pre hospital delay and its associated factors in acute myocardial infarction in a developing country. PLoS One 2021; 16:e0259979. [PMID: 34818360 PMCID: PMC8612565 DOI: 10.1371/journal.pone.0259979] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 10/29/2021] [Indexed: 01/03/2023] Open
Abstract
Background Early revascularization and treatment is key to improving clinical outcomes and reducing mortality in acute myocardial infarction (AMI). In low- and middle-income countries such as Bangladesh, timely management of AMI is challenging, with pre-hospital delays playing a significant role. This study was designed to investigate pre-hospital delay and its associated factors among patients presenting with AMI in the capital city of Dhaka. Methods This retrospective cohort study was conducted on 333 patients presenting with AMI over a 3-month period at two of the largest primary reperfusion-capable tertiary cardiac care centres in Dhaka. Of the total patients, 239(71.8%) were admitted in the National Institute of Cardiovascular Diseases, Dhaka and 94(28.2%) at Ibrahim Cardiac Hospital & Research Institute, Dhaka Data were collected from patients by semi-structured interview and hospital medical records. Pre-hospital delay (median and inter-quartile range) was calculated. Statistical significance was determined by Chi-square test. Multivariate logistic regression analysis was done to determine the independent predictors of pre-hospital delay. Results The mean age of the respondents was 53.8±11.2 years. Two-thirds (67.6%) of the respondents were males. Median total pre-hospital delay was 11.5 (IQR-18.3) hours with median decision time from symptom onset to seeking medical care being 3.0 (IQR: 11.0) hours. Nearly half (48.9%) of patients presented to the hospital more than 12 hours after symptom onset. On multivariate logistic regression analysis, AMI patients with absence of typical chest pain [OR 5.21; (95% CI: 2.5–9.9)], diabetes [OR: 1.7 (95% CI: 1.0–2.9)], residing/staying > 30 km away from nearest hospital at the time of onset [OR: 4.3(95% CI = 2.3–7.2)] and belonged to lower and middle class [OR: 1.9(95% CI = 1.0–3.5)] were significantly associated with pre-hospital delays. Conclusion Acute myocardial infarction (AMI) patients with atypical chest pain, diabetes, staying far away from nearest hospital and belonged to lower and middle socioeconomic strata were significantly associated with pre-hospital delays. The findings could have immense implications for improvements about timely reaching of AMI patients to the hospital within the context of their sociodemographic status and geographic barriers of the city.
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Affiliation(s)
| | - Md Nurul Amin
- Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
| | - Mashhud Zia Chowdhury
- Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
| | | | - Mohsin Ahmed
- Department of Cardiology, National Institute of Cardiovascular Diseases, Dhaka, Bangladesh
| | - F Aaysha Cader
- Department of Cardiology, Ibrahim Cardiac Hospital and Research Institute, Dhaka, Bangladesh
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Surviving to Acute Myocardial Infarction: The Role of Psychological Factors and Alexithymia in Delayed Time to Searching Care: A Systematic Review. J Clin Med 2021; 10:jcm10173813. [PMID: 34501261 PMCID: PMC8432253 DOI: 10.3390/jcm10173813] [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] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 08/18/2021] [Accepted: 08/19/2021] [Indexed: 12/16/2022] Open
Abstract
The time from symptom onset to reperfusion is a critical determinant of myocardial salvage and clinical outcomes in patients with acute myocardial infarction (AMI). This time period could be delayed if people do not seek help promptly and/or if the health system is not efficient in responding quickly and attending to these individuals. The aim of this study was to identify psychological factors associated with pre-hospital delay (PHD) or patients’ decisional delay (PDD) in people with an ongoing AMI. A search in PubMed/Medline from 1990 to 2021 with the keywords “pre-hospital delay” OR “prehospital delay” OR “patient delay” OR “decisional delay” OR “care seeking behavior” AND “psychological factors” OR “alexithymia” AND “myocardial infarction” was performed. Thirty-six studies were included, involving 10.389 patients. Wrong appraisal, interpretation and causal beliefs about symptoms, denial of the severity of the symptoms and high levels of alexithymia were found related to longer PHD or PDD. Alexithymia may be an overarching construct that explains the disparate findings of the studies exploring the role of psychological factors in PHD or PDD. Further studies are needed in order to analyse the role of alexithymia in patients with risk factors for AMI to prevent delay.
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Beza L, Leslie SL, Alemayehu B, Gary R. Acute coronary syndrome treatment delay in low to middle-income countries: A systematic review. IJC HEART & VASCULATURE 2021; 35:100823. [PMID: 34195352 PMCID: PMC8233123 DOI: 10.1016/j.ijcha.2021.100823] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/01/2021] [Accepted: 06/04/2021] [Indexed: 11/30/2022]
Abstract
Although morbidity and mortality rates are declining for acute coronary syndrome (ACS) in most high-income countries, it is rising at an alarming pace for low to middle income countries (LMICs). A major factor that is contributing to the poor clinical outcomes among LMICs is largely due to prehospital treatment delays. This systematic review was conducted to determine the mean length of time from symptom onset to treatment in LMICs and the sociodemographic, clinical and health system characteristics that contribute to treatment delays. We conducted a comprehensive review of the relevant literature published in English between January 1990 through May 2020 using predefined inclusion and exclusion criteria. Twenty-nine studies were included and time to treatment was defined from ACS symptom onset to first medical contact and dichotomized further as less than or >12-hours. The mean time from symptom onset to first medical contact was 12.7 h which ranged from 10-minutes to 96 h. There was consensus among studies that being older, female, illiterate, living in a rural area, and financially limited was associated with longer treatment delays. Lack of a developed emergency transportation system, poor communication and organization between community facilities and interventional facilities were also cited as major contributors for ACS treatment delays. Findings from this systematic review provide future directions to potentially reduce prehospital delays in LMICs and improve ACS outcomes.
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Affiliation(s)
- Lemlem Beza
- College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Sharon L Leslie
- Woodruff Health Sciences Center Library, Emory University, Atlanta, Georgia
| | - Bekele Alemayehu
- 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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ALAhmadi AF, ALSaedi MF, Alahmadi AE, Alharbi MG, Alharbi IH, Radman Al-Dubai SA. Pre-hospital delay among patients with acute myocardial infarction in Saudi Arabia. A cross-sectional study. Saudi Med J 2020; 41:819-827. [PMID: 32789422 PMCID: PMC7502961 DOI: 10.15537/smj.2020.8.25185] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To estimate the pre-hospital delay time among patients diagnosed with acute myocardial infarction and to determine factors associated with pre-hospital delay. METHODS A cross-sectional study was conducted among 200 patients with myocardial infarction at Madinah Cardiac Center, Al Madinah Al Munawarah, Saudi Arabia between November 2019 and March 2020. Data were collected by direct physician-subject interviews. We used the validated version of the modified response to symptoms questionnaire. Chi-square test, t test, and multivariate analysis were used to examine factors associated with pre-hospital delay. RESULTS The median pre-hospital delay time was 3.7 hours. Among all the patients, 126 patients (63%) arrived at the hospital later than 2 hours from the onset of symptoms. Factors that were significantly associated with pre-hospital delay included a previous information on acute coronary syndrome (adjusted odds ratio [adj OR]=0.35, 95% confidence interval [CI] 0.1-0.6), history of hypercholesteremia (adj OR=2.3, 95% CI 1.1-4.7), arrived by ambulance (adj OR=0.3, 95% CI 0.1-0.8), and increased pain intensity (adj OR=0.7, 95% CI 0.6-0.9). CONCLUSION Approximately two-thirds of the patients arrived later than 2 hours from the onset of symptoms. A previous information about acute coronary syndrome, history of hypercholesteremia, arrived by ambulance, and increased pain intensity were associated with pre-hospital delay. The study recognizes the need for educational programs about acute myocardial infarction symptoms and the bene ts of availing an ambulance service.
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Affiliation(s)
- Ahmed F ALAhmadi
- Saudi Board of Preventive Medicine, Ministry of Health, Al Madinah Al Munawarah, Kingdom of Saudi Arabia. E-mail.
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Jalbani FA, Shaikh S, Fatima S. Frequency and determinants of timely arrival among patients of acute myocardial infarction at a public sector tertiary care hospital in Karachi. Pak J Med Sci 2020; 36:914-919. [PMID: 32704263 PMCID: PMC7372653 DOI: 10.12669/pjms.36.5.2104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To determine the time from onset of symptoms to start of fibrinolysis and treatment in acute ST elevated myocardial infarction patients and identify the factors which cause delay in treatment. Methods: A cross sectional study was conducted at National Institute of Cardiovascular Diseases, Karachi on 360 conveniently selected patients of ST elevated myocardial infarction from July to September in the year 2017. Structured questionnaire was used to obtain detailed information on socio-demographics, factors which cause delay and timing of onset of symptoms to arrival of patient in emergency ward. Results: Overall, the total average time from the start of symptoms to initiation of treatment was 119.85+-63.32 minutes.. Only 5.1% patient reached within one hour while 57.7% reached within two hours. Old age group of 60 and above was positively associated with timely arrival (OR=2.75, 95% CI 1.33-5.68, p=0.006). Significant positive association of using personal car as mode of transport to reach the hospital (OR=5.25, 95% CI 2.94-9.35, p<0.001) was also found as compared to using ambulance. Distance from facility was suggestive of negative association in the model but was statistically insignificant. Conclusion: According to the findings of this study, more than one third of patients reached the hospital within two hours of initiation of symptoms while only 5.1% reached within one hour. The delay was mostly pre-hospital attributed to arranging transport, stay at first medical contact and time taken from first medical contact to the hospital.
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Affiliation(s)
- Faryal Akber Jalbani
- Dr. Faryal Akber Jalbani, Research Department, National Institute of Cardiovascular Diseases, Karachi, Pakistan
| | - Shiraz Shaikh
- Dr. Shiraz Shaikh, APPNA Institute of Public Health, Jinnah Sind Medical University Karachi, Pakistan
| | - Subhani Fatima
- Dr. Subhani Fatima, Research Department, National Institute of Cardiovascular Diseases, Karachi, Pakistan
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Rafi A, Sayeed Z, Sultana P, Aik S, Hossain G. Pre-hospital delay in patients with myocardial infarction: an observational study in a tertiary care hospital of northern Bangladesh. BMC Health Serv Res 2020; 20:633. [PMID: 32646521 PMCID: PMC7346615 DOI: 10.1186/s12913-020-05505-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 07/02/2020] [Indexed: 12/21/2022] Open
Abstract
Background Delayed hospital presentation is a hindrance to the optimum clinical outcome of modern therapies of Myocardial infarction (MI). This study aimed to investigate the significant factors associated with prolonged pre-hospital delay and the impact of this delay on in-hospital mortality among patients with MI in Northern Bangladesh. Methods This cross sectional study was conducted in December 2019 in cardiology ward of a 1000-bed tertiary care hospital of Bangladesh. Patients admitted in the ward with the diagnosis of myocardial infarction were included in the study. Socio demographic data, clinical features and patients’ health seeking behavior was collected in a structured questionnaire from the patients. Median with interquartile range (IQR) of pre hospital delay were calculated and compared between different groups. Chi-square (χ2) test and binary logistic regression were used to estimate the determinants of pre-hospital delay and effect of pre-hospital delay on in-hospital mortality. Results Three hundred thirty-seven patients was enrolled in the study and their median (IQR) pre-hospital delay was 9.0 (13.0) hours. 39.5% patients admitted in the specialized hospital within 6 h. In logistic regression, determinants of pre-hospital delay were patients age (for < 40 years aOR 2.43, 95% CI 0.73–8.12; for 40 to 60 years aOR 0.44, 95% CI 0.21–0.93), family income (for lower income aOR 5.74, 95% CI 0.89–37.06; for middle income aOR 14.22, 95% CI 2.15–94.17), distance from primary care center ≤5 km (aOR 0.42, 95% CI 0.12–0.90), predominant chest pain (aOR 0.15, 95% CI 0.05–0.48), considering symptoms as non-significant (aOR 17.81, 95% CI 5.92–53.48), referral from primary care center (for government hospital aOR 4.45, 95% CI 2.03–9.74; for private hospital OR 98.67, 95% CI 11.87–820.34); and not having family history of MI (aOR 2.65, 95% CI 1.24–5.71) (R2 = 0.528). Risk of in-hospital mortality was almost four times higher who admitted after 6 h compared to their counterpart (aOR 0.28, 95% CI 0.12–0.66); (R2 = 0.303). Conclusion Some modifiable factors contribute to higher pre-hospital delay of MI patients, resulting in increased in-hospital mortality. Patients’ awareness about cardiovascular diseases and improved referral pathway of the existing health care system may reduce this unexpected delay.
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Affiliation(s)
- Abdur Rafi
- Rajshahi Medical College, Rajshahi, 6100, Bangladesh
| | | | - Papia Sultana
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh
| | - Saw Aik
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh.,Department of Orthopaedic Surgery, University of Malaya, National Orthopaedic Centre of Excellence for Research and Learning (NOCERAL), Kuala Lumpur, Malaysia
| | - Golam Hossain
- Department of Statistics, University of Rajshahi, Rajshahi, Bangladesh.
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Koohi F, Khalili D. Knowledge, Attitude, and Practice Regarding Cardiovascular Diseases in Adults Attending Health Care Centers in Tehran, Iran. Int J Endocrinol Metab 2020; 18:e101612. [PMID: 33257905 PMCID: PMC7695352 DOI: 10.5812/ijem.101612] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 09/01/2020] [Accepted: 09/13/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Studies on knowledge, attitude, and practice (KAP) can be valuable for public health to help in developing targeted educational programs and assessing the effectiveness of interventional programs. OBJECTIVES This study was designed to determine the level of current knowledge, attitude, and practice (KAP) regarding cardiovascular diseases (CVDs), CVD risk factors and symptoms in adults attending health care centers in Tehran province. METHODS A cross-sectional study was performed using a self-administered questionnaire with score of 0 - 100 on adults aged > 20 years attending ten health care centers in Tehran province, Iran. Descriptive and multivariate logistic regression analyses were used in data analysis. RESULTS A total of 300 adults (51.3% females) with a mean age of 39.71 ± 12.1 years participated in this study. The median (IQR) score for knowledge about CVD was 91.7 (16.7); approximately 80% of respondents' awareness was highly satisfactory and hypertension was the commonest identified risk factor followed by obesity. Furthermore, the median (IQR) score for attitude was 89 (18); 70% of respondents had a highly satisfactory attitude about CVD. Regarding physical activity and nutrition/smoking behaviors, just 10.7% and 32% had highly satisfactory behavior, respectively. In the multivariate logistic regression analysis, attending university education and age ≥ 40 years were independent factors of a better level of CVD knowledge; attending university education, and having a family history of chronic disease were independent factors of a better level of CVD attitude. Regarding a higher physical activity behavior, being a man, and for a better nutrition & smoking behavior, attending university education were the only independent factors. CONCLUSIONS Although more than half of the current study participants had high knowledge and attitude about CVD, their behaviors is not satisfactory. Therefore, it is necessary to establish more effective educational interventions aimed at promoting positive health behaviors and explaining to the public that knowledge and action regarding the reduction of risk factors are linked to reduced CVD and mortality.
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Affiliation(s)
- Fatemeh Koohi
- Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Davood Khalili
- Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Department of Biostatistics and Epidemiology, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
- Corresponding Author: Prevention of Metabolic Disorders Research Center, Research Institute for Endocrine Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Psychological and cognitive factors related to prehospital delay in acute coronary syndrome: A systematic review. Int J Nurs Stud 2020; 108:103613. [PMID: 32473396 DOI: 10.1016/j.ijnurstu.2020.103613] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 04/08/2020] [Accepted: 04/13/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND In acute coronary syndrome the time elapsed between the start of symptoms and the moment the patient receives treatment is an important determinant of survival and subsequent recovery. However, many patients do not receive treatment as quickly as recommended, mostly due to substantial prehospital delays such as waiting to seek medical attention after symptoms have started. OBJECTIVE To conduct a systematic review with meta-analysis of the relationship between nine frequently investigated psychological and cognitive factors and prehospital delay. DESIGN A protocol was preregistered in PROSPERO [CRD42018094198] and a systematic review was conducted following PRISMA guidelines. DATA SOURCES The following databases were searched for quantitative articles published between 1997 and 2019: Medline (PubMed), Web of Science, Scopus, Psych Info, PAIS, and Open grey. REVIEW METHODS Study risk of bias was assessed with the NIH Quality Assessment Tool for Observational, Cohort, and Cross-Sectional Studies. A best evidence synthesis was performed to summarize the findings of the included studies. RESULTS Forty-eight articles, reporting on 57 studies from 23 countries met the inclusion criteria. Studies used very diverse definitions of prehospital delay and analytical practices, which precluded meta-analysis. The best evidence synthesis indicated that there was evidence that patients who attributed their symptoms to a cardiac event (n = 37), perceived symptoms as serious (n = 24), or felt anxiety in response to symptoms (n = 15) reported shorter prehospital delay, with effect sizes indicating important clinical differences (e.g., 1.5-2 h shorter prehospital delay). In contrast, there was limited evidence for a relationship between prehospital delay and knowledge of symptoms (n = 18), concern for troubling others (n = 18), fear (n = 17), or embarrassment in asking for help (n = 14). CONCLUSIONS The current review shows that symptom attribution to cardiac events and some degree of perceived threat are fundamental to speed up help-seeking. In contrast, social concerns and barriers in seeking medical attention (embarrassment or concern for troubling others) may not be as important as initially thought. The current review also shows that the use of very diverse methodological practices strongly limits the integration of evidence into meaningful recommendations. We conclude that there is urgent need for common guidelines for prehospital delay study design and reporting.
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Satish P, Khetan A, Barbhaya D, Agarwal M, Madan Mohan SK, Josephson R, Webel AR. A qualitative study of facilitators and barriers to cardiovascular risk factor control in a semiurban population in India. J Family Med Prim Care 2019; 8:3773-3778. [PMID: 31879612 PMCID: PMC6924214 DOI: 10.4103/jfmpc.jfmpc_492_19] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Revised: 08/22/2019] [Accepted: 09/05/2019] [Indexed: 12/13/2022] Open
Abstract
Cardiovascular (CV) risk factors like diabetes and hypertension are poorly controlled in both rural and urban India. This study was designed to identify the reasons for suboptimal control in a semiurban population in India. A total of 70 participants from the Study to Expand Heart Associated Treatments (SEHAT) trial, conducted in West Bengal, India. We qualitatively examined perspectives regarding CV risk factor control using focus group discussions based on the theory of reasoned action. Qualitative content analysis was used to analyze prevailing themes. Participants demonstrated a generalized knowledge of healthy lifestyle practices but lacked insight into disease-specific prevention methods. We further noticed significant gaps in the translation of existing knowledge into behavior. While personal and systemic barriers exist, factors like high patient motivation and a deep sense of trust in providers can potentially be harnessed to improve risk factor control in the community. We identified key facilitators and barriers to CV risk factor control in the community using a knowledge attitude behavior approach. Our findings provide direction for the development of community-based CV risk reduction models.
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Affiliation(s)
- Priyanka Satish
- Department of Medicine, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Aditya Khetan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Dweep Barbhaya
- Department of Pharmacology, Seth G S Medical College, Mumbai, Maharashtra, India
| | - Manyoo Agarwal
- Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA
| | - Sri Krishna Madan Mohan
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Richard Josephson
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University, Cleveland, OH, USA
- Department of Cardiovascular Medicine, Case Western Reserve University School of Medicine, Cleveland, OH 44122, USA
| | - Allison R. Webel
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44122, USA
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Rehman S, Li X, Wang C, Ikram M, Rehman E, Liu M. Quality of Care for Patients with Acute Myocardial Infarction (AMI) in Pakistan: A Retrospective Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E3890. [PMID: 31615067 PMCID: PMC6844119 DOI: 10.3390/ijerph16203890] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/11/2019] [Accepted: 10/12/2019] [Indexed: 12/21/2022]
Abstract
A wide variation exists in the practice patterns of acute myocardial infarction (AMI) care worldwide, leading to differences in clinical outcomes. This study aims to evaluate the quality of process care and its impact on in-hospital outcomes among AMI patients in Pakistan, as no such study has been conducted in Pakistan thus far based upon recommended guidelines. We investigated a sample of 2663 AMI patients across 11 territory hospitals in Punjab province of Lahore, Faisalabad, Multan, Rawalpindi, and Islamabad from January 1, 2016 to December 31, 2017, with an in-hospital mortality rate of 8.6%. We calculated compliance rates of quality indicators (QIs) for all eligible patients. The association between process care and in-hospital outcome was assessed using hierarchical generalized linear model that adjusted for patient and hospital characteristics. In addition, we examined the effect of patient composite scores on clinical outcomes. Aspirin (73.08%) and clopidogrel (67.86%) indicated relatively better conformance than other QIs. The percutaneous coronary intervention also showed significantly low adherence. All QIs showed no significant association with in-hospital mortality. In contrast, 4 out of 8 QIs were observed positively correlated with in-hospital length of stay (LOS). The overall patient composite score was found to be statistically significant with in-hospital LOS. The assessment of quality of care showed low adherence to clinical care recommendations, and increased adherence was associated with longer in-hospital LOS among AMI patients. Evaluation of valid QIs for AMI treatment and their impact on in-hospital outcomes is an important tool for improving health care delivery in the overall AMI population in Pakistan. Low adherence to performance measures strongly compel to focus on guideline-based tools for AMI in Pakistan.
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Affiliation(s)
- Shazia Rehman
- Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin 150081, China.
| | - Xi Li
- Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin 150081, China.
| | - Chao Wang
- Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin 150081, China.
| | - Muhammad Ikram
- College of Economics and management, Nanjing University of Aeronautics and Astronautics, 29 Jiangsu Avenue, Nanjing 211106, China.
| | - Erum Rehman
- School of Mathematics and Statistics, Southwest University of Finance and Economics, Chengdu 610074, China.
| | - Meina Liu
- Department of Biostatistics, School of Public Health, Harbin Medical University, No.157 Baojian Road, Harbin 150081, China.
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Rahman MN, Artani A, Baloch F, Hussain B. Severity of Chest Pain among Acute Myocardial Infarction Patients with Diagonal Branch Vessel Disease: A Pilot Study. Cureus 2019; 11:e5519. [PMID: 31687294 PMCID: PMC6819063 DOI: 10.7759/cureus.5519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2019] [Accepted: 08/29/2019] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Acute myocardial infarction (AMI) patients present with variable clinical manifestations such as shortness of breath, nausea, etc. among which chest pain is the most common. Previous studies have reported that the clinical presentation of AMI patients with branch vessel disease is indistinguishable from epicardial coronary vessel disease. However, our experience suggests patients with branch vessel disease experience severe chest pain, especially those with a diagonal branch. Therefore, we aim to study the association of chest pain severity with isolated diagonal branch vessel disease as a culprit vessel in AMI patients. METHODS It is a retrospective case-control design, where 10 cases and 40 historic controls were recruited in the study. Cases were patients with isolated diagonal branch disease, whereas controls were patients with epicardial vessel disease in AMI. We reviewed Coronary Angiograms of adult patients who presented with acute myocardial infarction and had undergone coronary angiography at Aga Khan University Hospital, Karachi (AKUH). Information on pain scores was measured using the Numeric Pain Rating Scale (NRS) before administration of analgesics. Other relevant variables were also recorded on a pre-structured questionnaire. RESULTS The mean age of all the participants in the study was 60 ± 11.0 years, with 16% of the patients being women. Among all AMI patients, the intensity of chest pain in patients with isolated diagonal branch vessel disease was 2.6 units higher as compared to those with other epicardial coronary vessel diseases (p-value: <0.001; 95% CI: 1.67 - 3.46). CONCLUSION This preliminary study indicates severe chest pain can be a differentiating symptom in AMI patients with diagonal branch disease. It emphasizes clinicians to look for a possibility of a diagonal branch as a culprit vessel in AMI for better judgment, as it is often overlooked. future studies may be conducted at multiple centers for larger sample size and better generalizability.
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Association between exposure to health information and mortality: Reduced mortality among women exposed to information via TV programs. Soc Sci Med 2019; 221:124-131. [DOI: 10.1016/j.socscimed.2018.12.019] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Revised: 12/07/2018] [Accepted: 12/11/2018] [Indexed: 12/23/2022]
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Short-Term Association between Black Carbon Exposure and Cardiovascular Diseases in Pakistan’s Largest Megacity. ATMOSPHERE 2018. [DOI: 10.3390/atmos9110420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
This study investigated the association between black carbon (BC) exposure and hospital admissions (HAs) and outpatient department/emergency room (OPD/ER) visits for cardiovascular diseases (CVD) among residents of Karachi, the largest city in Pakistan. We measured daily concentrations of BC in fine particulate matter (PM2.5) and collected records of HAs and OPD/ER visits for CVD from 2 major tertiary care hospitals serving Karachi for 6 weeks continuously during each quarter over 1 year (August 2008–August 2009). We subsequently analyzed daily counts of hospital and BC data over 0–3 lag days. Daily mean BC concentrations varied from 1 to 32 µg/m3. Results suggest that BC concentrations are associated with CVD HAs and OPD/ER visits. However, associations were generally only observed when modeled with BC from Tibet Center, the commercial-residential site, as compared to Korangi, the industrial-residential site. Overall, low statistical significance suggests that while BC may be a valuable indicator for CVD health risks from combustion-derived particles, further evaluation of the constituents of PM2.5 and their relative contributions to CVD health impacts is necessary.
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Sex differences in symptoms experienced, knowledge about symptoms, symptom attribution, and perceived urgency for treatment seeking among acute coronary syndrome patients in Karachi Pakistan. Heart Lung 2018; 47:584-590. [PMID: 30107891 DOI: 10.1016/j.hrtlng.2018.06.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Patients' experience of acute coronary syndrome (ACS) symptoms is important in determining their prehospital delay. OBJECTIVE To explore gender differences in acute symptoms of ACS, knowledge about the symptoms, their attribution, and perception of urgency, among Pakistani ACS patients. METHODS Comparative, cross-sectional study design with 249 ACS patients. RESULTS The most commonly reported symptoms were ghabrahat (fidgetiness), chest pain, and chest heaviness. Most atypical symptoms were experienced more by women, such as nausea/vomiting (p < 0.001), backache (p < 0.001), palpitations (p = 0.004), and epigastric pain (p = 0.005). Chest pain and palpitations were the symptoms most commonly attributed to cardiac causes, whereas epigastric pain was most commonly attributed to non-cardiac causes by both men and women. Significantly more women than men perceived dyspnea (p = 0.026), nausea/vomiting (p = 0.027), sweating (p = 0.014), and palpitations (p = 0.01) as symptoms not at all urgent for treatment. CONCLUSIONS Gender disparity in symptom experience along with the women's perception of non-urgency for their symptoms, could lead to delayed care seeking.
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Ahmed S, Khan A, Ali SI, Saad M, Jawaid H, Islam M, Saiyed H, Fatima S, Khan A, Basham MA, Hussain SA, Akhtar M, Kausar F, Hussain A, Fatima K. Differences in symptoms and presentation delay times in myocardial infarction patients with and without diabetes: A cross-sectional study in Pakistan. Indian Heart J 2017; 70:241-245. [PMID: 29716701 PMCID: PMC5993922 DOI: 10.1016/j.ihj.2017.07.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 07/16/2017] [Accepted: 07/25/2017] [Indexed: 11/23/2022] Open
Abstract
Objective A short pre-hospital delay, from the onset of symptoms to rapid initiation of reperfusion therapy, is a crucial factor in determining prognosis of myocardial infarction (MI). The purpose of this study was to evaluate symptoms and presentation delay times in MI patients with and without diabetes. Methods This cross-sectional study was conducted in 3 tertiary care hospitals of Pakistan over a period of 6 months. The study sample consisted of 280 consenting individuals diagnosed with ST-elevation MI (STEMI) or Non-ST elevation MI (NSTEMI), out of which 130 were diabetic and 150 were non-diabetic. Data was collected using a standardized questionnaire, investigating MI symptoms along with causes and duration of pre-hospital delay within 72 hours of admission. Results No significant difference was found in the intensity of chest pain between diabetics and non-diabetics. Atypical symptoms of MI such as anxiety (p < 0.001), cold sweats (p = 0.034) and epigastric pain (p = 0.017) were more frequently reported in diabetics. MI patients with diabetes had a significantly longer presentation delay time with 75% of the patients presenting after elapse of 3 h. Only a few patients reported to the hospital within an hour of onset of symptoms (n = 23, 8.2%), out of which majority were non-diabetics (n = 18). A majority of patients (n = 146, 52%) in both groups did not use emergency medical services. Conclusion This study provides an incentive for further research, aiming to reduce pre hospital delay along with investigating the effectiveness of emergency medical services.
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Affiliation(s)
- Saba Ahmed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Ariba Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan.
| | - Syed Ibaad Ali
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Saad
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hafsa Jawaid
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Mahnoor Islam
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Hanieya Saiyed
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Sarosh Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Aiman Khan
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Maleeha A Basham
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | | | - Maheen Akhtar
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Fatima Kausar
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Afshan Hussain
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
| | - Kaneez Fatima
- Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan
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Youssef GS, Kassem HH, Ameen OA, Al Taaban HS, Rizk HH. Pre-hospital and hospital delay in patients with non-ST elevation acute coronary syndromes in tertiary care. Egypt Heart J 2017; 69:177-181. [PMID: 29622974 PMCID: PMC5883492 DOI: 10.1016/j.ehj.2017.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 01/23/2017] [Indexed: 11/27/2022] Open
Abstract
Background Early presentation is desirable in all cases of acute prolonged chest pain. Causes of delayed presentation vary widely across geographic regions because of different patients' profile and different healthcare capabilities. Objectives To detect causes of delay of Non-ST elevation acute coronary syndrome (NSTE-ACS) patients in our country. Methods Patients admitted with NSTE-ACS were included. We recorded the time delay between the onsets of acute severe symptoms till their arrival to the hospital (Pre-hospital delay). We also recorded the time delay between the arrival to hospital and the institution of definitive therapy (hospital delay). Causes of pre-hospital delay are either patient- or transportation-related, while hospital delay causes are either staff- or system-related. Results We recruited 315 patients, 200 (63.5%) were males, 194 (61.6%) hypertensives, 180 (57.1%) diabetics, 106 (33.7%) current smokers and 196 (62.2%) patients had prior history of cardiac diseases. The mean pre-hospital delay time was 8.7 ± 9.7 h. Sixty-six percent of this time was due to patient-related causes and 34% of pre-hospital delay time was spent in transportation. The mean hospital delay time was 2.3 ± 0.95 h. In 89.8% of cases, the hospital delay was system-related while in 10.2% the reason was staff-related. The mean total delay time to definitive therapy was 11.0 ± 9.8 h. Conclusion Pre-hospital delay was mainly patient-related. Hospital delay was mainly related to healthcare resources. Governmental measures to promote ambulance emergency services may reduce the pre-hospital delay, while improving the utilization of healthcare resources may reduce hospital delay.
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Affiliation(s)
- G S Youssef
- Cardiovascular Department, Kasr Al Ainy Medical School, Cairo University, Egypt
| | - H H Kassem
- Cardiovascular Department, Kasr Al Ainy Medical School, Cairo University, Egypt
| | - O A Ameen
- Cardiovascular Department, Beni-Suef University, Egypt
| | - H S Al Taaban
- Cardiovascular Department, Kasr Al Ainy Medical School, Cairo University, Egypt
| | - H H Rizk
- Cardiovascular Department, Kasr Al Ainy Medical School, Cairo University, Egypt
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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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Zock E, Kerkhoff H, Kleyweg RP, van de Beek D. Intrinsic factors influencing help-seeking behaviour in an acute stroke situation. Acta Neurol Belg 2016; 116:295-301. [PMID: 26732617 PMCID: PMC4989004 DOI: 10.1007/s13760-015-0555-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 10/12/2015] [Indexed: 02/03/2023]
Abstract
The proportion of stroke patients eligible for intravenous or intra-arterial treatment is still limited because many patients do not seek medical help immediately after stroke onset. The aim of our study was to explore which intrinsic factors and considerations influence help-seeking behaviour of relatively healthy participants, confronted with stroke situations. Semi-structured interviews were conducted with 25 non-stroke participants aged 50 years or older. We presented 5 clinical stroke situations as if experienced by the participants themselves. Recognition and interpretation of symptoms were evaluated and various factors influencing help-seeking behaviour were explored in-depth. We used the thematic synthesis method for data analysis. Five themes influencing help-seeking behaviour in a stroke situation were identified: influence of knowledge, views about seriousness, ideas about illness and health, attitudes towards others and beliefs about the emergency medical system. A correct recognition of stroke symptoms or a correct interpretation of the stroke situations did not automatically result in seeking medical help. Interestingly, similar factors could lead to different types of actions between participants. Many intrinsic, as well as social and environmental factors are of influence on help-seeking behaviour in an acute stroke situation. All these factors seem to play a complex role in help-seeking behaviour with considerable inter-individual variations. Accomplishing more patients eligible for acute stroke treatment, future research should focus on better understanding of all factors at various levels grounded in a theory of help-seeking behaviour.
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Beig JR, Tramboo NA, Kumar K, Yaqoob I, Hafeez I, Rather FA, Shah TR, Rather HA. Components and determinants of therapeutic delay in patients with acute ST-elevation myocardial infarction: A tertiary care hospital-based study. J Saudi Heart Assoc 2016; 29:7-14. [PMID: 28127213 PMCID: PMC5247299 DOI: 10.1016/j.jsha.2016.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 05/30/2016] [Accepted: 06/03/2016] [Indexed: 11/28/2022] Open
Abstract
Background Delayed reperfusion is associated with worse outcomes in ST-segment elevation myocardial infarction (STEMI). This study was conducted to assess the components and determinants of therapeutic delay in STEMI patients of our state. Methods This study included consecutive patients of STEMI admitted to the coronary care units of two tertiary care hospitals in Srinagar, between 2012 and 2015. Various components of treatment delay including the patient’s decision to delay, referral delay, transportation delay, prehospital delay, and door-to-needle time were calculated. Factors associated with delayed treatment and clinico-demographic correlates of late presentation were identified. Results During a period of 3 years, 523 patients (mean age, 57.6 ± 10.5 years) were enrolled in this study. Thrombolysis was administered to 60.2% patients, while 39.8% of patients could not be thrombolysed because of late presentation. The median treatment delay was 250 minutes. Prehospital delay constituted about 83.8% of total treatment delay. Patient’s decision to delay, referral delay, and transport delay constituted 59%, 16%, and 25% of prehospital delay, respectively. Median door-to-needle time was 40 minutes. Residence in rural areas [odds ratio (OR), 2.35; 95% confidence interval (CI), 1.60–3.46], absence of prior coronary artery disease (OR, 1.54; 95% CI, 1.00–2.39), and negative family history of coronary artery disease (OR; 2.76; 95% CI, 1.86–4.10), were identified as independent predictors of delayed presentation (p < 0.001). Interestingly, 44.7% of the patients presented late due to misdiagnosis by local healthcare providers. Conclusion The standard of STEMI management in our state is far from ideal, and calls for a lot of improvement. Major efforts to reduce prehospital and in-hospital treatment delays are urgently needed.
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Alfasfos N, Darawad MW, Nofal B, Samarkandi OA, Abdulqader B. Knowledge, Attitudes, Beliefs and Perceived Risk of Acute Coronary Syndrome among Jordanian Patients. Health (London) 2016. [DOI: 10.4236/health.2016.815175] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Darawad MW, Alfasfos N, Saleh Z, Saleh AM, Hamdan-Mansour A. Predictors of delay in seeking treatment by Jordanian patients with acute coronary syndrome. Int Emerg Nurs 2015; 26:20-5. [PMID: 26459606 DOI: 10.1016/j.ienj.2015.09.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Revised: 09/08/2015] [Accepted: 09/10/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND ACS management aims for early coronary reperfusion, which should be within one hour from symptoms onset. This time was found to be relatively long, and many patients died before hospital arrival. In Jordan, this phenomenon is not clearly understood with a discrepancy between the reported durations of delay time. AIMS To evaluate Jordanian ACS patients' delay time in seeking medical care, along with predictors of delay. METHODS A descriptive, cross-sectional design was utilized to conveniently recruit 160 Jordanian ACS patients. Data were collected using chart review and the Modified ACS Response Questionnaire. RESULTS The mean delay time was 7.8 hours (SD =3.5), with none of participants presenting within one hour. Delay time correlated negatively with ACS history, knowledge, attitudes, beliefs, and perceived risk (r = -0.448, r = -0.400, r = -0.408, r = -0.261, r = -0.411, respectively) and positively with health perception (r = 0.469). A 4-predictor model (history, beliefs, health perception, STEMI diagnosis) was revealed explaining 40% of variance in delay time (R(2)=.400, F (14,145) = 6.908, P < .001). CONCLUSION Improving ACS patients' health seeking behaviors can be achieved when all components of care are considered together.
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Affiliation(s)
| | - Nedal Alfasfos
- Faculty of Nursing, Amman Private University, Amman, Jordan
| | - Zyad Saleh
- Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Ali M Saleh
- Faculty of Nursing, The University of Jordan, Amman, Jordan
| | - Ayman Hamdan-Mansour
- Al-Farabi College for Dentistry and Nursing, Al-Farabi College, Riyadh 11514, Saudi Arabia
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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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Kiani F, Hesabi N, Arbabisarjou A. Assessment of Risk Factors in Patients With Myocardial Infarction. Glob J Health Sci 2015; 8:255-62. [PMID: 26234995 PMCID: PMC4804079 DOI: 10.5539/gjhs.v8n1p255] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 01/11/2023] Open
Abstract
Background: Coronary artery diseases (CAD) are one of the important health problems in the world, although considerable progresses have been made to decrease the mortality, they are still the first cause of death in many countries. Hence, the necessity of examining effective factors and risk factors on CAD can be one of the most important health priorities in many countries like Iran. Objective: This study was performed to assess the risk factors in patients with myocardial infarction (MI) in Zahedan. Materials and Methods: This is a cross sectional study in which 213 patients were examined. They had been diagnosed to have heart failure. Data gathering took 18 months. Data gathering tool was a designed checklist which was filled up by an experienced nurse during interview. Obtained results were recorded in files and analyzed in SPSS 21. Results: Results showed that 70% of patients were women and only 30% were men. 48% of them were illiterate and patients mean age was 58.3. SD had been 12.6. The mean of pain onset time till referring to hospital was 11 hours with SD of 2.1. 17% of patients (coronary artery diseases history), 25.5% (hypertension history), 26% (diabetes history), 15.5% (cholesterol history), 13% (smoking) and 3% have reported CABG history. The majority of people who referred had inferior MI (40.4%). 67.1% normal rhythm, 2.8% atrial fibrillation and 16% had ventricular tachycardia. Statistical tests showed a significant correlation between sex and the mean of referring time (p<0.05) but the relation between age and referring time was not significant. Conclusion: Effective risk factors on MI were recognized in this study. Some of them such as age, sex and education cannot be modified but many are controllable such as hypertension, diabetes, cholesterol, and smoking and on time referring after pain onset. Having considered the results of this study health promotion for society and especially vulnerable people can be provided by omitting or reducing risk factors.
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Abed MA, Khalil AA, Moser DK. The Contribution of Symptom Incongruence to Prehospital Delay for Acute Myocardial Infarction Symptoms Among Jordanian Patients. Res Nurs Health 2015; 38:213-21. [DOI: 10.1002/nur.21658] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/18/2015] [Indexed: 01/13/2023]
Affiliation(s)
- Mona A. Abed
- Assistant Professor; College of Nursing; Hashemite University; Zarqa 13115 Jordan
| | - Amani A. Khalil
- Associate Professor; Faculty of Nursing; The University of Jordan; Amman Jordan
| | - Debra K. Moser
- Professor; College of Nursing; University of Kentucky; Lexington KY
- School of Nursing; University of Ulster; Belfast Ireland
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Allana S, Khowaja K, Ali TS, Moser DK, Khan AH. Gender differences in factors associated with prehospital delay among acute coronary syndrome patients in Pakistan. J Transcult Nurs 2014; 26:480-90. [PMID: 26541388 DOI: 10.1177/1043659614524787] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
PURPOSE To identify gender differences in prehospital delay time (PDT) and its associated factors among acute coronary syndrome (ACS) patients. DESIGN Descriptive cross-sectional comparative study. METHODS This study was conducted among 249 ACS patients at two tertiary care hospitals of a large metropolitan city of Pakistan. Data were collected through the modified Response to Symptoms Questionnaire. RESULTS The median PDT of women was found to be 7 hours, compared to 3.5 hours among men (p = .001). Results of the regression analysis indicated that most women delayed because of social factors, such as attendants' responses to their symptoms (p = .002), and because they were worried about expenses required for the treatment (p = .002); yet, most men delayed owing to individual factors, such as waiting for symptoms to subside (p< .001), and not recognizing the symptoms as being cardiac related (p< .001). Having anxiety and lack of knowledge about symptoms was associated with extended PDT among both genders. CONCLUSION Women delayed longer than men in seeking treatment for their ACS symptoms. Different factors were associated with PDT in women and men. This study may provide important insights for designing interventional studies to reduce PDT in Pakistani ACS patients.
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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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Vaidya A, Aryal UR, Krettek A. Cardiovascular health knowledge, attitude and practice/behaviour in an urbanising community of Nepal: a population-based cross-sectional study from Jhaukhel-Duwakot Health Demographic Surveillance Site. BMJ Open 2013; 3:e002976. [PMID: 24157816 PMCID: PMC3808775 DOI: 10.1136/bmjopen-2013-002976] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES This study determined the knowledge, attitude and practice/behaviour of cardiovascular health in residents of a semiurban community of Nepal. DESIGN To increase the understanding of knowledge, attitude and practice/behaviour towards cardiovascular health, we conducted in-home interviews using a questionnaire based on the WHO STEPwise approach to surveillance and other resources, scoring all responses. We also recorded blood pressure and took anthropometric measurements. SETTING Our study was conducted as part of the Heart-Health-Associated Research and Dissemination in the Community project in the Jhaukhel-Duwakot Health Demographic Surveillance Site in two urbanising villages near Kathmandu. PARTICIPANTS The study population included 777 respondents from six randomly selected clusters in both villages. RESULTS Seventy per cent of all participants were women and 26.9% lacked formal education. The burden of cardiovascular risk factors was high; 20.1% were current smokers, 43.3% exhibited low physical activity and 21.6% were hypertensive. Participants showed only poor knowledge of heart disease causes; 29.7% identified hypertension and 11% identified overweight and physical activity as causes, whereas only 2.2% identified high blood sugar as causative. Around 60% of respondents did not know any heart attack symptoms compared with 20% who knew 2-4 symptoms. Median percentage scores for knowledge, attitude and practice/behaviour were 79.3, 74.3 and 48, respectively. Nearly 44% of respondents had insufficient knowledge and less than 20% had highly satisfactory knowledge. Among those with highly satisfactory knowledge, only 14.7% had a highly satisfactory attitude and 19.5% and 13.9% had satisfactory and highly satisfactory practices, respectively. CONCLUSIONS Our study demonstrates a gap between cardiovascular health knowledge, attitude and practice/behaviour in a semiurban community in a low-income nation, even among those already affected by cardiovascular disease.
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Affiliation(s)
- Abhinav Vaidya
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
- Nordic School of Public Health NHV, Gothenburg, Sweden
| | - Umesh Raj Aryal
- Department of Community Medicine, Kathmandu Medical College, Kathmandu, Nepal
- Nordic School of Public Health NHV, Gothenburg, Sweden
| | - Alexandra Krettek
- Nordic School of Public Health NHV, Gothenburg, Sweden
- Department of Internal Medicine and Clinical Nutrition, Institute of Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
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Farshidi H, Rahimi S, Abdi A, Salehi S, Madani A. Factors Associated With Pre-hospital Delay in Patients With Acute Myocardial Infarction. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:312-6. [PMID: 24083004 PMCID: PMC3785905 DOI: 10.5812/ircmj.2367] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/17/2011] [Revised: 07/09/2012] [Accepted: 07/15/2012] [Indexed: 12/19/2022]
Abstract
Background Treatment of patients with acute myocardial infarction (AMI) is time related, so delay in treatment could affect prognosis. Recognizing pre-hospital or in-hospital delays in initiating treatment and reducing these factors is very efficacious in treatment of these patients. Objectives The aim of this study is evaluate the causes of pre-hospital delay just as other studies on effect of different variables such as socioeconomic and personal factors on pre-hospital delay in with patients with AMI. Materials and Methods A cross sectional study was carried out on 227 patients with acute myocardial infarction and demographic data, educational level, marital status, type of transfer to hospital and delay in arrival to hospital were recorded. Results 35.7% patients arrived during one hour of symptom onset, and 7.9% arrived after 24 hours. Patients having high level education (P = 0.0492) and with a family history of coronary artery disease (P = 0.01) had significantly less delay in arriving to hospital. Age, marital status, gender, and route of transfer to hospital were not related with pre-hospital delay (P > 0.05). Patients thought most common cause of delay in arrival was unawareness of coronary artery disease (38.8%) and self-medication (34.3%). Conclusions Increasing awareness of patients about cardiovascular symptoms and their risk factors could be helpful in patient's decision in seeking medical help. So general education via media and primary and middle schools could be helpful.
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Affiliation(s)
- Hossein Farshidi
- Hormozgan Cardiovascular Research Center, Hormozgan University of Medical Sciences, IR Iran
| | - Shafei Rahimi
- Hormozgan Cardiovascular Research Center, Hormozgan University of Medical Sciences, IR Iran
- Corresponding author: Shafei Rahimi, Hormozgan Cardiovascular Research Center¸ Shahid Mohammadi Hospital, Jomhori Islami Boulevard, Bandar Abbass, IR Iran, Tel: +98-7613336680, Fax: +98-7613354055, E-mail:
| | - Ahmadnoor Abdi
- Hormozgan Cardiovascular Research Center, Hormozgan University of Medical Sciences, IR Iran
| | - Sarah Salehi
- Hormozgan Cardiovascular Research Center, Hormozgan University of Medical Sciences, IR Iran
| | - Abdoulhossain Madani
- Hormozgan Cardiovascular Research Center, Hormozgan University of Medical Sciences, IR Iran
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Baxter SK, Allmark P. Reducing the time-lag between onset of chest pain and seeking professional medical help: a theory-based review. BMC Med Res Methodol 2013; 13:15. [PMID: 23388093 PMCID: PMC3570316 DOI: 10.1186/1471-2288-13-15] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2012] [Accepted: 02/04/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Research suggests that there are a number of factors which can be associated with delay in a patient seeking professional help following chest pain, including demographic and social factors. These factors may have an adverse impact on the efficacy of interventions which to date have had limited success in improving patient action times. Theory-based methods of review are becoming increasingly recognised as important additions to conventional systematic review methods. They can be useful to gain additional insights into the characteristics of effective interventions by uncovering complex underlying mechanisms. METHODS This paper describes the further analysis of research papers identified in a conventional systematic review of published evidence. The aim of this work was to investigate the theoretical frameworks underpinning studies exploring the issue of why people having a heart attack delay seeking professional medical help. The study used standard review methods to identify papers meeting the inclusion criterion, and carried out a synthesis of data relating to theoretical underpinnings. RESULTS Thirty six papers from the 53 in the original systematic review referred to a particular theoretical perspective, or contained data which related to theoretical assumptions. The most frequently mentioned theory was the self-regulatory model of illness behaviour. Papers reported the potential significance of aspects of this model including different coping mechanisms, strategies of denial and varying models of treatment seeking. Studies also drew attention to the potential role of belief systems, applied elements of attachment theory, and referred to models of maintaining integrity, ways of knowing, and the influence of gender. CONCLUSIONS The review highlights the need to examine an individual's subjective experience of and response to health threats, and confirms the gap between knowledge and changed behaviour. Interventions face key challenges if they are to influence patient perceptions regarding seriousness of symptoms; varying processes of coping; and obstacles created by patient perceptions of their role and responsibilities. A theoretical approach to review of these papers provides additional insight into the assumptions underpinning interventions, and illuminates factors which may impact on their efficacy. The method thus offers a useful supplement to conventional systematic review methods.
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Affiliation(s)
- Susan K Baxter
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield, UK.
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Whitaker S, Baldwin T, Tahir M, Choudhry O, Senior A, Greenfield S. Public knowledge of the symptoms of myocardial infarction: a street survey in Birmingham, England. Fam Pract 2012; 29:168-73. [PMID: 21976661 DOI: 10.1093/fampra/cmr079] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Myocardial infarction (MI) is a leading cause of death in the UK. A good clinical outcome depends on rapid treatment following the onset of symptoms. A person's knowledge of typical symptoms determines how quickly they present to the medical services. OBJECTIVES To investigate knowledge of MI symptoms among the general population and the relationship between age, gender and socio-economic status with knowledge. METHODS Street survey of 302 participants in Birmingham, UK, using an interviewer-assisted questionnaire. RESULTS Of seven symptoms accepted in the medical literature as typical of an MI, central chest pain was the most frequently identified (75% of the sample), followed by arm pain or numbness (40%), shortness of breath (35%), fainting or dizziness (21%) and sweating (21%). Feeling or being sick and neck or jaw pain were mentioned by 8.1% and 5.9%, respectively, while an atypical or inapplicable symptom, collapse (9.9%) was mentioned more often than these. Over half the sample knew only two or fewer MI symptoms. The mean number of typical symptoms identified was 2.2 (SD = 1.28). Respondents from professional occupations and those with previous experience of MI, whether direct or indirect, showed better awareness. CONCLUSIONS The study demonstrated a paucity of knowledge of MI symptoms among the general public. Such findings provide a baseline to guide public health campaigns targeting awareness of MI.
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Affiliation(s)
- Sean Whitaker
- College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
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Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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O'Connor RE, Bossaert L, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Vanden Hoek TL, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2010; 122:S422-65. [PMID: 20956257 DOI: 10.1161/circulationaha.110.985549] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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