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Tabowei G, Dadzie SK, Ahmed S, Lohana M, Shahzad M, Zehra SN, Zubair M, Khan A. Comparison of the Clinical Manifestations of Acute Coronary Syndrome Between Diabetic and Non-diabetic Patients: A Systematic Review and Meta-Analysis. Cureus 2024; 16:e64311. [PMID: 39130937 PMCID: PMC11316346 DOI: 10.7759/cureus.64311] [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: 07/09/2024] [Indexed: 08/13/2024] Open
Abstract
The presentation of acute coronary syndrome (ACS) in patients with type 2 diabetes mellitus (T2DM) may differ from that of non-diabetic patients, potentially leading to delayed diagnosis and treatment. This meta-analysis aimed to compare the clinical presentation of ACS between diabetic and non-diabetic patients. A systematic search of PubMed, Excerpta Medica database (EMBASE), and Web of Science databases was conducted for observational studies published from January 2010 onwards. Studies comparing ACS symptoms between diabetic and non-diabetic patients were included. The odds ratio (OR) with 95% confidence intervals (CI) was calculated using a random-effects model. Eight studies with a total of 29,503 patients (23.03% diabetic) were included. Diabetic patients were significantly less likely to present with chest pain compared to non-diabetic patients (OR: 0.43, 95% CI: 0.30 to 0.63, p<0.001). Anxiety (OR: 2.20, 95% CI: 1.17-4.14), shortness of breath (OR: 1.49, 95% CI: 1.11-2.01), and neck pain (OR: 1.62, 95% CI: 1.03-2.54) were significantly more common in diabetic patients. Sweating/cold sweat was less common in diabetics (OR: 0.60, 95% CI: 0.34-1.07), though not statistically significant. Other symptoms showed minimal differences between groups. High heterogeneity was observed across studies for most symptoms. This meta-analysis demonstrates that diabetic patients with ACS are less likely to experience typical chest pain and more likely to present with atypical symptoms such as anxiety, shortness of breath, and neck pain. These findings emphasize the need for healthcare providers to maintain high vigilance for atypical ACS presentations in diabetic patients. Tailored diagnostic approaches, modified triage protocols, and enhanced patient education are crucial to improving the timely diagnosis and treatment of ACS in this high-risk population.
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Affiliation(s)
- Godfrey Tabowei
- Internal Medicine, Texas Tech University Health Sciences Center, Odessa, USA
| | - Samuel K Dadzie
- Internal Medicine, Piedmont Athens Regional Medical Center, Athens, USA
| | - Saeed Ahmed
- Cardiology, Mohtarma Benazir Bhutto Shaheed Medical College, Mirpur, PAK
| | - Muskan Lohana
- Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | | | | | | | - Areeba Khan
- Critical Care Medicine, United Medical and Dental College, Karachi, PAK
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2
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Spek M, Erkelens DCA, van Het Goor-van Wezep C, van Smeden M, Den Ruijter HM, Wouters LTCM, Venekamp RP, Rutten FH, Zwart DL. Diabetes and risk of acute coronary syndrome in callers with chest discomfort: Cross-sectional study in out-of-hours primary care. Diabetes Res Clin Pract 2024; 212:111684. [PMID: 38697299 DOI: 10.1016/j.diabres.2024.111684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 04/18/2024] [Accepted: 04/22/2024] [Indexed: 05/04/2024]
Abstract
AIMS We investigated the differences in prevalence of acute coronary syndrome (ACS) by presence versus absence of diabetes in males and females with chest discomfort who called out-of-hours primary care (OHS-PC). METHODS A cross-sectional study performed in the Netherlands. Patients who called the OHS-PC in the Utrecht region, the Netherlands between 2014 and 2017 with acute chest discomfort were included. We compared those with diabetes with those without diabetes. Multivariable logistic regression was used to determine the relation between diabetes and (i) high urgency allocation and (ii) ACS. RESULTS Of the 2,195 callers with acute chest discomfort, 180 (8.2%) reported having diabetes. ACS was present in 15.3% of males (22.0% in those with diabetes) and 8.4% of females (18.8% in those with diabetes). Callers with diabetes did not receive a high urgency more frequently (74.4% vs. 67.8% (OR: 1.38; 95% CI 0.98-1.96). However, such callers had a higher odds for ACS (OR: 2.17; 95% CI 1.47-3.19). These differences were similar for females and males. CONCLUSIONS Diabetes holds promise as diagnostic factor in callers to OHS-PC with chest discomfort. It might help triage in this setting given the increased risk of ACS in those with diabetes.
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Affiliation(s)
- Michelle Spek
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands.
| | - Daphne C A Erkelens
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Coralie van Het Goor-van Wezep
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Maarten van Smeden
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Hester M Den Ruijter
- Laboratory of Experimental Cardiology, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Loes T C M Wouters
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Roderick P Venekamp
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Frans H Rutten
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Dorien L Zwart
- Department of General Practice & Nursing Science, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht University, Utrecht, The Netherlands
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Glynn L, Lind M, Andersson T, Eliasson B, Hofmann R, Nyström T. Trends in Survival After First Myocardial Infarction in People With Diabetes. J Am Heart Assoc 2024; 13:e034741. [PMID: 38761078 PMCID: PMC11179798 DOI: 10.1161/jaha.123.034741] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2024] [Accepted: 04/16/2024] [Indexed: 05/20/2024]
Abstract
BACKGROUND The aim of this study was to investigate temporal trends in survival and subsequent cardiovascular events in a nationwide myocardial infarction population with and without diabetes. METHODS AND RESULTS Between 2006 and 2020, we identified 2527 individuals with type 1 diabetes, 48 321 individuals with type 2 diabetes and 243 170 individuals without diabetes with first myocardial infarction in national health care registries. Outcomes were trends in all-cause death after 30 and 365 days, cardiovascular death and major adverse cardiovascular events (ie, nonfatal stroke, nonfatal myocardial infarction, cardiovascular death, and heart failure hospitalization). Pseudo-observations were used to estimate the mortality risk, with 95% CIs, using linear regression, adjusted for age and sex. Individuals with type 1 diabetes were younger (62±12.2 years) and more often women (43.6%) compared with individuals with type 2 diabetes (75±10.8 years; women, 38.1%), and individuals without diabetes (73±13.2 years; women, 38.4%). Early death decreased in people without diabetes from 23.1% to 17.5%, (annual change -0.48% [95% CI, -0.52% to -0.44%]) and in people with type 2 diabetes from 22.6% to 19.3% (annual change, -0.33% [95% CI, -0.43% to -0.24%]), with no such significant trend in people with type 1 diabetes from 23.8% to 21.7% (annual change, -0.18% [95% CI, -0.53% to 0.17%]). Similar trends were observed with regard to 1-year death, cardiovascular death, and major adverse cardiovascular events. CONCLUSIONS During the past 15 years, the trend in survival and major adverse cardiovascular events in people with first myocardial infarction without diabetes and with type 2 diabetes have improved significantly. In contrast, a similar improvement was not seen in people with type 1 diabetes.
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Affiliation(s)
- Linn Glynn
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Marcus Lind
- Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden
- Department of Medicine, NU-Hospital Group Uddevalla Sweden
- Department of Molecular and Clinical Medicine Institute of Medicine, University of Gothenburg Gothenburg Sweden
| | - Tomas Andersson
- Institute of Environmental Medicine, Karolinska Institutet Stockholm Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm Stockholm Sweden
| | - Björn Eliasson
- Department of Medicine Sahlgrenska University Hospital Gothenburg Sweden
| | - Robin Hofmann
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden
| | - Thomas Nyström
- Department of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm Sweden
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Cao JY, Zhang LX, Zhou XJ. Development and validation of a nomogram model for predicting the risk of pre-hospital delay in patients with acute myocardial infarction. World J Cardiol 2024; 16:80-91. [PMID: 38456069 PMCID: PMC10915893 DOI: 10.4330/wjc.v16.i2.80] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Revised: 01/02/2024] [Accepted: 02/02/2024] [Indexed: 02/21/2024] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is a severe cardiovascular disease caused by the blockage of coronary arteries that leads to ischemic necrosis of the myocardium. Timely medical contact is critical for successful AMI treatment, and delays increase the risk of death for patients. Pre-hospital delay time (PDT) is a significant challenge for reducing treatment times, as identifying high-risk patients with AMI remains difficult. This study aims to construct a risk prediction model to identify high-risk patients and develop targeted strategies for effective and prompt care, ultimately reducing PDT and improving treatment outcomes. AIM To construct a nomogram model for forecasting pre-hospital delay (PHD) likelihood in patients with AMI and to assess the precision of the nomogram model in predicting PHD risk. METHODS A retrospective cohort design was employed to investigate predictive factors for PHD in patients with AMI diagnosed between January 2022 and September 2022. The study included 252 patients, with 180 randomly assigned to the development group and the remaining 72 to the validation group in a 7:3 ratio. Independent risk factors influencing PHD were identified in the development group, leading to the establishment of a nomogram model for predicting PHD in patients with AMI. The model's predictive performance was evaluated using the receiver operating characteristic curve in both the development and validation groups. RESULTS Independent risk factors for PHD in patients with AMI included living alone, hyperlipidemia, age, diabetes mellitus, and digestive system diseases (P < 0.05). A nomogram model incorporating these five predictors accurately predicted PHD occurrence. The receiver operating characteristic curve analysis indicated area under the receiver operating characteristic curve values of 0.787 (95% confidence interval: 0.716-0.858) and 0.770 (95% confidence interval: 0.660-0.879) in the development and validation groups, respectively, demonstrating the model's good discriminatory ability. The Hosmer-Lemeshow goodness-of-fit test revealed no statistically significant disparity between the anticipated and observed incidence of PHD in both development and validation cohorts (P > 0.05), indicating satisfactory model calibration. CONCLUSION The nomogram model, developed with independent risk factors, accurately forecasts PHD likelihood in AMI individuals, enabling efficient identification of PHD risk in these patients.
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Affiliation(s)
- Jiao-Yu Cao
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China.
| | - Li-Xiang Zhang
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
| | - Xiao-Juan Zhou
- Department of Cardiology, The First Affiliated Hospital of USTC, Division of Life Science and Medicine, University of Science and Technology of China, Hefei 230001, Anhui Province, China
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Schmitz T, Wein B, Raake P, Heier M, Peters A, Linseisen J, Meisinger C. Do patients with diabetes with new onset acute myocardial infarction present with different symptoms than non-diabetic patients? Front Cardiovasc Med 2024; 11:1324451. [PMID: 38287984 PMCID: PMC10822885 DOI: 10.3389/fcvm.2024.1324451] [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] [Received: 10/19/2023] [Accepted: 01/03/2024] [Indexed: 01/31/2024] Open
Abstract
Background The objective of this study was to investigate the differences in presenting symptoms between patients with and without diabetes being diagnosed with an acute myocardial infarction (AMI). Methods A total of 5,900 patients with a first-time AMI were included into the analysis. All patients aged between 25 and 84 years were recorded by the population-based Myocardial Infarction Registry in Augsburg, Germany, between 2010 and 2017. The presence (yes/no) of 12 AMI typical symptoms during the acute event was assessed within the scope of a face-to-face interview. Multivariable adjusted logistic regression models were calculated to analyze the associations between presenting symptoms and diabetes mellitus in AMI patients. Results Patients with diabetes had significantly less frequent typical pain symptoms, including typical chest pain. Also, other symptoms like sweating, vomiting/nausea, dizziness/vertigo and fear of death/feeling of annihilation occurred significantly more likely in non-diabetic patients. The only exception was the symptom of shortness of breath, which was found significantly more often in patients with diabetes. In multivariable-adjusted regression models, however, the observed effects were attenuated. In patients younger than 55 years, the associations between diabetes and various symptoms were mainly missing. Conclusions Type 2 diabetes mellitus is a risk factor not only for the development of AMI, but is also associated with an adverse outcome after AMI. Atypical clinical presentation additionally complicates the diagnostic process. It is therefore essential for physicians to be aware of the more often atypical symptoms that diabetic AMI patients report.
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Affiliation(s)
- Timo Schmitz
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Bastian Wein
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Philip Raake
- Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany
| | - Margit Heier
- KORA Study Centre, University Hospital of Augsburg, Augsburg, Germany
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology, Neuherberg, Germany
| | - Annette Peters
- Helmholtz Zentrum München, German Research Center for Environmental Health, Institute for Epidemiology, Neuherberg, Germany
- Chair of Epidemiology, Institute for Medical Information Processing, Biometry and Epidemiology, Medical Faculty, Ludwig-Maximilians-Universität München, Munich, Germany
- German Center for Diabetes Research (DZD) Neuherberg, Neuherberg, Germany
| | - Jakob Linseisen
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
| | - Christa Meisinger
- Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany
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6
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Kumar A, Sanghera A, Sanghera B, Mohamed T, Midgen A, Pattison S, Marston L, Jones MM. Chest pain symptoms during myocardial infarction in patients with and without diabetes: a systematic review and meta-analysis. Heart 2023; 109:1516-1524. [PMID: 37080764 DOI: 10.1136/heartjnl-2022-322289] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2022] [Accepted: 03/26/2023] [Indexed: 04/22/2023] Open
Abstract
OBJECTIVE Chest pain (CP) is key in diagnosing myocardial infarction (MI). Patients with diabetes mellitus (DM) are at increased risk of an MI but may experience less CP, leading to delayed treatment and worse outcomes. We compared the prevalence of CP in those with and without DM who had an MI. METHODS The study population was people with MI presenting to healthcare services. The outcome measure was the absence of CP during MI, comparing those with and without DM. Medline and Embase databases were searched to 18 October 2021, identifying 9272 records. After initial independent screening, 87 reports were assessed for eligibility against the inclusion criteria, quality and risk of bias assessment (Strengthening the Reporting of Observational Studies in Epidemiology and Newcastle-Ottawa criteria), leaving 22 studies. The meta-analysis followed Meta-analysis Of Observational Studies in Epidemiology criteria and reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Pooled ORs, weights and 95% CIs were calculated using a random-effects model. RESULTS This meta-analysis included 232 519 participants from 22 studies and showed an increased likelihood of no CP during an MI for those with DM, compared with those without. This was 43% higher in patients with DM in the cohort and cross-sectional studies (OR: 1.43; 95% CI: 1.26 to 1.62), and 44% higher in case-control studies (OR: 1.44; 95% CI: 1.11 to 1.87). CONCLUSION In patients with an MI, patients with DM are less likely than those without to have presentations with CP recorded. Clinicians should consider an MI diagnosis when patients with DM present with atypical symptoms and treatment protocols should reflect this, alongside an increased patient awareness on this issue. PROSPERO REGISTRATION NUMBER CRD42017058223.
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Affiliation(s)
| | | | | | | | - Ariella Midgen
- Royal Brompton & Harefield NHS Foundation Trust, London, UK
| | - Sophie Pattison
- UCL Library Services UCL Medical School (Royal Free Campus), UCL, London, UK
| | - Louise Marston
- Research Department of Primary Care and Population Health, UCL, London, UK
| | - Melvyn M Jones
- Research Department of Primary Care and Population Health, UCL, London, UK
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7
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Blakeman JR, Prasun MA, Kim M. Predictors of acute coronary syndrome symptom knowledge, attitudes, and beliefs in adults without self-reported heart disease. Heart Lung 2023; 60:102-107. [PMID: 36947932 DOI: 10.1016/j.hrtlng.2023.03.006] [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: 12/14/2022] [Revised: 03/06/2023] [Accepted: 03/10/2023] [Indexed: 03/22/2023]
Abstract
BACKGROUND The time of symptom onset to the time an individual decides to seek care is the most significant contributor to total treatment delay. OBJECTIVES To explore predictors of ACS symptom knowledge, attitudes, and beliefs in adults without diagnosed heart disease. METHODS We used a cross-sectional, descriptive, and correlational design, employing an online survey including the ACS Response Index and the avoidance subscale of the Coping Strategy Indicator. We leveraged social media platforms and a university email list-serv to enroll participants. Stepwise hierarchical linear regressions were used. RESULTS We analyzed responses from 981 participants, with a mean age of 35.2 years (SD 16.5) and 75% female. The regression analyses yielded models that explained 14%, 23%, and 25% of the variance for knowledge, beliefs, and attitudes, respectively. Ethnicity, race, exposure to ACS symptom information (in the media or by teaching), and perceived health were the predictors of ACS symptom knowledge, attitudes, and beliefs with the largest effect, though others were statistically significant. CONCLUSIONS The findings underscore the importance of community education to raise awareness of ACS symptoms while considering social determinants of health. Future research and clinician interventions for ACS symptom knowledge, attitudes and beliefs should be expanded with a focus on ethnicity and gender.
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Affiliation(s)
- John R Blakeman
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790-5810, USA.
| | - Marilyn A Prasun
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790-5810, USA
| | - MyoungJin Kim
- Mennonite College of Nursing, Illinois State University, Campus Box 5810, Normal, IL 61790-5810, USA
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8
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Kerola AM, Juonala M, Palomäki A, Semb AG, Rautava P, Kytö V. Case Fatality of Patients With Type 1 Diabetes After Myocardial Infarction. Diabetes Care 2022; 45:1657-1665. [PMID: 35679070 PMCID: PMC9274223 DOI: 10.2337/dc22-0042] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 04/17/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Type 1 diabetes is a risk factor for myocardial infarction (MI). We aimed to evaluate the case fatality in patients with type 1 diabetes after MI. RESEARCH DESIGN AND METHODS Consecutive patients experiencing MI with type 1 diabetes (n = 1,935; 41% female; mean age 62.5 years) and without diabetes (n = 74,671) admitted to 20 hospitals in Finland from 2005 to 2018 were studied using national registries. The outcome of interest was death within 1 year after MI. Differences between groups were balanced by multivariable adjustments and propensity score matching. RESULTS Case fatality was higher in patients with type 1 diabetes than in propensity score-matched controls without diabetes at 30 days (12.8% vs. 8.5%) and at 1 year (24.3% vs. 16.8%) after MI (hazard ratio 1.55; 95% CI 1.32-1.81; P < 0.0001). Patients with type 1 diabetes had poorer prognosis in subgroups of men and women and of those with and without ST-elevation MI, with and without revascularization, with and without atrial fibrillation, and with and without heart failure. The relative fatality risk in type 1 diabetes was highest in younger patients. Older age, heart failure, peripheral vascular disease, renal failure, and no revascularization were associated with worse prognosis after MI. The case fatality among patients with type 1 diabetes decreased during the study period, but outcome differences compared with patients without diabetes remained similar. CONCLUSIONS Patients with type 1 diabetes are at higher risk of death after MI than patients without diabetes. Our findings call for attention to vigorous cardiovascular disease prevention in patients with type 1 diabetes.
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Affiliation(s)
- Anne M Kerola
- Rheumatology, Inflammation Center, Helsinki University Hospital, Helsinki, Finland.,Faculty of Medicine, University of Helsinki, Helsinki, Finland
| | - Markus Juonala
- Department of Medicine, University of Turku, Turku, Finland
| | - Antti Palomäki
- Department of Medicine, University of Turku, Turku, Finland.,Centre for Rheumatology and Clinical Immunology, Division of Medicine, Turku University Hospital, Turku, Finland
| | - Anne Grete Semb
- Preventive Cardio-Rheuma Clinic, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Päivi Rautava
- Department of Public Health, University of Turku, Turku, Finland.,Turku Clinical Research Center, Turku University Hospital, Turku, Finland
| | - Ville Kytö
- Heart Center, Turku University Hospital and University of Turku, Turku, Finland.,Research Center of Applied and Preventive Cardiovascular Medicine, University of Turku, Turku, Finland.,Center for Population Health Research, Turku University Hospital and University of Turku, Turku, Finland.,Administrative Center, Hospital District of Southwest Finland, Turku, Finland.,Department of Public Health, Faculty of Medicine, University of Helsinki, Helsinki, Finland
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9
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Acute Coronary Syndrome in Patients with Diabetes mellitus: Features of the Course and Manifestations of Pain Syndrome. Fam Med 2022. [DOI: 10.30841/2307-5112.1-2.2022.260497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Acute coronary syndrome (ACS) remains a common cause of hospitalization for patients with diabetes mellitus (DM). Due to development of diabetic neuropathy, it is believed that this category of patients is characterized by a high frequency of atypical acute coronary syndrome, but data on this are quite contradictory.
The objective: to determine the features of the pain syndrome and its severity in patients with acute coronary syndrome and concomitant diabetes.
Materials and methods. The study involved 36 patients with diabetes (22 men and 14 women) aged 44–86 years, hospitalized urgently for ACS. Pain syndrome was assessed at the time of hospitalization and immediately after coronary artery revascularization according to the following criteria: visual analog scale (VAS), Numerical Rating Scale (NRS), clinical data, and biochemical markers.
Results. The majority of patients (91.67%) at the time of hospitalization complained of chest pain, the rest were not bothered by any pain. During the survey, patients described pain as «burning» (30.56%), «squeezing» (30.56%), «squeezing» (25.0%), «tingling» (5.56%). There were also complaints of difficulty breathing (13.89%), shortness of breath (11.1%), palpitations (41.67%). The appearance of excessive sweating was noticed by 16.67% of patients. There was no statistically significant difference between the results of pain assessment by VAS and NRS (p>0.1). The average value of glycemia at the time of hospitalization was 8.19±3.45 mmol/l (men – 8.17±3.61 mmol/l, women – 8.28±3.13 mmol/l). Glycemia greater than 10.0 mmol/l was detected in 8 patients, which was 22.22% of all patients. This category of patients was dominated by patients with severe pain (62.5%).
Conclusions. In patients with ACS and diabetes, the typical clinical picture of ACS prevailed (91.67% of patients) over the painless form. Prior to revascularization, moderate and severe pain occurred with equal frequency; there is no statistical difference between blood pressure, heart rate and glycemia (p>0.1) in patients with severe and moderate pain. Hyperglycemia (≥10.0 mmol/l) was found in 22.22%, among this category of patients was dominated by patients with severe pain.
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Fujihara N, Hamada S, Yoshida M, Tsukushi S, Fujihara Y. Factors Affecting Delay in Initial Treatment of Patients with Soft Tissue Sarcomas. J Hand Surg Asian Pac Vol 2022; 27:135-140. [PMID: 35135426 DOI: 10.1142/s2424835522500163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Soft tissue sarcomas (STS) are rare, and little is known about the factors that affect the delays in the initial treatment. The aim of this study is to quantify the period between onset of symptoms and start of treatment of STS and determine the factors affecting delays in initial treatment. Methods: This is a retrospective study of all STS treated in our institution between October 2009 and March 2019. We analysed patient record to determine the period from onset of symptoms to start of initial treatment. We also collected data with regard to patient characteristics and features of the tumour. Tumours were classified into upper extremity, lower extremity, trunk and others based on location of the tumour. Statistical tests were done to identify factors that affected delay in initial treatment. Results: The study included 134 patients (76 male and 58 female) with STS with an average age of 56.6 years. The tumours involved the upper extremity in 20 patients, lower extremity and trunk in 50 patients each and other areas in 14 patients. The most frequent histological subtypes were liposarcomas (n = 31, 23.5%) and undifferentiated pleomorphic sarcomas (n = 24, 18.2%). Initial treatment was delayed by an average of 9.9 months for all groups. The period of treatment delay for tumours involving the upper extremity was shorter (7.9 months) and these tumours were smaller at initial presentation (57.6 mm) compared to tumours in other locations (p < 0.05). Other factors that were positively associated with treatment delays were a history of diabetes mellitus (p = 0.037) and smoking (p = 0.026). Conclusion: Patients with upper-extremity STS may have the benefit of a relatively better prognosis as they present earlier and with a smaller tumour. In addition, factors, such as diabetes and smoking, which indicate a low interest in health also influenced the delay in the initial treatment. Level of Evidence: Level III (Therapeutic).
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Affiliation(s)
- Nasa Fujihara
- Department of Orthopaedic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Shunsuke Hamada
- Department of Orthopaedic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Masahiro Yoshida
- Department of Orthopaedic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Satoshi Tsukushi
- Department of Orthopaedic Surgery, Aichi Cancer Center, Nagoya, Japan
| | - Yuki Fujihara
- Department of Orthopaedic Surgery, Nagoya Ekisaikai Hospital, Nagoya, Japan
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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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12
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Kang G. Interventions are needed to improve communication about symptoms of acute coronary syndrome and the appropriate response to symptoms for patients. PATIENT EDUCATION AND COUNSELING 2020; 103:1064-1065. [PMID: 31704033 DOI: 10.1016/j.pec.2019.10.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 10/20/2019] [Accepted: 10/22/2019] [Indexed: 06/10/2023]
Affiliation(s)
- GuanYang Kang
- Department of Cardiology, Bin Hai Wan Central Hospital of Dongguan, The Dongguan Affiliated Hospital of Medical College of Jinan University (also called The Fifth People's Hospital of Dongguan, Taiping People's Hospital of Dongguan). 111, Humen Road, Humen, Dongguan 523000, Guandong, China.
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O'Donnell S, Monahan P, McKee G, McMahon G, Curtin E, Farrell S, Moser D. Towards prompt electrocardiogram acquisition in triage: Preliminary testing of a symptom-based clinical prediction rule for the Android tablet. Eur J Cardiovasc Nurs 2019; 18:289-298. [PMID: 30620215 DOI: 10.1177/1474515118821023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND For patients with suspected acute coronary syndrome, international guidelines indicate that an Electrocardiogram (ECG) should be performed within 10 min of first medical contact, however success at achieving these guidelines is limited. AIMS The purpose of this study was to develop and perform initial testing of a clinical prediction rule embedded in a tablet application, and to expedite the identification of patients who require an electrocardiogram within 10 min. METHODS This derivation of the Acute Coronary Syndrome Application (AcSAP) comprised of three local studies, an unpublished audit and literature critique. The AcSAP was prospectively tested over four months in patients presenting to the Emergency Department (ED) of a Dublin teaching hospital. An audit form retrieved data pertaining to times of: registration to the emergency department, triage, first electrocardiogram and diagnosis. The AcSAP was subsequently evaluated by experienced triage nurses ( n=18) who had utilised it. RESULTS The AcSAP was activated 379 times. Patients with ST Elevation Myocardial Infarction (STEMI) and non-ST Elevation Myocardial Infarction (NSTEMI) were significantly more likely to return a categorisation of 'immediate ECG' or 'ECG within 10 min' ( p<0.001). There was a significant difference in 'triage to ECG' times across categories, the 'immediate ECG' categorisation resulting in the shortest time ( p=0.002). Evaluations suggest that staff found the tool quick and easy to use and results seemed accurate. CONCLUSION Testing of the AcSAP suggests that it accurately identifies patients who require an ECG within 10 min. As such, it has the potential to support the meeting of clinical guidelines for ECG acquisition.
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Affiliation(s)
- Sharon O'Donnell
- 1 School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | | | - Gabrielle McKee
- 1 School of Nursing and Midwifery, Trinity College Dublin, Ireland
| | | | | | - Sean Farrell
- 3 Emergency Department, St James's Hospital, Ireland
| | - Debra Moser
- 4 College of Nursing, University of Kentucky, Lexington, Kentucky, USA
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Factors associated with delay in transfer of patients with ST-segment elevation myocardial infarction from first medical contact to catheterization laboratory: Lessons from CRAC, a French prospective multicentre registry. Arch Cardiovasc Dis 2019; 112:3-11. [DOI: 10.1016/j.acvd.2018.04.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 04/06/2018] [Accepted: 04/09/2018] [Indexed: 11/19/2022]
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Kim HS, Eun SJ, Hwang JY, Lee KS, Cho SI. Symptom clusters and treatment time delay in Korean patients with ST-elevation myocardial infarction on admission. Medicine (Baltimore) 2018; 97:e0689. [PMID: 29742716 PMCID: PMC5959405 DOI: 10.1097/md.0000000000010689] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Most patients with acute myocardial infarction (AMI) experience more than one symptom at onset. Although symptoms are an important early indicator, patients and physicians may have difficulty interpreting symptoms and detecting AMI at an early stage. This study aimed to identify symptom clusters among Korean patients with ST-elevation myocardial infarction (STEMI), to examine the relationship between symptom clusters and patient-related variables, and to investigate the influence of symptom clusters on treatment time delay (decision time [DT], onset-to-balloon time [OTB]). This was a prospective multicenter study with a descriptive design that used face-to-face interviews. A total of 342 patients with STEMI were included in this study. To identify symptom clusters, two-step cluster analysis was performed using SPSS software. Multinomial logistic regression to explore factors related to each cluster and multiple logistic regression to determine the effect of symptom clusters on treatment time delay were conducted. Three symptom clusters were identified: cluster 1 (classic MI; characterized by chest pain); cluster 2 (stress symptoms; sweating and chest pain); and cluster 3 (multiple symptoms; dizziness, sweating, chest pain, weakness, and dyspnea). Compared with patients in clusters 2 and 3, those in cluster 1 were more likely to have diabetes or prior MI. Patients in clusters 2 and 3, who predominantly showed other symptoms in addition to chest pain, had a significantly shorter DT and OTB than those in cluster 1. In conclusion, to decrease treatment time delay, it seems important that patients and clinicians recognize symptom clusters, rather than relying on chest pain alone. Further research is necessary to translate our findings into clinical practice and to improve patient education and public education campaigns.
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Affiliation(s)
- Hee-Sook Kim
- Division of Infectious Disease Control, Korea Centers for Disease Control and Prevention, Cheongju
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University College of Medicine, Daejeon
| | - Jin Yong Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine, Jinju
| | - Kun-Sei Lee
- Department of Preventive Medicine, Konkuk University College of Medicine, Seoul, South Korea
| | - Sung-il Cho
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul
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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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