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Hummel B, van Oortmerssen JA, Borst C, Harskamp RE, Galenkamp H, Postema PG, van Valkengoed IG. Sex and ethnic differences in unrecognized myocardial infarctions: Observations on recognition and preventive therapies from the multiethnic population-based HELIUS cohort. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2024; 20:200237. [PMID: 38283611 PMCID: PMC10818071 DOI: 10.1016/j.ijcrp.2024.200237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2023] [Revised: 12/18/2023] [Accepted: 01/05/2024] [Indexed: 01/30/2024]
Abstract
Background Epidemiological studies suggest sex differences in the prevalence and characteristics of unrecognized and recognized myocardial infarction (uMI, rMI). Despite increasingly diverse populations, observations are limited in multiethnic contexts. Gaining better understanding may inform policy makers and healthcare professionals on populations at risk of uMI who could benefit from preventive measures. Methods We used baseline data from the multiethnic population-based HELIUS cohort (2011-2015; Amsterdam, the Netherlands). Using logistic regressions, we studied sex differences in the prevalence and proportion of uMIs across ethnic groups. Next, we studied whether symptoms, clinical parameters, and sociocultural factors were associated with uMIs. Finally, we compared secondary preventive therapies in women and men with a uMI or rMI. We relied on pathological Q-waves on a resting electrocardiogram as the electrocardiographic signature for (past) MI. Results Overall, and in Turkish and Moroccan subgroups, the prevalence of uMIs was higher in men than women. The proportion of uMIs was similar in women (21.0%) and men (18.4%), yet varied by ethnicity. In women and men, symptoms (chest pain, dyspnea) and clinical parameters (hypertension, hypercholesterolemia), and in women also lower educational level and diabetes were associated with lower odds of uMIs. Women (0.0%) and men (3.6%) with uMI were unlikely to receive secondary preventive therapies compared to those with rMI (28.1-40.9%). Conclusions The prevalence of uMIs was higher in men than women, and sex differences in the proportion of uMIs varied somewhat across ethnic groups. People with uMIs did not receive adequate preventative medications, posing a risk for recurrent events.
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Affiliation(s)
- Bryn Hummel
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | | | - CharlotteS.M. Borst
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Ralf E. Harskamp
- Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - Henrike Galenkamp
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
| | - Pieter G. Postema
- Departments of Experimental and Clinical Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
| | - Irene G.M. van Valkengoed
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
| | - IMPRESS consortium
- Department of Public and Occupational Health, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Department of Epidemiology, Erasmus MC, Rotterdam, the Netherlands
- Department of General Practice, Amsterdam UMC, Location AMC, Amsterdam, the Netherlands
- Amsterdam Public Health, Health Behaviours and Chronic Diseases, Amsterdam, the Netherlands
- Departments of Experimental and Clinical Cardiology, Heart Center, Amsterdam UMC Location AMC, Amsterdam, the Netherlands
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Jin J, Yang H, Guo Z, L V X, Jiang X, Ding C. Relationships of illness perception, symptoms response and social support with acute myocardial infarction patients' prehospital delay in rural China: protocol for a cross-sectional study. BMJ Open 2023; 13:e073010. [PMID: 37438062 DOI: 10.1136/bmjopen-2023-073010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/14/2023] Open
Abstract
INTRODUCTION The timely treatment of acute myocardial infarction (AMI) patients is of utmost importance, and yet, there remains a significant disparity between urban and rural areas in China due to the unequal distribution of medical resources. The manifestation of symptoms and psychosocial factors play a crucial role in shaping medical decisions for AMI patients. It is well established that minimising prehospital delay (PHD) is crucial for the successful implementation of recanalisation therapy and reducing mortality in out-of-hospital settings. However, there remains a paucity of studies investigating the correlation between illness perception, symptom response, social support, and PHD in AMI patients. AIM The aim of this study was to analyse the relationship pathways between symptom response, illness perception, social support and PHD time in patients with AMI in rural areas of China. METHODS A primary care-based cross-sectional study was designed to investigate the inpatients initially diagnosed with AMI in the emergency department of three tertiary care hospitals in three counties in northern Zhejiang Province by convenience sampling method from January 2023 to December 2023. A minimum of 286 patients will be enrolled (voluntary response sample). Each participant will complete a paper-based questionnaire to gather research outcomes. Statistical analyses will be performed using logistic regression and structural equation model with PHD as main outcome parameter. DISCUSSION This is the first study of the factors influencing PHD in AMI in rural China using structural equation model. Our study will address this gap in the available research. The implementation and findings of this study may provide a reliable basis for reducing PHD in AMI patients in rural areas and establish a relevant theoretical foundation for the implementation of targeted interventions and risk prevention measures in primary care hospitals.
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Affiliation(s)
- Jingfen Jin
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
- Key Laboratory of the Diagnosis and Treatment of Severe Trauma and Burn of Zhejiang Province, Hangzhou, China
| | - Haifeng Yang
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
| | - Zhiting Guo
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
| | - Xuebing L V
- Department of Emergency, Changxing County People's Hospital, Changxing, China
| | - Xiuju Jiang
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
| | - Chuanqi Ding
- Department of Nursing, Changxing County People's Hospital, Huzhou, China
- Department of Nursing, Zhejiang University School of Medicine Second Affiliated Hospital, Hangzhou, China
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Fålun N, Langørgen J, Fridlund B, Pettersen T, Rotevatn S, Norekvål TM. Patients' reflections on prehospital symptom recognition and timely treatment of myocardial infarction. Eur J Cardiovasc Nurs 2021; 20:526-533. [PMID: 33580773 DOI: 10.1093/eurjcn/zvaa035] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Revised: 12/10/2020] [Accepted: 12/16/2020] [Indexed: 11/13/2022]
Abstract
AIMS Early treatment is crucial to successful therapy in patients with acute myocardial infarction (MI). Prehospital delay is associated with increased morbidity and mortality. There is little empirical evidence of patients' reflections on prehospital symptoms of MI and timely treatment at the time of discharge from hospital. To explore patients' reflections on prehospital symptoms of MI and their experiences of interaction with local hospitals, general practitioners, and laypersons. METHODS AND RESULTS An inductive explorative design with a qualitative method approach was used to conduct in-depth interviews of patients after confirmed MI. Twenty patients were purposefully selected based on age and gender. Face-to-face, semi-structured interviews were conducted prior to hospital discharge. The interviews were organized around a set of predetermined, open-ended questions, transcribed verbatim and analysed using qualitative content analysis. There were patients who acted upon severe symptoms of MI by seeking medical assistance. Patients commonly experienced that the time from the onset of symptoms to treatment posed a transitional challenge. They did not take subtle signs of MI seriously; they underestimated symptoms of MI and delayed seeking medical assistance. Patients frequently experienced that healthcare professionals did not take them seriously, as they struggled to gain access to healthcare services. CONCLUSION This study highlights patients' unique experiences of the pathway from symptom onset to confirmed MI. Severe chest pain is associated with MI and triggers an immediate need for care. However, patients often underestimated moderate chest pain or subtle signs and symptoms of MI. Existing knowledge gaps concerning the misinterpretation of symptoms in primary care need to be addressed in order to reduce this clinical challenge.
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Affiliation(s)
- Nina Fålun
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
| | - Jørund Langørgen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
| | - Bengt Fridlund
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway.,Centre of Interprofessional Collaboration within Emergency care (CISE), Linnaeus University, 35195 Växjö, Sweden
| | - Trond Pettersen
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
| | - Svein Rotevatn
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway
| | - Tone M Norekvål
- Department of Heart Disease, Haukeland University Hospital, Jonas Lies vei 65, NO-5021 Bergen, Norway.,Department of Clinical Science, University of Bergen, Jonas Lies veg 87, 5021 Bergen, Norway
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Alrawashdeh A, Nehme Z, Williams B, Smith K, Stephenson M, Bernard S, Bray J, Stub D. Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction. Eur J Cardiovasc Nurs 2021; 20:243–251. [PMID: 33611404 DOI: 10.1177/1474515120953737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction. METHODS This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011-January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression. RESULTS The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range=17-176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10-11.83; and 8.02; 3.65-17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours. CONCLUSION Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient's decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.
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Affiliation(s)
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Monash University, Australia
| | - Karen Smith
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Michael Stephenson
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia.,Baker IDI Heart and Diabetes Institute, Australia
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Pre-hospital predictors of an adverse outcome among patients with dyspnoea as the main symptom assessed by pre-hospital emergency nurses - a retrospective observational study. BMC Emerg Med 2020; 20:89. [PMID: 33172409 PMCID: PMC7653705 DOI: 10.1186/s12873-020-00384-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 10/30/2020] [Indexed: 01/10/2023] Open
Abstract
Background Dyspnoea is one of the most common reasons for patients contacting emergency medical services (EMS). Pre-hospital Emergency Nurses (PENs) are independently responsible for advanced care and to meet these patients individual needs. Patients with dyspnoea constitute a complex group, with multiple different final diagnoses and with a high risk of death. This study aimed to describe on-scene factors associated with an increased risk of a time-sensitive final diagnosis and the risk of death. Methods A retrospective observational study including patients aged ≥16 years, presenting mainly with dyspnoea was conducted. Patients were identified thorough an EMS database, and were assessed by PENs in the south-western part of Sweden during January to December 2017. Of 7260 missions (9% of all primary missions), 6354 were included. Among those, 4587 patients were randomly selected in conjunction with adjusting for unique patients with single occasions. Data were manually collected through both EMS- and hospital records and final diagnoses were determined through the final diagnoses verified in hospital records. Analysis was performed using multiple logistic regression and multiple imputations. Results Among all unique patients with dyspnoea as the main symptom, 13% had a time-sensitive final diagnosis. The three most frequent final time-sensitive diagnoses were cardiac diseases (4.1% of all diagnoses), infectious/inflammatory diseases (2.6%), and vascular diseases (2.4%). A history of hypertension, renal disease, symptoms of pain, abnormal respiratory rate, impaired consciousness, a pathologic ECG and a short delay until call for EMS were associated with an increased risk of a time-sensitive final diagnosis. Among patients with time-sensitive diagnoses, approximately 27% died within 30 days. Increasing age, a history of renal disease, cancer, low systolic blood pressures, impaired consciousness and abnormal body temperature were associated with an increased risk of death. Conclusions Among patients with dyspnoea as the main symptom, age, previous medical history, deviating vital signs, ECG pattern, symptoms of pain, and a short delay until call for EMS are important factors to consider in the prehospital assessment of the combined risk of either having a time-sensitive diagnosis or death. Supplementary Information Supplementary information accompanies this paper at 10.1186/s12873-020-00384-1.
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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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Abstract
See Article Stehli et al
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Affiliation(s)
- Martha Gulati
- 1 Division of Cardiology University of Arizona-Phoenix Phoenix AZ
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