1
|
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.
Collapse
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
| |
Collapse
|
2
|
Abu Taha A, AbuRuz ME, Momani A. Morphine Use Did Not Eliminate the Effect of Pain on Complications After Acute Myocardial Infarction. Open Nurs J 2022. [DOI: 10.2174/18744346-v16-e2206202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background:
Patients with Acute Myocardial Infarction (AMI) are usually present complaining of severe chest pain. This pain results from an imbalance between oxygen supply and demand, leading to severe complications. Different guidelines recommend using Morphine as a drug of choice for treating this pain.
Objective:
This study aimed to check the effect of chest pain and Morphine use on complications rate after AMI.
Methods:
This was a prospective observational study with a consecutive sample of 300 patients with AMI. Data were collected by direct patients interview and medical records review in the emergency departments & Intensive Care Units (ICU). Any complication developed within the hospital stay and after AMI was recorded. All correlated variables were analyzed using the binary logistic regression model.
Results:
The sample included 176 (58.7%) men and 124 (41.3%) women with a mean age of 56.92±12.13 years. A total of 83 patients (27.7%) developed one or more in-hospital complications. Acute recurrent ischemia was the most frequent complication; 70 (23.3%). Severe chest pain (≥ 7), duration of chest pain (more than 5 minutes), history of previous MI, and history of hypertension increased the occurrence of complications by 13%, 7%, 63%, and 25%, respectively. However, the use of Morphine did not have any protective effect against the development of these complications.
Conclusion:
The severity and duration of chest pain increased the occurrence of complications. Morphine administration did not have any protective effect against the development of these complications. Thus, it is recommended to update different policies and guidelines to use other types of chest pain relief methods, e.g., treating the underlying cause of chest pain and addressing the imbalance between oxygen supply and demand.
Collapse
|
3
|
Beza L, Alemayehu B, Addissie A, Azazh A, Gary R. Treatment Seeking Behaviors and Associated Factors among Patients Experiencing Acute Coronary Syndrome Using Health Belief Model in Addis Ababa, Ethiopia. Ethiop J Health Sci 2022; 32:781-790. [PMID: 35950066 PMCID: PMC9341033 DOI: 10.4314/ejhs.v32i4.15] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 05/04/2022] [Indexed: 11/17/2022] Open
Abstract
Background Acute coronary syndrome (ACS) is a life-threatening condition. The mortality rate will be reduced if immediate treatment is provided. Patients' awareness of ACS is limited, so they do not seek help as quite often as they should. The level of treatment seeking behavior and associated factors among ACS patients admitted to three hospitals in Addis Ababa, Ethiopia, were assessed using a health belief model. Methods A cross-sectional study was conducted among 330 ACS patients from November 2019 to December 2020. Sociodemographic and clinical variables data were extracted using pre-tested checklist. The outcome and other variables data were collected using the checklist and structured questionnaire. The data were entered into Epi-data 3.1 and exported to STATA 17.1 for analysis. Descriptive statistics relevant to the variable was performed. A multivariable logistic regression was used to identify factors associated with treatment seeking behavior. Results This study revealed that the mean time from symptom onset to arrival at the emergency unit (EU) was 24 ± 19.5 hours, slightly < half of the participants (n=149, 45.1 %) had adequate treatment seeking behavior. Perceived threat (AOR=1.03,95% CI:1.01–1.06, p=0.002), perceived benefits (AOR=1.09, 95%CI: 1.02–1.0, p≤0.001), self-efficacy (AOR=1.16, 95% CI :1.01- 1.22, p≤0.001), education (AOR=2.2,95%CI:1.31–3.9, p≤0.01) self-autonomy (AOR=3.1,95%CI:1.82–5.4, p<.001) and no depression (AOR=1.9,95%CI:1.1–3.3, p≤0.05) were found to have significantly association with adequate treatment seeking behavior. Conclusion This study indicates, less than half of ACS patients had adequate treatment seeking behavior. Thus, context-specific behavioral interventions, along with public awareness campaigns about ACS, should be implemented.
Collapse
Affiliation(s)
- Lemlem Beza
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Bekele Alemayehu
- Department of Internal Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Adamu Addissie
- Addis Ababa University, College of Health Sciences, Addis Ababa, Ethiopia
| | - Aklilu Azazh
- Department of Emergency Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Rebecca Gary
- Nell Hodgson Woodruff School of Nursing, Emory University, Atlanta, Georgia
| |
Collapse
|
4
|
Shahbazpour J, Abbasi M, Eskandari N, Aghaali M, Norouzadeh R. Study of outcomes of delay in referral of patients with acute myocardial infarction. JOURNAL OF EDUCATION AND HEALTH PROMOTION 2022; 11:95. [PMID: 35573608 PMCID: PMC9093645 DOI: 10.4103/jehp.jehp_810_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 07/11/2021] [Indexed: 06/15/2023]
Abstract
BACKGROUND Delay in seeking medical help in patients with acute myocardial infarction (AMI) challenges the patients in terms of diagnosis and treatment. This study aimed to evaluate the outcomes of delay referral (≥12 h) in patients with AMI. MATERIALS AND METHODS In this retrospective cohort study, the medical records of 252 patients with AMI (2017-2019) admitted to Shahid Beheshti Hospital, Qom, Iran, was reviewed. Data collection tool was a researcher-made data sheet that included demographic characteristics, times, hospitalization costs, risk factors, history of heart disease, results of paraclinical tests, clinical information at the time of admission, and outcomes of delayed referral. Data were analyzed using t-test, Chi-square, Kaplan-Meier estimator, log-rank test, Cox regression by STATA, and SPSS (version 25). RESULTS The levels of troponin, creatine phosphokinase, lactate dehydrogenase were significantly higher in the delayed referral group (P < 0.05). After treatment, the cardiac ejection fraction was significantly different in the nondelayed referral (41.56 ± 9.16) and the delayed referral group (38.39 ± 11.01) (P < 0.001). There was no significant difference in the percentage of hospital deaths in the groups (P = 0.078). CONCLUSION Delayed referral of patients with AMI is associated with decreased physiological cardiac function, which complicates recovery for these patients.
Collapse
Affiliation(s)
- Jafar Shahbazpour
- Department of Medical Surgical Nursing, School of Nursing, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Abbasi
- Department of Nursing, School of Nursing, Qom University of Medical Sciences, Qom, Iran
| | - Narges Eskandari
- Department of Midwifery, School of Medicine, Qom University of Medical Sciences, Qom, Iran
| | - Mohammad Aghaali
- Department of Family and Community Medicine, School of Medicine, Neuroscience Research Center Qom University of Medical Sciences, Qom, Iran
| | - Reza Norouzadeh
- Department of Nursing, School of Nursing and Midwifery, Shahed University, Tehran, Iran
| |
Collapse
|
5
|
Blakeman JR, Prasun MA. Perceived personal risk and vulnerability in recognizing and responding to symptoms of acute coronary syndrome: an integrative review. Eur J Cardiovasc Nurs 2021; 21:405-413. [PMID: 34893826 DOI: 10.1093/eurjcn/zvab112] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 10/20/2021] [Accepted: 11/05/2021] [Indexed: 11/14/2022]
Abstract
BACKGROUND Simply knowing the common symptoms of acute coronary syndrome (ACS) is not sufficient to ensure prompt care-seeking when these symptoms occur. Factors other than symptom knowledge contribute to prompt care-seeking behaviours and correct symptom attribution to the heart. OBJECTIVES To explore how perceived personal risk and perceived personal vulnerability towards ACS affect a person's ACS symptom recognition and attribution and also how this perception affects a person's response to ACS symptoms. DESIGN An integrative review, using Whittemore and Knafl's approach. DATA SOURCES PubMed, Academic Search Complete, CINAHL Complete, APA PsycINFO, and APA PsycARTICLES. ELIGIBILITY CRITERIA FOR STUDY SELECTION We included studies that (i) were original human-subjects research or secondary analyses of human-subjects research, (ii) provided information about how perceptions of risk or perceptions of vulnerability towards ACS or heart disease affect symptom recognition, attribution, and/or response to symptoms, and (iii) were published in English. RESULTS Thirteen articles were included. Studies were conducted in nine different countries and were descriptive or exploratory in nature. The existing evidence suggests that perceived personal risk or vulnerability towards heart disease may promote earlier care-seeking for ACS symptoms and facilitates attribution of symptoms to the heart. CONCLUSION The designs of the included studies limit causal attribution, and additional prospective and intervention-based research is needed to determine how perceived risk/vulnerability may affect care-seeking and ACS symptom attribution. Increasing perceptions of vulnerability towards heart disease may reduce care seeking delay.
Collapse
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
| |
Collapse
|
6
|
Seguin M, Lasco G, Bin Idris K, Mendoza J, Mohd Kadri NH, Krauss S, D'Silva J, Shaffril HM, Fadzil MF, Palafox B, Renedo A, Nafiza MN, Majid F, Razak AA, Yusoff K, Palileo-Villanueva L, Dans A, Mallari E, Balabanova D, McKee M. Patient pathways for cardiovascular diseases in Malaysia and the Philippines: a systematic review. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16412.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Cardiovascular diseases (CVDs) are the leading cause of premature mortality in the world and are a growing public health concern in low- and middle-income countries (LMICs), including those in South East Asia. Their management requires coordinated responses by a range of healthcare providers, which should preferably be based on knowledge of the national context. We systematically review evidence on the pathways followed by patients with CVD in Malaysia and the Philippines to understand patient journeys, along with the barriers at each stage. Methods: We searched seven bibliographic databases and grey literature sources to identify material focused on the pathways followed by patients with CVD in Malaysia and the Philippines, and performed a narrative synthesis. Results: The search yielded 25 articles, 3 focused on the Philippines and 22 on Malaysia. Most articles were quantitative analyses that focused on hypertensive patients. Three examined secondary prevention post myocardial infarction, and one each examined acute myocardial infarction, heart failure, and atrial fibrillation. Reported barriers reflected capability (knowledge of behaviours to achieve control or the capacity to conduct these behaviours), intention (attitudes or motivations toward the behaviours to achieve control), and aspects of the health care system (availability, accessibility, affordability and acceptability of services). Conclusions: There are large gaps in our understanding of patient pathways in Malaysia and the Philippines that limit the development of evidence-based strategies to effectively address the CVD burden in South East Asian countries and in LMICs more broadly. Addressing these evidence gaps will require longitudinal mixed-methods studies following patients from initial diagnosis to long-term management.
Collapse
|
7
|
Wilson RE, Rush KL, Reid RC, Laberge CG. The symptom experience of early and late treatment seekers before an atrial fibrillation diagnosis. Eur J Cardiovasc Nurs 2020; 20:231-242. [PMID: 33909890 DOI: 10.1177/1474515120952220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/31/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Atrial fibrillation is a complex condition associated with a broad spectrum of symptoms, coupled with variability in the frequency, duration and severity of symptoms. Early treatment seeking is important to reduce the risk of stroke, heart failure and dementia. Despite the increasing prevalence, there remains a limited understanding of the symptom experience prior to an atrial fibrillation diagnosis, and how these experiences influence treatment-related decisions and time frames. AIMS This qualitative study aimed to explore the symptom experiences of patients receiving an early diagnosis of less than 48 hours and a late diagnosis of 48 hours or more after symptom awareness. METHODS Twenty-six adults were interviewed guided by the symptom experience model. The symptom checklist was used to probe patient's symptoms further. Data were analysed using a two-step approach to thematic analysis utilising concepts from the symptom experience model. RESULTS The two groups differed in their perception, evaluation and response to symptoms. The early diagnosis group (n = 6) experienced traumatic, severe and persistent symptoms, evoking concern and urgent treatment seeking. Conversely, the late diagnosis group (n = 20) reported more vague, paroxysmal symptoms that were readily ignored, self-theorised as non-illness related, and engaged in non-treatment strategies. Healthy self-perceptions, past experiences, atrial fibrillation knowledge and healthcare provider interactions influenced early or late treatment seeking. CONCLUSION For many, the atrial fibrillation pre-diagnosis was a tumultuous period, requiring prolonged periods to recognise symptoms and formulate treatment-seeking responses. This study may promote future research and strategies aimed at facilitating the early identification and response to symptoms among atrial fibrillation patients.
Collapse
Affiliation(s)
- Ryan E Wilson
- School of Nursing, The University of British Columbia, Canada
| | - Kathy L Rush
- School of Nursing, The University of British Columbia, Canada
| | - R Colin Reid
- School of Health and Exercise Sciences, The University of British Columbia, Canada
| | - Carol G Laberge
- School of Nursing, The University of British Columbia, Canada
| |
Collapse
|
8
|
Stassen W, Kurland L, Wallis L, Castren M, Vincent-Lambert C. Barriers and facilitators to implementing coronary care networks in South Africa: a qualitative study. Afr Health Sci 2020; 20:338-350. [PMID: 33402921 PMCID: PMC7750081 DOI: 10.4314/ahs.v20i1.39] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background ST-elevation myocardial infarction (STEMI) is on the rise in sub-Saharan Africa. South Africa consistently fails to deliver timely reperfusion to these patients, possibly due to under-developed coronary care networks (CCN). Objectives To determine the current perceived state of CCNs, to determine the barriers to optimising CCNs and to suggest facilitators to optimising CCNs within the South African context. Methods A qualitative descriptive approach was employed, by performing two structured in-depth and two focus group interviews (n=4 and 5, respectively), inviting a purposely heterogeneous sample of 11 paramedics (n=4), doctors (n=5), and nurses (n=2) working within different settings in South African CCNs. Recorded interviews were transcribed verbatim and subjected to content analysis. Results Participants described an under-resourced, unprioritised and fragmented CCN with significant variation in performance. Barriers to CCN optimisation resided in recognition and diagnosis of STEMI, transport and treatment decisions, and delays. Participants suggested that thrombolysing all STEMI patients could facilitate earlier reperfusion and that pre-hospital thrombolysis should be considered. Participants highlighted the need for regionalised STEMI guidelines, and the need for further research. Conclusion Numerous barriers were highlighted. Healthcare policy-makers should prioritise the development of CCNs that is underpinned by evidence and that is contextualised to each specific region within the South African health care system.
Collapse
|