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Lu X, Xia W, Wang X, Xie F, Sun X. Factors Associated with Symptom-to-Door Delay in Patients with ST-Segment Myocardial Infarction: A Systematic Review. Prehosp Disaster Med 2023; 38:485-494. [PMID: 37485671 DOI: 10.1017/s1049023x23006039] [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] [Indexed: 07/25/2023]
Abstract
BACKGROUND Decreasing symptom-to-door (S2D) delay is of vital importance for reducing morbidity and mortality in patients with ST-segment elevation myocardial infarction (STEMI). The factors associated with S2D delay in STEMI patients have not been well-characterized. OBJECTIVES The aim of this study was to identify factors associated with S2D delay in patients with STEMI. METHODS The PubMed, CINAHL, and Embase databases were searched for data. References from the selected articles and relevant background papers were also manually searched to identify additional eligible studies. The included articles were reviewed and assessed for risk of bias. The level of evidence for each identified factor was evaluated using a semiquantitative synthesis. RESULTS Twelve (12) papers were included in the review. Factors associated with S2D delay were complex and could be divided into sociodemographic, clinical history, and onset characteristics. The level of evidence regarding female sex and diabetes was strong, and the evidence was moderate regarding older age, smoking, history of hypertension, self-transport, or referral. CONCLUSIONS Female sex, older age, previous diabetes, previous hypertension, smoking, and self-transport are all strong or moderate risk factors for S2D time delay in patients with ST-segment myocardial infarction. More efforts should be made to educate at-risk populations concerning symptoms of STEMI and the importance of seeking early medical assistance.
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Affiliation(s)
- Xiuyan Lu
- Cardiology Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
| | - Wei Xia
- Cardiology Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
| | - Xinru Wang
- Nursing Department, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Fangyu Xie
- Cardiology Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
| | - Xiujie Sun
- Nursing Department, Qingdao Hospital, University of Health and Rehabilitation Sciences (Qingdao Municipal Hospital), Qingdao, Shandong Province, China
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Zhang LM, Geater AF, McNeil EB, Lin YP, Liu SC, Luo H, Wang YZ, Wen SC. Health Inequalities of STEMI Care Before Implementation of a New Regional Network: A Prefecture-Level Analysis of Social Determinants of Healthcare in Yunnan, China. Int J Health Policy Manag 2022; 11:1413-1424. [PMID: 34060274 PMCID: PMC9808331 DOI: 10.34172/ijhpm.2021.29] [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: 09/27/2020] [Accepted: 03/16/2021] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND As one of the most serious types of coronary heart disease, ST-elevation myocardial infarction (STEMI) faces huge challenges in the equal management and care of patients due to its life-threatening and time-critical condition. Health inequalities such as sex and age differences in STEMI care have been reported from developed countries. However, limited outcomes have been investigated and the major drivers of inequality are still unclear, especially in under-developed areas. This study aimed to explore the major drivers of health inequalities in STEMI care before implementation of a new regional network in the south-west of China. METHODS Prefecture-level data of STEMI patients before the implementation of a regional network were analysed retrospectively. Drivers of inequality were identified from six social determinants of health, namely area of residence, ethnicity, sex, age, education and occupation. Outcomes of STEMI care included timely presentation, reperfusion therapy, timely reperfusion therapy, heart failure, inpatient mortality, length of hospital stay, hospital costs, and various intervals of ischaemic time. RESULTS A total of 376 STEMI patients in the research area before implementation of the STEMI network were included. Compared with urban residents, rural patients were significantly less likely to have timely presentation (odds ratio [OR]=0.47, 95% CI: 0.28-0.80, P=.004) and timely reperfusion therapy (OR=0.32, 95% CI: 0.14-0.70, P=.005). Rural residents were less likely to present to hospital promptly than urban residents (HR=0.65, 95% CI=0.52-0.82, P<.001). In the first 3 hours of percutaneous coronary intervention (PCI) reperfusion delay and first 6 hours of total ischaemic time, rural patients had a significantly lower probability to receive prompt PCI (hazard ratio [HR]=0.40, 95% CI: 0.29-0.54, P<.001) and reperfusion therapy (HR=0.37, 95% CI: 0.25-0.56, P<.001) compared to urban patients. CONCLUSION Rural residents were a major vulnerable group before implementation of the regional STEMI network. No obvious inequalities in ethnicity, sex, age, education or occupation existed in STEMI care in Chuxiong Prefecture of China.
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Affiliation(s)
- Li Mei Zhang
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Alan Frederick Geater
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Edward B. McNeil
- Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Hat Yai, Thailand
| | - Yun Peng Lin
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
| | - Si Chen Liu
- Faculty of Dentistry, Prince of Songkla University, Hat Yai, Thailand
| | - Heng Luo
- People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
| | - Yuan Zhang Wang
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
| | - Shao Chang Wen
- Department of Cardiology, People’s Hospital of Chuxiong Prefecture, Yunnan, China
- Executive Office, Alliance of Chuxiong Prefecture Chest Pain Centres, Yunnan, China
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Fan ZY, Yang Y, Yin RY, Tang L, Zhang F. Effect of Health Literacy on Decision Delay in Patients With Acute Myocardial Infarction. Front Cardiovasc Med 2021; 8:754321. [PMID: 34917660 PMCID: PMC8669267 DOI: 10.3389/fcvm.2021.754321] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 11/04/2021] [Indexed: 11/13/2022] Open
Abstract
Background: Health literacy (HL) is a risk factor for adverse outcomes in patients with cardiovascular disease, and shorter pre-hospital delay time is crucial for successful treatment of acute myocardial infraction (AMI) patients. Most previous studies focused on the influencing factors of pre-hospital delay but ignore the essential contribution of decision delay. Aims: Therefore, the purpose of this study was to explore the effect of HL on decision delay. Methods: Continuously included AMI patients admitted to a grade A class three hospital in Chongqing. HL level was assessed using Brief Health Literacy Screen and categorized as adequate or inadequate. Mann-Whitney U-test and Chi-square test were used to compare the differences between groups, and binary logistic regression was used to analyze the association between HL and decision delay. Results: A total of 217 AMI patients were enrolled in this study, including 166 males (76.5%) and 51 females (23.5%), with the median age was 68 years old; 135 (62.2%) patients had delayed decision-making while 82 (37.8%) did not; 157 (72.7%) patients had inadequate HL and 59 (27.3%) had adequate HL. The total HL score of non-delayed group was higher than that in delayed group (9.22 vs. 7.02, P < 0.000). Conclusion: After adjusting for covariates, HL was significantly negatively associated with decision time. AMI patients with inadequate HL were more likely to delay seeking timely medical care.
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Affiliation(s)
- Zhao-Ya Fan
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Yuan Yang
- Department of Cardiovascular Medicine, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Ruo-Yun Yin
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Lei Tang
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
| | - Fan Zhang
- Research Center for Medicine and Social Development, Collaborative Innovation Center of Social Risks Governance in Health, School of Public Health and Management, Chongqing Medical University, Chongqing, China
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Analysis of potential factors contributing to refusal of invasive strategy after ST-segment elevation myocardial infarction in China. Chin Med J (Engl) 2021; 134:524-531. [PMID: 33652458 PMCID: PMC7929575 DOI: 10.1097/cm9.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Reduced application of percutaneous coronary intervention (PCI) is associated with higher mortality rates after ST-segment elevation myocardial infarction (STEMI). We aimed to evaluate potential factors contributing to the refusal of PCI in STEMI patients in China. Methods: We studied 957 patients diagnosed with STEMI in the emergency departments (EDs) of six public hospitals in China. The differences in baseline characteristics and 30-day outcome were investigated between patients who refused PCI and those who underwent PCI. Multivariable logistic regression was used to evaluate the potential factors associated with refusing PCI. Results: The potential factors contributing to refusing PCI were older than 65 years (odds ratio [OR] 2.66, 95% confidence interval [CI] 1.56–4.52, P < 0.001), low body mass index (BMI) (OR 0.91, 95% CI 0.84–0.98, P = 0.013), not being married (OR 0.29, 95% CI 0.17–0.49, P < 0.001), history of myocardial infarction (MI) (OR 2.59, 95% CI 1.33–5.04, P = 0.005), higher heart rate (HR) (OR 1.02, 95% CI 1.01–1.03, P = 0.002), cardiac shock in the ED (OR 5.03, 95% CI 1.48–17.08, P = 0.010), pre-hospital delay (>12 h) (OR 3.31, 95% CI 1.83–6.02, P < 0.001) and not being hospitalized in a tertiary hospital (OR 0.45, 95% CI 0.27–0.75, P = 0.002). Compared to men, women were older, were less often married, had a lower BMI and were less often hospitalized in tertiary hospitals. Conclusions: Patients who were older, had lower economic or social status, and had poorer health status were more likely to refuse PCI after STEMI. There was a sex difference in the potential predictors of refusing PCI. Targeted efforts should be made to improve the acceptance of PCI among patients with STEMI in China.
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Birnbach B, Höpner J, Mikolajczyk R. Cardiac symptom attribution and knowledge of the symptoms of acute myocardial infarction: a systematic review. BMC Cardiovasc Disord 2020; 20:445. [PMID: 33054718 PMCID: PMC7557019 DOI: 10.1186/s12872-020-01714-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 09/24/2020] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Since the knowledge of the symptoms of acute myocardial infarction (AMI) may reduce the decision time for patients to seek help in case of an AMI, we aimed to summarize evidence on the knowledge of the AMI symptoms and the symptom attribution in case of an acute coronary syndrome (ACS). METHODS Therefore, we systematically searched the databases PubMed, CINAHL, Embase, and Cochrane Library for relevant studies published between January 1, 2008 and 2019 (last search August 1, 2019). RESULTS A total of 86 studies were included, with a composite sample size of 354,497 participants. The weighted mean of the knowledge scores for the symptoms of AMI of 14,420 participants from the general population, was 42.1% (when maximum score was considered 100%) and 69.5% for 7642 cardiac patients. There was a substantially better level of knowledge for six symptoms ('chest pain or discomfort', 'shortness of breath', 'pain or discomfort in arms or shoulders', 'feeling weak, lightheaded, or faint', 'pain or discomfort in the jaw, neck, or back', and 'sweating') (49.8-88.5%) compared to the four less obvious/atypical symptoms 'stomach or abdominal discomfort', 'nausea or vomiting', 'headache', and 'feeling of anxiety' (8.7-36.7%). Only 45.1% of 14,843 patients, who experienced ACS, have correctly attributed their symptoms to a cardiac cause. CONCLUSION In conclusion, we found a moderate to good knowledge of "classic" and insufficient knowledge of less obvious symptoms of AMI. This might suggest that increasing knowledge about less obvious symptoms of AMI could be beneficial. It appears also important to address cardiac attribution of symptoms.
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Affiliation(s)
- Benedikt Birnbach
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Jens Höpner
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometrics and Informatics, Interdisciplinary Center for Health Sciences, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany.
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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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Lee SH, Kim HK, Jeong MH, Lee JM, Gwon HC, Chae SC, Seong IW, Park JS, Chae JK, Hur SH, Cha KS, Kim HS, Seung KB, Rha SW, Ahn TH, Kim CJ, Hwang JY, Choi DJ, Yoon J, Joo SJ, Hwang KK, Kim DI, Oh SK. Pre-hospital delay and emergency medical services in acute myocardial infarction. Korean J Intern Med 2020; 35:119-132. [PMID: 31766823 PMCID: PMC6960059 DOI: 10.3904/kjim.2019.123] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 06/19/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS Minimising total ischemic time (TIT) is important for improving clinical outcomes in patients with ST-segment elevation myocardial infarction who have undergone percutaneous coronary intervention (PCI). TIT has not shown a significant improvement due to persistent pre-hospital delay. This study aimed to investigate the risk factors associated with pre-hospital delay. METHODS Individuals enrolled in the Korea Acute Myocardial Infarction Registry-National Institutes of Health between 2011 and 2015 were included in this study. The study population was analyzed according to the symptom-to-door time (STDT; within 60 or > 60 minutes), and according to the type of hospital visit (emergency medical services [EMS], non-PCI center, or PCI center). RESULTS A total of 4,874 patients were included in the analysis, of whom 28.4% arrived at the hospital within 60 minutes of symptom-onset. Old age (> 65 years), female gender, and renewed ischemia were independent predictors of delayed STDT. Utilising EMS was the only factor shown to reduce STDT within 60 minutes, even when cardiogenic shock was evident. The overall frequency of EMS utilisation was low (21.7%). Female gender was associated with not utilising EMS, whereas cardiogenic shock, previous myocardial infarction, familial history of ischemic heart disease, and off-hour visits were associated with utilising EMS. CONCLUSION Factors associated with delayed STDT and not utilising EMS could be targets for preventive intervention to improve STDT and TIT.
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Affiliation(s)
- Seung Hun Lee
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyun Kuk Kim
- Department of Cardiology, Chosun University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- Department of Cardiology, Chonnam National University Hospital, Gwangju, Korea
- Correspondence to Myung Ho Jeong, M.D. Department of Cardiology, Chonnam National University Hospital, 42 Jebong-ro, Donggu, Gwangju 61469, Korea Tel: +82-62-220-6243, Fax: +82-62-228-7174, E-mail:
| | - Joo Myung Lee
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hyeon-Cheol Gwon
- Heart Vascular and Stroke Institute, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - In-Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Jong-Seon Park
- Division of Cardiology, Yeungnam University Medical Centre, Daegu, Korea
| | - Jei Keon Chae
- Division of Cardiology, Department of Internal Medicine, Chonbuk National University Medical School, Jeonju, Korea
| | - Seung-Ho Hur
- Department of Cardiovascular Medicine, Keimyung University Dongsan Medical Centre, Daegu, Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, Korea
| | - Hyo-Soo Kim
- Cardiovascular Centre, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Ki-Bae Seung
- Division of Cardiology, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Centre, Korea University Guro Hospital, Seoul, Korea
| | - Tae Hoon Ahn
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea
| | - Chong-Jin Kim
- Department of Cardiology, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jin-Yong Hwang
- Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong-Ju Choi
- Cardiovascular Centre, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Seung-Jae Joo
- Department of Internal Medicine, Jeju National University School of Medicine, Jeju, Korea
| | - Kyung-Kuk Hwang
- Department of Internal Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Doo-Il Kim
- Department of Internal Medicine, Inje University Haeundae Paik Hospital, Busan, Korea
| | - Seok Kyu Oh
- Division of Cardiology, Department of Internal Medicine, Wonkwang University School of Medicine, Iksan, Korea
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Mirzaei S, Steffen A, Vuckovic K, Ryan C, Bronas UG, Zegre-Hemsey J, DeVon HA. The association between symptom onset characteristics and prehospital delay in women and men with acute coronary syndrome. Eur J Cardiovasc Nurs 2019; 19:142-154. [PMID: 31510786 DOI: 10.1177/1474515119871734] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND A decision to delay seeking treatment for symptoms of acute coronary syndrome increases the risk of serious complications, disability, and death. AIMS The purpose of this study was to determine if there was an association between gradual vs abrupt symptom onset and prehospital delay for patients with acute coronary syndrome and to examine the relationship between activities at symptom onset and gradual vs abrupt symptom onset. METHODS This was a secondary analysis of a large prospective multi-center study. Altogether, 474 patients presenting to the emergency department with symptoms of acute coronary syndrome were included in the study. Symptom characteristics, activity at symptom onset, and prehospital delay were measured with the ACS Patient Questionnaire. RESULTS Median prehospital delay time was four hours. Being uninsured (β=0.120, p=0.031) and having a gradual onset of symptoms (β=0.138, p=0.003) were associated with longer delay. A diagnosis of ST-elevation myocardial infarction (β=-0.205, p=0.001) and arrival by ambulance (β=-0.317, p<0.001) were associated with shorter delay. Delay times were shorter for patients who experienced an abrupt vs gradual symptom onset (2.57 h vs 8 h, p<0.001). Among men with an abrupt onset of symptoms and a ST-elevation myocardial infarction diagnosis, 54% reported that symptoms were triggered by exertion (p=0.046). CONCLUSION Patients should be counselled that a gradual onset of symptoms for potential acute coronary syndrome is an emergency and that they should call 911. Men with ischemic heart disease or with multiple risk factors should be cautioned that symptom onset following exertion may represent acute coronary syndrome.
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Affiliation(s)
- Sahereh Mirzaei
- Department of Biobehavioral Health Science, University of Illinois, USA
| | - Alana Steffen
- Department of Health Systems Science, University of Illinois at Chicago, USA
| | - Karen Vuckovic
- Department of Biobehavioral Health Science, University of Illinois, USA
| | - Catherine Ryan
- Department of Biobehavioral Health Science, University of Illinois, USA
| | - Ulf G Bronas
- Department of Biobehavioral Health Science, University of Illinois, USA
| | | | - Holli A DeVon
- Department of Biobehavioral Health Science, University of Illinois, USA
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