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Baxi J, Chao JC, Dewan K, Yang NK, Pepe RJ, Deng X, Soliman FK, Volk L, Rahimi S, Russo MJ, Lee LY. Socioeconomic status as a predictor of post-operative mortality and outcomes in carotid artery stenting vs. carotid endarterectomy. Front Cardiovasc Med 2024; 11:1286100. [PMID: 38385132 PMCID: PMC10879273 DOI: 10.3389/fcvm.2024.1286100] [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: 08/31/2023] [Accepted: 01/08/2024] [Indexed: 02/23/2024] Open
Abstract
Background The association between low socioeconomic status (SES) and worse surgical outcomes has become an emerging area of interest. Literature has demonstrated that carotid artery stenting (CAS) poses greater risk of postoperative complications, particularly stroke, than carotid endarterectomy (CEA). This study aims to compare the impact of low SES on patients undergoing CAS vs. CEA. Methods The National Inpatient Sample (NIS) was queried for patients undergoing CAS and CEA from 2010 to 2015. Patients were stratified by highest and lowest median income quartiles by zip code and compared through demographics, hospital characteristics, and comorbidities defined by the Charlson Comorbidity Index (CCI). Primary outcome was in-hospital mortality. Secondary outcomes included acute kidney injury (AKI), post-operative stroke, sepsis, and bleeding requiring reoperation.Multivariable logistic regression was used to determine the effect of SES on outcomes. Results Five thousand four hundred twenty-five patients underwent CAS (Low SES: 3,516 (64.8%); High SES: 1,909 (35.2%) and 38,399 patients underwent CEA (Low SES: 22,852 (59.5%); High SES: 15,547 (40.5%). Low SES was a significant independent predictor of mortality [OR = 2.07 (1.25-3.53); p = 0.005] for CEA patients, but not for CAS patients [OR = 1.21 (CI 0.51-2.30); p = 0.68]. Stroke was strongly associated with low SES, CEA patients (Low SES = 1.5% vs. High SES = 1.2%; p = 0.03), while bleeding was with high SES, CAS patients (Low SES = 5.3% vs. High SES = 7.1%; p = 0.01). CCI was a strong predictor of mortality for both procedures [CAS: OR1.45 (1.17-1.80); p < 0.001. CEA: OR1.60 (1.45-1.77); p < 0.001]. Advanced age was a predictor of mortality post-CEA [OR = 1.03 (1.01-1.06); p = 0.01]. While not statistically significant, advanced age and increased mortality trended towards a positive association in CAS [OR = 1.05 (1.00-1.10); p = 0.05]. Conclusions Low SES is a significant independent predictor of post-operative mortality in patients who underwent CEA, but not CAS. CEA is also associated with higher incidence of stroke in low SES patients. Findings demonstrate the impact of SES on outcomes for patients undergoing carotid revascularization procedures. Prospective studies are warranted to further evaluate this disparity.
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Affiliation(s)
- Jigesh Baxi
- Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
| | - Joshua C. Chao
- Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
| | - Krish Dewan
- Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
| | - NaYoung K. Yang
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Russell J. Pepe
- Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
| | - Xiaoyan Deng
- School of Arts and Sciences, Rutgers University, New Brunswick, NJ, United States
| | - Fady K. Soliman
- Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
| | - Lindsay Volk
- Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
| | - Saum Rahimi
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
- Division of Vascular Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
| | - Mark J. Russo
- Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
| | - Leonard Y. Lee
- Division of Cardiothoracic Surgery, Department of Surgery, Robert Wood Johnson University Hospital, New Brunswick, NJ, United States
- Rutgers Robert Wood Johnson Medical School, Rutgers University, New Brunswick, NJ, United States
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Weininger D, Cordova JP, Wilson E, Eslava DJ, Alviar CL, Korniyenko A, Bavishi CP, Hong MK, Chorzempa A, Fox J, Tamis-Holland JE. Delays to Hospital Presentation in Women and Men with ST-Segment Elevation Myocardial Infarction: A Multi-Center Analysis of Patients Hospitalized in New York City. Ther Clin Risk Manag 2022; 18:1-9. [PMID: 35018099 PMCID: PMC8742618 DOI: 10.2147/tcrm.s335219] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 10/23/2021] [Indexed: 11/29/2022] Open
Abstract
Purpose Previous studies have shown longer delays from symptom onset to hospital presentation (S2P time) in women than men with acute myocardial infarction. The aim of this study is to understand the reasons for delays in seeking care among women and men presenting with an ST-Segment Elevation Myocardial Infarction (STEMI) through a detailed assessment of the thoughts, perceptions and patterns of behavior. Patients/Methods and Results A total of 218 patients with STEMI treated with primary angioplasty at four New York City Hospitals were interviewed (24% female; Women: 68.7 ± 13.1 years and men: 60.7 ± 13.8 years) between January 2009 and August 2012. A significantly larger percentage of women than men had no chest pain (62% vs 36%, p<0.01). Compared to men, a smaller proportion of women thought they were having a myocardial infarction (15% vs 34%, p=0.01). A larger proportion of women than men had S2P time >90 minutes (72% of women vs 54% of men, p= 0.03). Women were more likely than men to hesitate before seeking help, and more women than men hesitated because they did not think they were having an AMI (91% vs 83%, p=0.04). Multivariate regression analysis showed that female sex (Odds Ratio: 2.46, 95% CI 1.10–5.60 P=0.03), subjective opinion it was not an AMI (Odds Ratio 2.44, 95% CI 1.20–5.0, P=0.01) and level of education less than high school (Odds ratio 7.21 95% CI 1.59–32.75 P=0.01) were independent predictors for S2P >90 minutes. Conclusion Women with STEMI have longer pre-hospital delays than men, which are associated with a higher prevalence of atypical symptoms and a lack of belief in women that they are having an AMI. Greater focus should be made on educating women (and men) regarding the symptoms of STEMI, and the importance of a timely response to these symptoms.
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Affiliation(s)
| | | | | | | | - Carlos L Alviar
- NYU Medical Center and Bellevue Hospital Center, New York, NY, USA
| | | | | | - Mun K Hong
- Bassett Healthcare Network, Cooperstown, NY, USA
| | | | - John Fox
- Mount Sinai Beth Israel Hospital, New York, NY, USA
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Porter A, Brown CC, Tilford JM, Cima M, Zohoori N, McCormick D, Wilson MP, Amick BC, Romero JR. Association of the COVID-19 pandemic and dying at home due to ischemic heart disease. Prev Med 2021; 153:106818. [PMID: 34599924 PMCID: PMC8480010 DOI: 10.1016/j.ypmed.2021.106818] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/16/2021] [Accepted: 09/26/2021] [Indexed: 11/11/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been associated with a declining volume of patients seen in the emergency department. Despite the need for seeking urgent care for conditions such as myocardial infarction, many people may not seek treatment. This study seeks to measure associations between the COVID-19 pandemic and location of death among individuals who died from ischemic heart disease (IHD). Data obtained from death certificates from the Arkansas Department of Health was used to conduct a difference-in-difference analysis to assess whether decedents of IHD were more likely to die at home during the pandemic (March 2020 through September 2020). The analysis compared location of death for decedents of IHD pre and during the pandemic to location of death for decedents from non-natural causes. Before the pandemic, 50.0% of decedents of IHD died at home compared to 57.9% dying at home during (through September 2020) the pandemic study period (p < .001). There was no difference in the proportion of decedents who died at home from non-natural causes before and during the pandemic study period (55.8% vs. 53.5%; p = .21). After controlling for confounders, there was a 48% increase in the odds of dying at home from IHD during the pandemic study period (p < .001) relative to the change in dying at home due to non-natural causes. During the study period, there was an increase in the proportion of decedents who died at home due to IHD. Despite the ongoing pandemic, practitioners should emphasize the need to seek urgent care during an emergency.
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Affiliation(s)
- Austin Porter
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Arkansas Department of Health, Little Rock, AR 72205, United States of America.
| | - Clare C Brown
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - J Mick Tilford
- Fay W. Boozman College of Public Health, Department of Health Policy and Management, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Michael Cima
- Arkansas Department of Health, Little Rock, AR 72205, United States of America
| | - Namvar Zohoori
- Arkansas Department of Health, Little Rock, AR 72205, United States of America; Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Donald McCormick
- Arkansas Department of Health, Little Rock, AR 72205, United States of America
| | - Michael P Wilson
- Division of Research and Evidence-Based Medicine, Department of Emergency Medicine, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Department of Emergency Medicine Behavioral Emergencies Research (DEMBER) Lab, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - Benjamin C Amick
- Fay W. Boozman College of Public Health, Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, AR 72205, United States of America
| | - José R Romero
- Arkansas Department of Health, Little Rock, AR 72205, United States of America; Pediatric Infectious Diseases Section, University of Arkansas for Medical Sciences and Arkansas Children's Hospital, Little Rock, AR 72205, United States of America
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Patient Risk Interpretation of Symptoms Model (PRISM): How Patients Assess Cardiac Risk. J Gen Intern Med 2021; 36:2205-2211. [PMID: 34100233 PMCID: PMC8342696 DOI: 10.1007/s11606-021-06770-0] [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: 06/12/2020] [Accepted: 03/29/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND While there is a prevailing perception that coronary artery disease (CAD) is a "man's disease," little is known about the factors which influence cardiac risk assessment and whether it varies by gender. OBJECTIVES 1) Qualitatively capture the complexity of cardiac risk assessment from a patient-centered perspective. 2) Explore how risk assessment may vary by gender. 3) Quantitatively validate qualitative findings among a new sample. DESIGN This study was conducted in two parts: (1) semi-structured in-depth interviews were audio-recorded, transcribed verbatim, and analyzed using modified grounded theory; (2) emergent themes were surveyed in a separate sample to validate findings quantitatively. Differences were estimated using 2-tailed t-tests and kappa. PARTICIPANTS Participants who were referred for their first elective coronary angiogram for suspected CAD with at least 1 prior abnormal test were recruited from a tertiary care hospital. MAIN MEASURES Patient-centered themes were derived from part one. In part two, patients estimated the probability that their symptoms were heart-related at multiple time points. RESULTS Part 1 included 14 men and 17 women (mean age=63.3±11.8 years). Part 2 included 237 patients, of which 109 (46%) were women (mean age=66.0±11.3 years). Part 1 revealed that patients' risk assessment evolves in three distinct phases, which were captured using an Ishikawa framework entitled "Patient Risk Interpretation of Symptoms Model" (PRISM). Part 2 validated PRISM findings; while patients were more likely to attribute their symptoms to CAD over time (phase 1 vs. 3: 21% vs. 73%, p<0.001), women were marginally less likely than men to perceive symptoms as heart-related by phase 3 (67% women vs. 78% men, p=0.054). CONCLUSIONS Patient assessment of CAD risk evolves, and women are more likely to underestimate their risk than men. PRISM may be used as a clinical aid to optimize patient-centered care. Future studies should validate PRISM in different clinical settings.
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Perl L, Franzé A, D’Ascenzo F, Golomb N, Levi A, Vaknin-Assa H, Greenberg G, Assali A, De Ferrari GM, Kornowski R. Elderly Suffering from ST-Segment Elevation Myocardial Infarction-Results from a Database Analysis from Two Mediterranean Medical Centers. J Clin Med 2021; 10:jcm10112435. [PMID: 34070865 PMCID: PMC8199382 DOI: 10.3390/jcm10112435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Revised: 05/12/2021] [Accepted: 05/27/2021] [Indexed: 01/06/2023] Open
Abstract
Background: Little is known regarding primary percutaneous coronary intervention (pPCI) for ST-segment elevation myocardial infarction (STEMI) in the elderly. Methods: Data on 319 octogenarians, 641 septuagenarians, and 2451 younger patients was collected from an ongoing prospective registry of patients treated with pPCI for STEMI at two Mediterranean-area medical centers in 2009–2017. Results: More octogenarian patients were female (40.8 vs. 31.9 septuagenarians and 26.5% under 70 y, p < 0.01), had hypertension (79.5 vs. 69.5 and 45.9%, p < 0.01), renal failure (32.5 vs. 20.1 and 5.2%, p < 0.01), and a lower left-ventricular ejection fraction (42.0 vs. 44.9 and 47.6%, p = 0.012). At 1 month and 3 years after intervention, mortality was higher in the octogenarian patients (12.2 vs. 7.9%, p = 0.01; and 36.7 vs. 23.1%, p < 0.01, respectively), with no significant differences in the rates of recurrent myocardial infarction, target vessel revascularization, coronary artery bypass surgery, and cardiovascular death. Following adjustment for confounders, 3-year mortality was significantly higher in the octogenarians (HR 3.89 vs. 3.19 for septuagenarians, p < 0.01), but rates of major adverse cardiac events or cardiovascular death were not. Conclusions: Despite suffering from higher all-cause mortality, octogenarian patients treated with pPCI for STEMI do not suffer an increased risk of ischemic cardiac events relative to younger patients.
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Affiliation(s)
- Leor Perl
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Correspondence: or ; Tel.: +972-3-9372251; Fax: +972-3-9372460
| | - Alfonso Franzé
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.F.); (F.D.)
| | - Fabrizio D’Ascenzo
- Division of Cardiology, Department of Medical Sciences, Città della Salute e della Scienza, University of Turin, Corso Bramante 88, 10126 Turin, Italy; (A.F.); (F.D.)
| | - Noa Golomb
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Amos Levi
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Hana Vaknin-Assa
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Gabriel Greenberg
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
| | - Abid Assali
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
- Department of Cardiology, Meir Medical Center, Tchernichovsky St 59, Kfar-Saba 4428164, Israel
| | - Gaetano M. De Ferrari
- Department of Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Camillo Golgi 19, 27100 Pavia, Italy;
| | - Ran Kornowski
- Department of Cardiology, Rabin Medical Center—Beilinson Hospital, Petach Tikva 4941492, Israel; (N.G.); (A.L.); (H.V.-A.); (G.G.); (R.K.)
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 69978, Israel;
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Tisminetzky M, Gurwitz JH, Miozzo R, Nunes A, Gore JM, Lessard D, Yarzebski J, Granillo E, Goldberg RJ. Age Differences in the Chief Complaint Associated With a First Acute Myocardial Infarction and Patient's Care-Seeking Behavior. Am J Med 2020; 133:e501-e507. [PMID: 32199808 PMCID: PMC7483814 DOI: 10.1016/j.amjmed.2020.02.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Revised: 02/11/2020] [Accepted: 02/12/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND This study set out to describe age differences in patient's chief complaint related to a first myocardial infarction and how the "typicality" of patient's acute symptoms relates to extent of prehospital delay. METHODS The medical records of 2586 residents of central Massachusetts hospitalized at 11 greater Worcester medical centers with a first myocardial infarction on a biennial basis between 2001 and 2011 were reviewed. RESULTS The average age of the study population was 66.4 years, 39.6% were women, 40.2% were diagnosed with a ST-elevation myocardial infarction (STEMI), and 72.0 % presented with typical symptoms of myocardial infarction, namely acute chest pain or pressure. Patients were categorized into 5 age strata: >55 years (23%), 55-64 years (20%), 65-74 years (19%), 75-84 years (22%), and ≥85 years (16%). The lowest proportion (11%) of atypical symptoms of myocardial infarction was observed in patients <55 years, increasing to 17%, 28%, 40%, and 51% across the respective age groups. The most prevalent chief complaint reported at the time of hospitalization was chest pain, but the proportion of patients reporting this symptom decreased from the youngest (83%) to the oldest patient groups (45%). There was a slightly increased risk of prehospital delay across the different age groups (higher in the oldest old) in those who presented with atypical, rather than typical, symptoms of myocardial infarction. CONCLUSIONS The present results provide insights to the presenting chief complaint of patients hospitalized with a first myocardial infarction according to age and the relation of symptom presentation to patient's care-seeking behavior.
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Affiliation(s)
- Mayra Tisminetzky
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass.
| | - Jerry H Gurwitz
- Meyers Primary Care Institute, Worcester, Mass; Division of Geriatric Medicine, University of Massachusetts Medical School, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Ruben Miozzo
- Johns Hopkins Bloomberg School of Public Health Baltimore, Md
| | - Anthony Nunes
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Joel M Gore
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Darleen Lessard
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Jorge Yarzebski
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Edgard Granillo
- Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
| | - Robert J Goldberg
- Meyers Primary Care Institute, Worcester, Mass; Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, Mass
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Muhlestein JB, Anderson JL, Bethea CF, Severance HW, Mentz RJ, Barsness GW, Barbagelata A, Albert D, Le VT, Bunch TJ, Yanowitz F, May HT, Chisum B, Ronnow BS, Muhlestein JB. Feasibility of combining serial smartphone single-lead electrocardiograms for the diagnosis of ST-elevation myocardial infarction. Am Heart J 2020; 221:125-135. [PMID: 31986289 DOI: 10.1016/j.ahj.2019.12.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 12/21/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND The rate-limiting step in STEMI diagnosis often is the availability of a 12-lead electrocardiogram (ECG) and its interpretation. The potential may exist to speed the availability of 12-lead ECG information by using commonly available mobile technologies. We sought to test whether combining serial smartphone single-lead ECGs to create a virtual 12-lead ECG can accurately diagnose STEMI. METHODS Consenting patients presenting with symptoms consistent with a possible STEMI had contemporaneous standard 12-lead and smartphone '12-lead equivalent' ECG (produced by electronically combining serial single-lead ECGs) recordings obtained. Matched ECGs were evaluated qualitatively and quantitatively by a panel of blinded readers and classified as STEMI/STEMI equivalent (LBBB), Not-STEMI, or uninterpretable. Interpretable ECG pairs were graded as showing good, fair, or poor correlation. RESULTS Two hundred four subjects (age = 60 years, males = 57%, STEMI activation = 45%) were enrolled from 5 international sites. Smartphone ECG quality was graded as good in 151 (74.0%), fair in 32 (15.7%), poor in 8 (3.9%), and uninterpretable in 13 (6.4%). A STEMI/STEMI equivalent diagnosis was identified by standard 12-lead ECG in 57/204 (27.9%) recordings. For all interpretable pairs of smartphone ECGs compared with standard ECGs (n = 190), the sensitivity, specificity, and positive and negative predictive values for STEMI/STEMI equivalent by smartphone were 0.89, 0.84, 0.70 and 0.95, respectively. CONCLUSIONS A '12-lead equivalent' ECG obtained from multiple serial single-lead ECGs from a smartphone can identify STEMI with good correlation to a standard 12-lead ECG. This technology holds promise to improve outcomes in STEMI by enhancing the reach and speed of diagnosis and thereby early treatment.
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Affiliation(s)
- Joseph Boone Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, Department of Internal Medicine, Salt Lake City, Utah
| | - Jeffrey L Anderson
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, Department of Internal Medicine, Salt Lake City, Utah
| | | | - Harry W Severance
- Erlanger Institute for Clinical Research, UT College of Medicine, Chattanooga, Tennessee; Duke University, Durham, North Carolina
| | | | | | | | - David Albert
- AliveCor™ Corporation, San Franscisco, California
| | - Viet T Le
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; Rocky Mountain University of Health Professions, Masters of Physician Assistant Studies Program, Provo, Utah
| | - T Jared Bunch
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; Stanford University, Department of Internal Medicine, Palo Alto, California
| | - Frank Yanowitz
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, Department of Internal Medicine, Salt Lake City, Utah
| | - Heidi T May
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
| | - Benjamin Chisum
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
| | - Brianna S Ronnow
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah
| | - Joseph Brent Muhlestein
- Intermountain Medical Center, Intermountain Heart Institute, Salt Lake City, Utah; University of Utah, Department of Internal Medicine, Salt Lake City, Utah.
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Calé R, Pereira H, Pereira E, Vitorino S, de Mello S. Time to reperfusion in high-risk patients with myocardial infarction undergoing primary percutaneous coronary intervention. Rev Port Cardiol 2019; 38:637-646. [DOI: 10.1016/j.repc.2018.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2018] [Revised: 11/06/2018] [Accepted: 12/02/2018] [Indexed: 12/01/2022] Open
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Calé R, Pereira H, Pereira E, Vitorino S, de Mello S. Time to reperfusion in high-risk patients with myocardial infarction undergoing primary percutaneous coronary intervention. REVISTA PORTUGUESA DE CARDIOLOGIA (ENGLISH EDITION) 2019. [DOI: 10.1016/j.repce.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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10
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Rubinstein R, Matetzky S, Beigel R, Iakobishvili Z, Goldenberg I, Shechter M. Trends in management and outcome of acute coronary syndrome in women ≥80 years versus those <80 years in Israel from 2000–2016. Int J Cardiol 2019; 281:22-27. [DOI: 10.1016/j.ijcard.2019.01.076] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Revised: 01/15/2019] [Accepted: 01/21/2019] [Indexed: 11/27/2022]
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11
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Barbagelata A, Bethea CF, Severance HW, Mentz RJ, Albert D, Barsness GW, Le VT, Anderson JL, Bunch TJ, Yanowitz F, Chisum B, Ronnow BS, Muhlestein JB. Smartphone ECG for evaluation of ST-segment elevation myocardial infarction (STEMI): Design of the ST LEUIS International Multicenter Study. J Electrocardiol 2018; 51:260-264. [DOI: 10.1016/j.jelectrocard.2017.10.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Indexed: 11/16/2022]
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12
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Nesoff ED, Brownstein JN, Veazie M, O'Leary M, Brody EA. Time-to-Treatment for Myocardial Infarction: Barriers and Facilitators Perceived by American Indians in Three Regions. J Community Health 2018; 42:129-138. [PMID: 27613739 DOI: 10.1007/s10900-016-0239-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Early recognition of acute myocardial infarction (MI), followed by prompt emergency care, improves patient outcomes. Among rural American Indian (AI) populations there are disparities in access to care for MI and processes of care, resulting in poor MI-related health outcomes compared to the general population. We sought to gain an understanding of barriers related to MI time-to-treatment delays using a qualitative approach. We conducted semi-structured interviews and focus groups with AI key informants and community members in three Indian Health Service regions. Major barriers to care included long travel distance to care and lack of supporting infrastructure; distrust of the health care system; low overall literacy and basic health literacy; priority of family care-giving; and lack of specialized medical facilities and specialists. Findings suggest that improved time-to-treatment facilitators include educating the local community about the causes and consequences of MI and culturally-sensitive health communication, as well as addressing the quality of local systems of care and the community's perception of these systems. Pursuing these strategies may improve quality of care and reduce MI-related morbidity and mortality in rural AI populations.
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Affiliation(s)
- Elizabeth D Nesoff
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | - J Nell Brownstein
- Division for Heart Disease and Stroke Prevention, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop F-72, Atlanta, GA, 30341-3717, USA
| | - Mark Veazie
- Indian Health Service, 1215 N. Beaver Street, Suite #201, Flagstaff, AZ, 86001, USA
| | - Marcia O'Leary
- Missouri Breaks Industries Research, HCR 64 Box 52, Timber Lake, SD, 57656, USA
| | - Eric A Brody
- Native American Cardiology and Medical Service Program, University of Arizona Medical Center, 1501 North, Campbell Ave., PO Box 245202, Tucson, AZ, 85724, USA
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13
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Iacoe E, Ratner PA, Wong ST, Mackay MH. A cross-sectional study of ethnicity-based differences in treatment seeking for symptoms of acute coronary syndrome. Eur J Cardiovasc Nurs 2017; 17:297-304. [PMID: 29140107 DOI: 10.1177/1474515117741893] [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: 11/16/2022]
Abstract
BACKGROUND Patient-related delays in acquiring medical care for symptoms of acute coronary syndrome remain unacceptably long. Many clinical and sociodemographic characteristics associated with treatment-seeking delay are known; however, ethnicity has not been extensively evaluated. OBJECTIVE The purpose of this study was to examine ethnicity-based differences in the time-to-treatment-seeking intervals of patients experiencing symptoms of acute coronary syndrome. METHOD Data for this descriptive study were collected for the larger Acute Coronary Syndrome Care in Emergency Departments (ASCEND) study. The larger study is a prospective, observational study in which patients presenting to hospital emergency departments and triaged as having symptoms suggestive of acute coronary syndrome are identified. The primary outcome of this study, the time-to-treatment-seeking interval, was defined as the time between symptom onset and treatment seeking. The predictor variable, ethnicity, was measured with self-reported data and categorised as Chinese, South Asian, or 'Other' ethnic group. Participants in the 'Other' ethnic group were predominantly of European ancestry. Univariate and multivariate analyses were undertaken, along with nonparametric testing. RESULTS The study sample consisted of 419 participants: 36 Chinese, 126 South Asian, and 257 'Other' participants. The median time-to-treatment-seeking interval, for the total sample, was 180 minutes. A Kruskal-Wallis test demonstrated no statistically significant differences in the time-to-treatment-seeking intervals by ethnicity. CONCLUSION No ethnicity-based differences in the time-to-treatment-seeking intervals for symptoms of acute coronary syndrome were found. It is possible that Chinese and South Asian patients living in western countries are more aware of the potential signs and symptoms of acute coronary syndrome or feel more confident to access healthcare services than they have been previously.
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Affiliation(s)
- Emma Iacoe
- 1 St. Paul's Hospital, Providence Health Care, Canada
| | | | | | - Martha H Mackay
- 1 St. Paul's Hospital, Providence Health Care, Canada.,2 University of British Columbia, Canada
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14
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Abstract
Reperfusion therapy decreases myocardium damage during an acute coronary event and consequently mortality. However, there are unmet needs in the treatment of acute myocardial infarction, consequently mortality and heart failure continue to occur in about 10% and 20% of cases, respectively. Different strategies could improve reperfusion. These strategies, like generation of warning sign recognition and being initially assisted and transferred by an emergency service, could reduce the time to reperfusion. If the first electrocardiogram is performed en route, it can be transmitted and interpreted in a timely manner by a specialist at the receiving center, bypassing community hospitals without percutaneous coronary intervention capabilities. To administer thrombolytic therapy during transport to the catheterization laboratory could reduce time to reperfusion in cases with expected prolonged transport time to a percutaneous coronary intervention center or to a center without primary percutaneous coronary intervention capabilities with additional expected delay, known as pharmaco-invasive strategy. Myocardial reperfusion is known to produce damage and cell death, which defines the reperfusion injury. Lack of resolution of ST segment is used as a marker of reperfusion failure. In patients without ST segment resolution, mortality triples. It is important to note that, until recently, reperfusion injury and no-reflow were interpreted as a single entity and we should differentiate them as different entities; whereas no-reflow is the failure to obtain tissue flow, reperfusion injury is actually the damage produced by achieving flow. Therefore, treatment of no-reflow is obtained by tissue flow, whereas in reperfusion injury the treatment objective is protection of susceptible myocardium from reperfusion injury. Numerous trials for the treatment of reperfusion injury have been unsuccessful. Newer hypotheses such as “
controlled reperfusion”, in which the interventional cardiologist assumes not only the treatment of the culprit vessel but also the way to reperfuse the myocardium at risk, could reduce reperfusion injury.
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Affiliation(s)
- Alejandro Farah
- Interventional Cardiology Department, San Bernardo Hospital, Salta, Argentina
| | - Alejandro Barbagelata
- Universidad Católica de Buenos Aires, Buenos Aires, Argentina.,Department of Medicine, Duke University School of Medicine, Durham, NC, USA
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15
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Kim HS, Lee KS, Eun SJ, Choi SW, Kim DH, Park TH, Yun KH, Yang DH, Hwang SJ, Park KS, Kim RB. Gender Differences in Factors Related to Prehospital Delay in Patients with ST-Segment Elevation Myocardial Infarction. Yonsei Med J 2017; 58:710-719. [PMID: 28540982 PMCID: PMC5447100 DOI: 10.3349/ymj.2017.58.4.710] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 02/22/2017] [Accepted: 03/19/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The aim of our study was to investigate gender differences in factors related to prehospital delay and identify whether the knowledge of acute myocardial infarction symptoms affects this delay in Korean patients with ST-elevation myocardial infarction (STEMI). MATERIALS AND METHODS A total of 350 patients (286 men, 64 women) with confirmed STEMI were interviewed to investigate socio-demographics, history of disease, symptom onset time, and factors that contributed to delayed decision time in seeking treatment and hospital arrival time from symptom onset. Factors associated with prehospital delay were examined separately by gender using univariate and multivariate analyses. RESULTS Female patients had higher proportions of ≥60-minute decision time and ≥120-minute arrival time compared to male patients (33.9% vs. 23.1%, 60.9% vs. 52.1%, respectively). However, the difference was not statistically significant (p=0.093 and 0.214, respectively). Previous cardiovascular disease (CVD) was associated with increased decision time in men, whereas, in women, lower educational status caused a greater delay in decision time. Factors associated with hospital arrival time excluding delayed decision time were referral from another hospital, previous CVD, and percutaneous coronary intervention in men, and referral from another hospital in women. CONCLUSION Gender differences exist in factors related to prehospital delay. Therefore, public education to reduce prehospital delay should be conducted according to gender with a focus on the pertinent factors.
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Affiliation(s)
- Hee Sook Kim
- Division of Infectious Disease Surveillance, Korea Centers for Disease Control and Prevention, Cheongju, Korea
- Department of Public Health Science, Graduate School of Public Health and Institute of Health and Environment, Seoul National University, Seoul, Korea
| | - Kun Sei Lee
- Department of Preventive Medicine, Konkuk University College of Medicine, Seoul, Korea
| | - Sang Jun Eun
- Department of Preventive Medicine, Chungnam National University School of Medicine, Daejeon, Korea
| | - Si Wan Choi
- Department of Internal Medicine, Chungnam National University Hospital and School of Medicine, Daejeon, Korea
| | - Dae Hyeok Kim
- Department of Internal Medicine, Inha University Hospital, Incheon, Korea
| | - Tae Ho Park
- Department of Internal Medicine, Dong-A University College of Medicine, Busan, Korea
| | - Kyeong Ho Yun
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Iksan, Korea
| | - Dong Heon Yang
- Department of Internal Medicine, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok Jae Hwang
- Department of Internal Medicine, Gyeongsang National University School of Medicine and Hospital, Jinju, Korea
| | - Ki Soo Park
- Department of Preventive Medicine, Gyeongsang National University School of Medicine and Institute of Health Sciences, Jinju, Korea.
| | - Rock Bum Kim
- Center for Regional Cardiocerebrovascular Disease, Gyeongsang National University Hospital, Jinju, Korea.
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16
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Miller AL, Simon D, Roe MT, Kontos MC, Diercks D, Amsterdam E, Bhatt DL. Comparison of Delay Times from Symptom Onset to Medical Contact in Blacks Versus Whites With Acute Myocardial Infarction. Am J Cardiol 2017; 119:1127-1134. [PMID: 28237284 DOI: 10.1016/j.amjcard.2016.12.021] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Revised: 12/22/2016] [Accepted: 12/22/2016] [Indexed: 12/13/2022]
Abstract
Clinical outcomes in acute myocardial infarction (AMI) worsen with increasing delay between symptom onset and clinical presentation. Previous studies have shown that black patients with AMI have longer presentation delays. The objective of this analysis is to explore the potential contribution of community factors to presentation delays in black patients with AMI. We linked clinical data for 346,499 consecutive patients with AMI from Acute Coronary Treatment Intervention Outcomes Network Registry-Get With the Guidelines™ (2007-2014) to socioeconomic and community information from the American Community Survey. Black patients with AMI had longer symptom onset to first medical contact times than white patients (114 vs 101 minutes, p <0.0001) regardless of ambulance versus self-transport. Compared with white patients, black patients were younger and more likely to have clinical co-morbidities such as hypertension, diabetes, previous heart failure, and stroke. They were also more likely to live in urban communities with lower socioeconomic status, lower rates of long-term residence, and higher proportion of single-person households than white patients. In sequential linear regression models adjusting for patient demographic and clinical characteristics, logistic barriers to prompt presentation, and community socioeconomic and composition factors, black patients had a persistent 9% greater time from symptom onset to presentation compared with white patients (95% CI 8% to 11%, p <0.0001). In conclusion, the longer delay in time to presentation in black patients with AMI compared with white patients persists after accounting for a number of both patient and community factors.
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17
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Saseendran A, Ally K, Gangadevi P, Banakar PS. Effect of supplementation of lecithin and carnitine on growth performance and nutrient digestibility in pigs fed high-fat diet. Vet World 2017; 10:149-155. [PMID: 28344396 PMCID: PMC5352838 DOI: 10.14202/vetworld.2017.149-155] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2016] [Accepted: 01/03/2017] [Indexed: 11/16/2022] Open
Abstract
Aim: To study the effect of dietary supplementation of lecithin and carnitine on growth performance and nutrient digestibility in pigs fed high-fat diet. Materials and Methods: A total of 30 weaned female large white Yorkshire piglets of 2 months of age were selected and randomly divided into three groups allotted to three dietary treatments, T1 - Control ration as per the National Research Council nutrient requirement, T2 - Control ration plus 5% fat, and T3 - T2 plus 0.5% lecithin plus 150 mg/kg carnitine. The total dry matter (DM) intake, fortnightly body weight of each individual animal was recorded. Digestibility trial was conducted toward the end of the experiment to determine the digestibility coefficient of various nutrients. Results: There was a significant improvement (p<0.01) observed for pigs under supplementary groups T2 and T3 than that of control group (T1) with regards to growth parameters studied such as total DM intake, average final body weight and total weight gain whereas among supplementary groups, pigs reared on T3 group had better intake (p<0.01) when compared to T2 group. Statistical analysis of data revealed that no differences were observed (p>0.05) among the three treatments on average daily gain, feed conversion efficiency, and nutrient digestibility during the overall period. Conclusion: It was concluded that the dietary inclusion of animal fat at 5% level or animal fat along with lecithin (0.5%) and carnitine (150 mg/kg) improved the growth performance in pigs than non-supplemented group and from the economic point of view, dietary incorporation of animal fat at 5% would be beneficial for improving growth in pigs without dietary modifiers.
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Affiliation(s)
- Arathy Saseendran
- Department of Animal Nutrition, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur - 680 651, Kerala, India
| | - K Ally
- Department of Animal Nutrition, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur - 680 651, Kerala, India
| | - P Gangadevi
- Department of Animal Nutrition, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur - 680 651, Kerala, India
| | - P S Banakar
- Department of Animal Nutrition, College of Veterinary and Animal Sciences, Kerala Veterinary and Animal Sciences University, Mannuthy, Thrissur - 680 651, Kerala, India
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Wechkunanukul K, Grantham H, Clark RA. Global review of delay time in seeking medical care for chest pain: An integrative literature review. Aust Crit Care 2017; 30:13-20. [DOI: 10.1016/j.aucc.2016.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Revised: 04/07/2016] [Accepted: 04/08/2016] [Indexed: 01/09/2023] Open
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19
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Buckley T, McKinley S, Gallagher R, Dracup K, Moser DK, Aitken LM. The Effect of Education and Counselling on Knowledge, Attitudes and Beliefs about Responses to Acute Myocardial Infarction Symptoms. Eur J Cardiovasc Nurs 2016; 6:105-11. [PMID: 16839819 DOI: 10.1016/j.ejcnurse.2006.05.005] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2006] [Revised: 05/21/2006] [Accepted: 05/24/2006] [Indexed: 11/23/2022]
Abstract
The time that elapses from the onset of symptoms of acute myocardial infarction (AMI) to treatment has a significant effect on mortality and morbidity. This study reports the effectiveness of an education and counselling intervention on knowledge, attitudes and beliefs about AMI symptoms and the appropriate response to symptoms. The intervention was tested in a randomised controlled trial of 200 people with a history of coronary heart disease (CHD). The groups were equivalent at baseline on study outcomes, clinical history and sociodemographic characteristics with the exception of more women in the intervention group (38% vs. 24%). The results of repeated measures ANOVA showed that the intervention resulted in improved knowledge of CHD, AMI symptoms and the appropriate response to symptoms that was sustained to 12 months (p=0.02). There were no differences between groups' attitudes and beliefs over time. It is concluded that a short individual teaching and counselling intervention resulted in improved knowledge of CHD, AMI symptoms and the appropriate response to symptoms in people at risk of AMI sustained to 12 months.
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Affiliation(s)
- T Buckley
- University of Technology Sydney, Faculty of Nursing, Midwifery and Health, Sydney, NSW, Australia.
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20
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Meischke H, Diehr P, Rowe S, Cagle A, Eisenberg M. Evaluation of a Public Education Program Delivered by Firefighters on Early Recognition of a Heart Attack. Eval Health Prof 2016; 27:3-21. [PMID: 14994556 DOI: 10.1177/0163278703261199] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The Heart Attack Survival Kit (HASK) project is a prospective, randomized trial, testing the effectiveness of an intervention delivered door-to-door by firefighters to increase use of 911 and ingestion of aspirin for symptoms of acute myocardial infarction (AMI) among seniors in King County, Washington. Firefighters visited 24,582seniors in King County, Washington and delivered a Heart Attack Survival Kit. Another 24,191 senior households served as the control group. Outcomes of the program were measured by tracking 911 calls as well as survey data. This study reports on the results of the telephone survey with a random sample of seniors (N = 323) to assess their knowledge of and intentions to act during a heart emergency. Results of a logistic regression analysis showed that being female, be ing younger, and remembering the kit was significantly related to intentions to act appropriately to AMI symptoms. The results are discussed in terms of public education around AMI.
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21
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Madsen R, Birkelund R. Women's experiences during myocardial infarction: systematic review and meta-ethnography. J Clin Nurs 2016; 25:599-609. [PMID: 26771091 DOI: 10.1111/jocn.13096] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2015] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES The aim of this review is to identify, analyse and synthesise existing knowledge concerning female experiences during myocardial infarction. BACKGROUND There is a lack of knowledge about women's experiences during myocardial infarction, and a meta-synthesis is needed to synthesise existing evidence. DESIGN A systematic review and meta-ethnography. METHOD A systematic review was undertaken in September 2013. Four databases were searched. Grey literature and reference lists were screened for relevant studies. Four hundred and eighty-one papers were identified and 14 were included. The method of Noblit and Hare was used in the process of conducting this review and meta-ethnography. RESULTS Three themes were identified. 1. 'Feeling the changes in my body', 2. 'Understanding the changes in my body' and 3. 'Acting on the changes in my body'. The majority of women did not experience their body changes as being severe and threatening. Therefore, the women chose to wait or self-medicate before consulting others. The women who initially experienced the symptoms related to myocardial infarction as being severe and threatening, chose to consult others earlier than the majority of women. CONCLUSION Women's experiences and interpretation of body symptoms during myocardial infarction vary. Most commonly women do not initially recognise their body symptoms as being severe and life threatening. The theory of Merleau-Ponty's 'current and habituated body' is relevant for explaining women's ways of understanding and acting on their body changes during myocardial infarction. RELEVANCE FOR CLINICAL PRACTICE This review is relevant in a preventive and rehabilitating perspective for professionals working in health care. It helps professionals to understand women's experiences during myocardial infarction, optimises their ability to suspect myocardial infarction and teach women to react on these body changes.
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Affiliation(s)
- Rikke Madsen
- Horsens Regional Hospital and Aarhus University, Horsens, Denmark
| | - Regner Birkelund
- University of Southern Denmark & Lillebaelt Hospital, Vejle, Denmark
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22
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Gyberg A, Björck L, Nielsen S, Määttä S, Falk K. Women's help-seeking behaviour during a first acute myocardial infarction. Scand J Caring Sci 2015; 30:670-677. [PMID: 26582252 DOI: 10.1111/scs.12286] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2015] [Accepted: 08/04/2015] [Indexed: 11/27/2022]
Abstract
Studies indicate that the time from onset of symptoms to medical treatment has decreased in acute myocardial infarction (AMI). However, there are still variations indicating that women wait longer than men before making the decision to seek medical care. Multidimensional factors hindering and facilitating the decision have been identified in previous studies, though few have fully explored how social context affects women's expectations, interpretations and actions and so influences the decision-making process. The aim of this study was therefore to identify how women's experiences interacted and influenced the decision to seek medical care at their first AMI. Seventeen women, aged 38-75 years, were interviewed, at home or in the hospital, between June 2011 and May 2012. Grounded theory was used as a method, and data collection and analysis were carried out simultaneously. The results showed that before deciding to seek medical care, these women went through three defined but interrelated processes that together hindered their normal activities and made them act according to existential needs. The women's experiences of the progression of the disease, in terms of both symptoms and time, were very different, so they sought medical care at different times, sometimes life-threateningly late and sometimes before developing an AMI. Three mechanisms had to coincide if the women were to receive medical care. First, the women had to acknowledge their symptoms as something more than common bodily changes. Second, the healthcare system had to be accessible when the women made their decision to seek care. Third, the women must have come into contact with healthcare providers when the heart muscle had taken enough damage to measure.
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Affiliation(s)
- Anna Gyberg
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Lena Björck
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.,Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Susanne Nielsen
- Department of Molecular and Clinical Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sylvia Määttä
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Kristin Falk
- Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden
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Shehab A, Al-Habib K, Hersi A, Al-Faleh H, Alsheikh-Ali A, Almahmeed W, Suleiman KJ, Al-Motarreb A, Suwaidy JA, Asaad N, AlSaid S, Hashim M, Amin H. Quality of care in primary percutaneous coronary intervention for acute ST-segment -elevation myocardial infarction: Gulf RACE 2 experience. Ann Saudi Med 2014; 34:482-7. [PMID: 25971820 PMCID: PMC6074571 DOI: 10.5144/0256-4947.2014.482] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Primary percutaneous coronary intervention (pPCI) has been recognized as an effective management strategy for acute ST-segment-elevation myocardial infarction (STEMI). However, there is no first-hand information regarding the quality of pPCI procedures in the Arabian Gulf countries. This study aims to explore the quality of pPCI practice. DESIGN AND SETTINGS The Gulf Race II was designed as a prospective, multinational, multicentre registry of acute coronary events, focusing on the epidemiology, management practices, and outcomes of patients with acute coronary syndrome. The study recruited consecutive patients aged 18 years and above from 65 hospitals in 6 adjacent Middle Eastern countries (Bahrain, Saudi Arabia, Qatar, Oman, United Arab Emirates, and Yemen). PATIENTS AND METHODS We used data from the Gulf Registry of Acute Coronary Events (Gulf RACE 2). We analyzed data on patients who received pPCI to assess the guidelines-supported performance measure of door-to-balloon (D2B).
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Affiliation(s)
- Abdulla Shehab
- A Shehab, MD, Department of Internal Medicine,, College of Medicine and Health Sciences,, UAE University, Al Ain, United Arab Emirates, T: +971506161028,, F: +97137672 995,
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24
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Abstract
The appropriate timing of angiography to facilitate revascularization is essential to optimize outcomes in patents with ST-segment-elevation myocardial infarction and non-ST-segment-elevation acute coronary syndromes. Timely reperfusion of the infarct-related coronary artery in ST-segment-elevation myocardial infarction both with fibrinolysis or percutaneous coronary intervention minimizes myocardial damage, reduces infarct size, and decreases morbidity and mortality. Primary percutaneous coronary intervention is the preferred reperfusion method if it can be performed in a timely manner. Strategies to reduce health system-related delays in reperfusion include regionalization of ST-segment-elevation myocardial infarction care, performing prehospital ECGs, prehospital activation of the catheterization laboratory, bypassing geographically closer nonpercutaneous coronary intervention-capable hospitals, bypassing the percutaneous coronary intervention-capable hospital emergency department, and early and consistent availability of the catheterization laboratory team. With implementation of such strategies, there has been significant improvement in process measures, including door-to-balloon time. However, despite reductions in door-to-balloon times, there has been little change during the past several years in in-hospital mortality, suggesting additional factors including patient-related delays, optimization of tissue-level perfusion, and cardioprotection must be addressed to improve patient outcomes further. Early angiography followed by revascularization when appropriate also reduces rates of death, MI, and recurrent ischemia in patients with non-ST-segment-elevation acute coronary syndromes, with the greatest benefits realized in the highest risk patients. Among patients with non-ST-segment-elevation acute coronary syndromes with multivessel disease, choice of revascularization modality should be made as in stable coronary artery disease, with a goal of complete ischemic revascularization.
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Affiliation(s)
- Akshay Bagai
- From the Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.); Mount Sinai Medical Center and The Cardiovascular Research Foundation, New York, NY (G.D.D.); Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY (G.W.S.); and Duke Clinical Research Institute, Durham, NC (C.B.G.).
| | - George D Dangas
- From the Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.); Mount Sinai Medical Center and The Cardiovascular Research Foundation, New York, NY (G.D.D.); Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY (G.W.S.); and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Gregg W Stone
- From the Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.); Mount Sinai Medical Center and The Cardiovascular Research Foundation, New York, NY (G.D.D.); Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY (G.W.S.); and Duke Clinical Research Institute, Durham, NC (C.B.G.)
| | - Christopher B Granger
- From the Terrence Donnelly Heart Centre, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada (A.B.); Mount Sinai Medical Center and The Cardiovascular Research Foundation, New York, NY (G.D.D.); Columbia University Medical Center and The Cardiovascular Research Foundation, New York, NY (G.W.S.); and Duke Clinical Research Institute, Durham, NC (C.B.G.)
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25
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Tummala SR, Farshid A. Patients' understanding of their heart attack and the impact of exposure to a media campaign on pre-hospital time. Heart Lung Circ 2014; 24:4-10. [PMID: 25240573 DOI: 10.1016/j.hlc.2014.07.063] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2014] [Revised: 07/05/2014] [Accepted: 07/15/2014] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients with acute myocardial infarction (AMI) have a limited understanding of AMI symptoms and risk factors. This can lead to delays in the recognition of an AMI and hospital presentation. We aimed to assess patients' understanding of their AMI symptoms and risk factors and also assess the impact of exposure to a media campaign on their pre-hospital time. METHODS We surveyed 100 AMI patients admitted to the Canberra Hospital. We asked them about their AMI symptoms and risk factors and the impact of the National Heart Foundation (NHF) advertisements on their AMI experience. RESULTS Only 26% of patients recognised that they were having an AMI. In 34% of cases, an ambulance was called. There was no significant difference in the median pre-hospital time between patients who encountered the NHF advertisements and those who had not (133 minutes vs. 137 minutes, p=0.809). Only 22% of patients could identify all of their personal AMI risk factors. CONCLUSIONS Most AMI patients do not initially recognise their condition nor do they call for an ambulance. Exposure to the NHF advertisements had no significant influence on reducing pre-hospital time in this cohort. Most patients have a limited understanding of AMI risk factors and causes.
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Affiliation(s)
- Shrikar R Tummala
- College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 2601, Australia
| | - Ahmad Farshid
- College of Medicine, Biology and Environment, Australian National University, Canberra, ACT 2601, Australia; Department of Cardiology, The Canberra Hospital, Canberra, ACT 2605, Australia.
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Slow-onset and Fast-onset Symptom Presentations In Acute Coronary Syndrome (ACS): New Perspectives on Prehospital Delay in Patients with ACS. J Emerg Med 2014; 46:507-15. [DOI: 10.1016/j.jemermed.2013.08.038] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2012] [Revised: 03/19/2013] [Accepted: 08/14/2013] [Indexed: 11/19/2022]
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Shavelle DM, Chen AY, Matthews RV, Roe MT, de Lemos JA, Jollis J, Thomas JL, French WJ. Predictors of reperfusion delay in patients with ST elevation myocardial infarction self-transported to the hospital (from the American Heart Association's Mission: Lifeline Program). Am J Cardiol 2014; 113:798-802. [PMID: 24393257 DOI: 10.1016/j.amjcard.2013.11.036] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2013] [Revised: 11/18/2013] [Accepted: 11/18/2013] [Indexed: 11/19/2022]
Abstract
Primary percutaneous coronary intervention for ST elevation myocardial infarction (STEMI) is beneficial if performed in a timely manner. Self-transport patients with STEMI have prolonged treatment times compared with Emergency Medical Services-transported patients. This study evaluated self-transport patients with STEMI undergoing primary percutaneous coronary intervention to identify factors associated with prolonged door-to-balloon (D2B) times. From January 2007 to March 2011, data for 13,379 self-transport patients with STEMI treated at 432 hospitals in the Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines Registry were evaluated. Patients with a D2B time >90 minutes were compared with those with D2B time ≤90 minutes. Factors associated with prolonged D2B (>90 minutes) were explored using logistic generalized estimating equations. The median (twenty-fifth, seventy-fifth percentiles) D2B time for the entire cohort was 72 minutes (58, 86), and 19% had a D2B time of >90 minutes. Over the study period, there was a significant increase in the percentage of patients achieving D2B time ≤90 minutes. There were significant baseline differences between patients with D2B time ≤ versus >90 minutes. The main factors associated with prolonged treatment time were off-hour presentation (weekends and 7 p.m. to 7 a.m. weekdays), not obtaining an electrocardiogram within 10 minutes of hospital arrival, previous coronary artery bypass surgery, black race, older age, and female gender. In conclusion, although prolonged delay from arrival to electrocardiographic acquisition is a modifiable factor contributing to prolonged D2B times among self-transport patients with STEMI, additional factors (age, race, and gender) indicate that historic disparities for cardiovascular care still persist in terms of contemporary metrics for STEMI reperfusion.
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Affiliation(s)
- David M Shavelle
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California.
| | - Anita Y Chen
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Ray V Matthews
- Division of Cardiovascular Medicine, University of Southern California, Los Angeles, California
| | - Matthew T Roe
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - James A de Lemos
- Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - James Jollis
- Duke Clinical Research Institute, Duke University Medical Center, Durham, North Carolina
| | - Joseph L Thomas
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, California
| | - William J French
- Division of Cardiology, Harbor UCLA Medical Center, Torrance, California
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Mackay MH, Ratner PA, Nguyen M, Percy M, Galdas P, Grunau G. Inconsistent measurement of acute coronary syndrome patients' pre-hospital delay in research: a review of the literature. Eur J Cardiovasc Nurs 2014; 13:483-93. [PMID: 24532675 DOI: 10.1177/1474515114524866] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Patients' treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research. METHODS AND RESULTS We reviewed the English-language literature from 1998-2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing. CONCLUSION We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.
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Affiliation(s)
- Martha H Mackay
- School of Nursing, University of British Columbia, Canada St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | - Michelle Nguyen
- St. Paul's Hospital (Providence Health Care), Vancouver, Canada
| | | | | | - Gilat Grunau
- School of Nursing, University of British Columbia, Canada
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Gao Y, Zhang HJ. The effect of symptoms on prehospital delay time in patients with acute myocardial infarction. J Int Med Res 2013; 41:1724-31. [DOI: 10.1177/0300060513488511] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Objective To improve time to treatment, the effects of acute myocardial infarction (AMI) symptoms on prehospital delay time (PDT) were investigated. Methods Patients with AMI completed a questionnaire on their AMI symptoms and their general knowledge of AMI symptoms. Results In total, 116 patients completed questionnaires. The mean PDT was 7.3 ± 2.4 h; the median PDT was 2.2 h. Each patient experienced a mean of 3.6 symptoms during their AMI. PDT was significantly shorter in the following groups: patients with chest compression pain/chest discomfort, profuse sweating or dyspnoea than in patients with other symptoms; patients presenting with typical rather than atypical symptoms; patients with pain scores >6 compared with scores ≤6; patients who were aware rather than unaware of AMI symptoms. Patients actually having AMI symptoms and patients being aware of AMI symptoms were inversely correlated with PDT. There was a linear relationship between pain scores and PDT. Conclusion Public awareness of AMI symptoms should be enhanced, in order to shorten PDT and improve AMI survival rates.
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Affiliation(s)
- Yu Gao
- Department of Cardiology, The First Affiliated Hospital of Liaoning Medical University, Jinzhou, Liaoning Province, China
| | - Hui-jun Zhang
- Nursing School, Liaoning Medical University, Jinzhou, Liaoning Province, China
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Zoghbi WA, Arend TE, Oetgen WJ, May C, Bradfield L, Keller S, Ramadhan E, Tomaselli GF, Brown N, Robertson RM, Whitman GR, Bezanson JL, Hundley J. 2012 ACCF/AHA Focused Update Incorporated Into the ACCF/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non–ST-Elevation Myocardial Infarction. Circulation 2013; 127:e663-828. [DOI: 10.1161/cir.0b013e31828478ac] [Citation(s) in RCA: 181] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Sterling MR, Echeverria SE, Merlin MA. The Effect of Language Congruency on the Out-of-Hospital Management of Chest Pain. WORLD MEDICAL & HEALTH POLICY 2013. [DOI: 10.1002/wmh3.46] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Jneid H, Ettinger SM, Ganiats TG, Philippides GJ, Jacobs AK, Halperin JL, Albert NM, Creager MA, DeMets D, Guyton RA, Kushner FG, Ohman EM, Stevenson W, Yancy CW. 2012 ACCF/AHA focused update incorporated into the ACCF/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 61:e179-347. [PMID: 23639841 DOI: 10.1016/j.jacc.2013.01.014] [Citation(s) in RCA: 373] [Impact Index Per Article: 33.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Damasceno CA, de Queiroz TL, Santos CADST, Mussi FC. [Factors associated with the decision to seek health care in myocardial infarction: gender differences]. Rev Esc Enferm USP 2013; 46:1362-70. [PMID: 23380779 DOI: 10.1590/s0080-62342012000600012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2011] [Accepted: 04/25/2012] [Indexed: 11/21/2022] Open
Abstract
Analyze cognitive and emotional variables between genders in terms of the decision time (DT) to seek care when experiencing symptoms of myocardial infarction. One hundred adults were interviewed at two hospitals in Salvador-BA. The analysis used percentage means, the chi-square test, and a robust linear regression model. Most participants were male, with a mean age of 58.78 years and a low socioeconomic status. The geometrical mean of the sample was 1.1h (0.9h for men, and 1.4h for women). A shorter decision time was found for those who considered their symptoms to be severe, and a longer decision time for those who expected symptoms to improve and took something to feel better, with statistically significant associations. An interaction was observed between gender and the following variables: waiting for symptoms to improve (p=0.014), concealing symptoms (p=0.016) and asking for help (p=0.050), thus an association was observed between the variables of interest and DT. The decision times were long and were affected by cognitive, emotional and gender variables. Nursing care may promote early assistance.
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Affiliation(s)
- Carla Almeida Damasceno
- Departamento de Ciências Exatas, Universidade Estadual de Feira de Santana, Salvador, BA, Brasil.
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Kushner FG, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2012; 127:e362-425. [PMID: 23247304 DOI: 10.1161/cir.0b013e3182742cf6] [Citation(s) in RCA: 1057] [Impact Index Per Article: 88.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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O'Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2012; 61:e78-e140. [PMID: 23256914 DOI: 10.1016/j.jacc.2012.11.019] [Citation(s) in RCA: 2173] [Impact Index Per Article: 181.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Mistry NF, Vesely MR. Acute coronary syndromes: from the emergency department to the cardiac care unit. Cardiol Clin 2012; 30:617-27. [PMID: 23102036 DOI: 10.1016/j.ccl.2012.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Acute coronary syndromes result in a significant burden of morbidity and mortality in the United States. This spectrum of acute coronary thrombosis (including unstable angina, non-ST-segment elevation myocardial infarction, and ST-elevation myocardial infarction) has been well studied in large clinical trials. This review details the initial management of patients presenting with possible acute coronary syndromes in the context of care from the emergency department to the cardiac care unit. The importance of a rapid and focused evaluation, risk stratification, and appropriate therapies are discussed.
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Affiliation(s)
- Neville F Mistry
- Department of Medicine, Division of Cardiology, University of Maryland School of Medicine, 110 South Paca Street, 7th Floor, Baltimore, MD 21201, USA
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The impact on anxiety and perceived control of a short one-on-one nursing intervention designed to decrease treatment seeking delay in people with coronary heart disease. Eur J Cardiovasc Nurs 2012; 11:160-7. [PMID: 21126918 DOI: 10.1016/j.ejcnurse.2010.11.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Patient delay in seeking treatment for acute coronary syndrome symptoms remains a problem. Thus, it is vital to test interventions to improve this behavior, but at the same time it is essential that interventions not increase anxiety. PURPOSE To determine the impact on anxiety and perceived control of an individual face-to-face education and counseling intervention designed to decrease patient delay in seeking treatment for acute coronary syndrome symptoms. METHODS This was a multicenter randomized controlled trial of the intervention in which anxiety data were collected at baseline, 3-months and 12-months. A total of 3522 patients with confirmed coronary artery disease were enrolled; data from 2597 patients with anxiety data at all time points are included. The intervention was a 45 min education and counseling session, in which the social, cognitive and emotional responses to acute coronary syndrome symptoms were discussed as were barriers to early treatment seeking. Repeated measures analysis of covariance was used to compare anxiety and perceived control levels across time between the groups controlling for age, gender, ethnicity, education level, and comorbidities. RESULTS There were significant differences in anxiety by group (p = 0.03). Anxiety level was stable in patients in the control group, but decreased across time in the intervention group. Perceived control increased across time in the intervention group and remained unchanged in the control group (p = 0.01). CONCLUSION Interventions in which cardiac patients directly confront the possibility of an acute cardiac event do not cause anxiety if they provide patients with appropriate strategies for managing symptoms.
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Women's Experiences and Behaviour at Onset of Symptoms of ST Segment Elevation Acute Myocardial Infarction. Eur J Cardiovasc Nurs 2011; 10:241-7. [DOI: 10.1016/j.ejcnurse.2010.10.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2010] [Revised: 10/07/2010] [Accepted: 10/08/2010] [Indexed: 11/20/2022]
Abstract
Background: Minimizing time from onset of symptoms to treatment (treatment delay) is crucial for patients with ST segment elevation acute myocardial infarction (STEMI), and one of the great challenges is to reduce the delay relating to the prehospital behaviour of the patient (patient delay). Studies indicate that women delay longer than men and insights into this area could lead to improved health education programmes aimed at reducing patient delay in women with STEMI. Method: Open interviews with 14 women with STEMI were held during their hospital stay from June to September 2009. The interviews were aimed at exploring determinants of treatment delay, and were carried out and analysed within a phenomenological framework. Findings: Three themes emerged important for the delay in seeking medical assistance: (1) Knowledge and ideas of AMI symptoms and risks. (2) Ambivalence whether to call for medical assistance or to cope with the situation. (3) Actions and strategies taken after onset of symptoms. Conclusions: Three factors determined whether women showed appropriate behaviour for reduced patient delay after onset of symptoms: (1) identifying the symptoms as being of cardiac origin, (2) having a prepared action plan in case of an emergency situation, and (3) living with someone or contacting other persons.
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Wright RS, Anderson JL, Adams CD, Bridges CR, Casey DE, Ettinger SM, Fesmire FM, Ganiats TG, Jneid H, Lincoff AM, Peterson ED, Philippides GJ, Theroux P, Wenger NK, Zidar JP, Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Zidar JP. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines developed in collaboration with the American Academy of Family Physicians, Society for Cardiovascular Angiography and Interventions, and the Society of Thoracic Surgeons. J Am Coll Cardiol 2011; 57:e215-367. [PMID: 21545940 DOI: 10.1016/j.jacc.2011.02.011] [Citation(s) in RCA: 276] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Mathews R, Peterson ED, Li S, Roe MT, Glickman SW, Wiviott SD, Saucedo JF, Antman EM, Jacobs AK, Wang TY. Use of emergency medical service transport among patients with ST-segment-elevation myocardial infarction: findings from the National Cardiovascular Data Registry Acute Coronary Treatment Intervention Outcomes Network Registry-Get With The Guidelines. Circulation 2011; 124:154-63. [PMID: 21690494 DOI: 10.1161/circulationaha.110.002345] [Citation(s) in RCA: 136] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Activation of emergency medical services (EMS) is critical for the early triage and treatment of patients experiencing ST-segment-elevation myocardial infarction, yet data regarding EMS use and its association with subsequent clinical care are limited. METHODS AND RESULTS We performed an observational analysis of 37 634 ST-segment-elevation myocardial infarction patients treated at 372 US hospitals participating in the National Cardiovascular Data Registry Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With the Guidelines between January 2007 and September 2009, and examined independent patient factors associated with EMS transportation versus patient self-transportation. We found that EMS transport was used in only 60% of ST-segment-elevation myocardial infarction patients. Older patients, those living farther from the hospital, and those with hemodynamic compromise were more likely to use EMS transport. In contrast, race, income, and education level did not appear to be associated with the mode of transport. Compared with self-transported patients, EMS-transported patients had significantly shorter delays in both symptom-onset-to-arrival time (median, 89 versus 120 minutes; P<0.0001) and door-to-reperfusion time (median door-to-balloon time, 63 versus 76 minutes; P<0.0001; median door-to-needle time, 23 versus 29 minutes; P<0.0001). CONCLUSIONS Emergency medical services transportation to the hospital is underused among contemporary ST-segment-elevation myocardial infarction patients. Nevertheless, use of EMS transportation is associated with substantial reductions in ischemic time and treatment delays. Community education efforts are needed to improve the use of emergency transport as part of system-wide strategies to improve ST-segment-elevation myocardial infarction reperfusion care.
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Affiliation(s)
- Robin Mathews
- Duke Clinical Research Institute, Duke University Medical Center, 2400 Pratt St, Durham, NC 27705, USA.
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Gravely S, Tamim H, Smith J, Daly T, Grace SL. Non-symptom-related factors contributing to delay in seeking medical care by patients with heart failure: a narrative review. J Card Fail 2011; 17:779-87. [PMID: 21872149 DOI: 10.1016/j.cardfail.2011.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2010] [Revised: 05/03/2011] [Accepted: 05/05/2011] [Indexed: 11/18/2022]
Abstract
BACKGROUND Delay in seeking timely medical care by patients with acute coronary syndrome and stroke has been well established in the literature, but less is known about delay in care-seeking behavior by patients with heart failure (HF). The purpose of this narrative review was to synthesize the literature regarding non-symptom-related factors that contribute to delay in seeking medical care for HF symptoms. METHODS AND RESULTS A literature search of Scopus, Medline, and Pubmed was conducted for published articles from database inception to July 2009. Available evidence has shown that non-symptom-related factors, such as HF severity, HF history, age, and ethnocultural background, were related to delay in certain studies; however, null results have also been reported. Other non-symptom-related factors, such as male gender, initial contact with a primary care physician, arriving in the emergency department by means other than ambulance, and patient responses such as self-care, low anxiety, and hopelessness, may play a role in longer delay. CONCLUSIONS Although this review identified several non-symptom-related factors that may be implicated in care-seeking delay, health care professionals should be vigilant in identifying all high-risk individuals and educating them about warning signs of HF. Moreover, access to outpatient chronic disease management programs that may have potential to reduce care-seeking delay behavior should be explored.
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Cost NG, Bush NC, Barber TD, Huang R, Baker LA. Pediatric testicular torsion: demographics of national orchiopexy versus orchiectomy rates. J Urol 2011; 185:2459-63. [PMID: 21527194 DOI: 10.1016/j.juro.2011.01.016] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2010] [Indexed: 10/18/2022]
Abstract
PURPOSE While the timely diagnosis and management of pediatric torsion can lead to testicular salvage, limited data exist on rates of orchiopexy vs orchiectomy and associated factors. Thus, we examined the Pediatric Health Information System database for torsion outcomes and demographics at American pediatric hospitals. MATERIALS AND METHODS Using the Pediatric Health Information System database we performed a 7-year retrospective cohort study in children 1 to 17 years old with a primary ICD-9 diagnosis of torsion, assessing CPT codes for orchiopexy and orchiectomy. Data were analyzed with SPSS®, version 17.0. RESULTS Of 2,876 patients who underwent surgery for an ICD-9 diagnosis code of testicular torsion 918 (31.9%) underwent orchiectomy at a mean age of 10.7 years and 1,958 (68.1%) underwent orchiopexy at a mean age of 12.6 years (p <0.0001). In the age groups 1 to 9, 10 to 13 and 14 years or greater 274 (49.9%), 311 (29.4%) and 333 patients (26.2%), respectively, underwent orchiectomy. A higher orchiectomy rate was seen at age 1 to 9 vs 10 years or greater. Torsion and orchiectomy rates did not vary by season or geographic region. A higher orchiectomy rate was seen in black vs white children (37.6% vs 28.1%) and in patients without vs with private insurance (36.7% vs 27.0%). Multivariate analysis revealed an association of age (p <0.0001), race (p <0.0001) and insurance status (p <0.001) with orchiectomy. CONCLUSIONS Nationally an average of 32% of the 411 pediatric torsion cases explored annually result in orchiectomy. Identified factors increasing the orchiectomy risk included age 1 to 9 years, black race and lack of private insurance. Efforts should continue to identify modifiable variables that can increase testicular salvage in patients with testicular torsion.
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Affiliation(s)
- Nicholas G Cost
- Division of Pediatric Urology and Department of Research (RH), Children's Medical Center and University of Texas Southwestern Medical Center at Dallas, TX, USA.
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Anderson JL, Adams CD, Antman EM, Bridges CR, Califf RM, Casey DE, Chavey WE, Fesmire FM, Hochman JS, Levin TN, Lincoff AM, Peterson ED, Theroux P, Wenger NK, Wright RS, Smith SC. 2011 ACCF/AHA Focused Update Incorporated Into the ACC/AHA 2007 Guidelines for the Management of Patients With Unstable Angina/Non-ST-Elevation Myocardial Infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 123:e426-579. [PMID: 21444888 DOI: 10.1161/cir.0b013e318212bb8b] [Citation(s) in RCA: 349] [Impact Index Per Article: 26.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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Bossaert L, O'Connor RE, Arntz HR, Brooks SC, Diercks D, Feitosa-Filho G, Nolan JP, Hoek TLV, Walters DL, Wong A, Welsford M, Woolfrey K. Part 9: Acute coronary syndromes: 2010 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science with Treatment Recommendations. Resuscitation 2011; 81 Suppl 1:e175-212. [PMID: 20959169 DOI: 10.1016/j.resuscitation.2010.09.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
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McKinley S, Aitken LM, Marshall AP, Buckley T, Baker H, Davidson PM, Dracup K. Delays in presentation with acute coronary syndrome in people with coronary artery disease in Australia and New Zealand. Emerg Med Australas 2011; 23:153-61. [PMID: 21489162 DOI: 10.1111/j.1742-6723.2011.01385.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To report time from the onset of symptoms to hospital presentation in Australian and New Zealand patients with subsequently confirmed acute coronary syndrome, and to identify factors associated with prehospital delay time in these patients. METHODS Patients with coronary artery disease enrolled in a randomized clinical trial testing an intervention to reduce delay in responding to acute coronary syndrome symptoms had been followed for 24 months. In cases of admission to the ED for possible acute coronary syndrome, medical records were reviewed to determine the diagnosis, prehospital delay time, mode of transport to the hospital and aspirin use before admission. Clinical and demographic data were taken from the trial database. RESULTS Patients (n= 140) had an average (SD) age of 67.3 (11.5) years; 36% were female. Two-thirds of patients went to hospital by ambulance and 89.3% had a final diagnosis of unstable angina. The median time from onset of symptoms to arrival at the ED was 2 h and 25 min (interquartile range 1:25-4:59); 12.1% arrived ≤ 1 h and 66% within 4 h. Multiple linear regression analysis showed that use of ambulance (Beta = 0.247, P= 0.012) and younger age (Beta = 0.198, P= 0.043) were independent predictors of shorter delay times. CONCLUSION The time from the onset of symptoms to hospital presentation was too long for maximal benefit from treatment in most patients. Further efforts are needed to reduce treatment-seeking delay in response to symptoms of acute coronary syndrome.
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Affiliation(s)
- Sharon McKinley
- Northern Sydney Central Coast Health, Critical Care Nursing Professorial Unit, Sydney, New South Wales, Australia.
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Barriers and Facilitators to Using 9-1-1 and Emergency Medical Services in a Limited English Proficiency Chinese Community. J Immigr Minor Health 2011; 14:307-13. [DOI: 10.1007/s10903-011-9449-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cao Y, Davidson PM, DiGiacomo M, Yang M. Prehospital Delay for Acute Coronary Syndrome in China. J Cardiovasc Nurs 2010; 25:487-96. [DOI: 10.1097/jcn.0b013e3181dae42d] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Novak K, Aljinovic J, Kostic S, Capkun V, Novak Ribicic K, Batinic T, Stula I, Puljak L. Pain to hospital times after myocardial infarction in patients from Dalmatian mainland and islands, southern Croatia. Croat Med J 2010; 51:423-31. [PMID: 20960592 PMCID: PMC2969137 DOI: 10.3325/cmj.2010.51.423] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To analyze pre-hospital delay in patients with myocardial infarction from mainland and islands of Split-Dalmatian County, southern Croatia. METHODS The study included all patients with myocardial infarction transported by ambulance to the University Hospital Split in 1999, 2003, and 2005. Pre-hospital delay was analyzed in the following intervals: pain-to-call, call-to-ambulance, ambulance-to-door, and door-to-coronary care unit interval. Patients were categorized according to the location from which they were transported: Split, mainland >15 km from Split, and islands. RESULTS There were 1314 patients (62.9% men) transported and hospitalized for myocardial infarction. Total pre-hospital delay (pain-to-hospital) was significantly reduced from 1999 to 2005 (5.2 hours vs 4.3 hours, P=0.011). Seventy-five patients (5.7%) were admitted to the coronary care unit within the recommended time-frame of less than 90 minutes, none of which was from the islands, while 248 patients (18.9%) were admitted more than 12 hours from the onset of pain. CONCLUSION Pre-hospital delay in patients with myocardial infarction in southern Croatia is still too long, especially in patients coming from outside of Split. Prognosis and survival of such patients may be improved by introducing changes to the health care system in remote areas, such as out-of-hospital thrombolysis, greater use of telemedicine, training of lay persons and paramedics in defibrillation, introduction of quality assessment mechanisms, and improved patient transport.
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Affiliation(s)
- Katarina Novak
- Department of Anatomy, Histology and Embryology, School of Medicine in Split, Soltanska 2, 21000 Split, Croatia
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Young Hee Nam, Kwang Soo Cha, Jeong Hwan Kim, Sun Yi Park, Tae Ho Park, Moo Hyun Kim, Young Dae Kim. Reduction of Door-to-Balloon Time by New Performance Processes in Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention. Angiology 2010; 62:257-64. [DOI: 10.1177/0003319710380682] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The aim of this study was to determine whether the adoption of new performance processes reduced the door-to-balloon time for primary percutaneous coronary intervention (PCI). To reduce the door-to-balloon time, we adopted 3 new performance processes: concurrent activation at the emergency department rather than stepwise activation; direct phone call rather than using a pager or message; patient transferred to catheterization laboratory before the PCI team arrive. A total of 139 consecutive patients were compared before and after the new performance processes. After the adoption of the new processes, median door-to-balloon time reduced significantly from 133 to 76 minutes (P < .0001) and patients undergoing primary PCI within 90 minutes increased significantly from 16% to 72% (P < .0001). Among the subdivisions of the door-to-balloon time, door-to-consent time and door-to-laboratory arrival time decreased significantly (50.0 vs 20.5 minutes, P < .0001; 95.0 vs 40.0 minutes, P < .0001, respectively).
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Affiliation(s)
- Young Hee Nam
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Kwang Soo Cha
- Department of Cardiology, Pusan National University Hospital, Busan, South Korea,
| | - Jeong Hwan Kim
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Sun Yi Park
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Tae Ho Park
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
| | - Young Dae Kim
- Department of Cardiology, Dong-A University Hospital, Busan, South Korea
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