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Paratz ED, La Gerche A, Thompson PL. Declining Recognition of Chest Pain as a Cardiac Symptom Should Act as a Shot in The Arm. Heart Lung Circ 2023; 32:435-437. [PMID: 37080637 DOI: 10.1016/j.hlc.2023.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Affiliation(s)
- Elizabeth D Paratz
- Baker Heart & Diabetes Institute, Melbourne, Vic, Australia; St Vincent's Hospital Melbourne, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry & Health Sciences, Melbourne University, Melbourne, Vic, Australia.
| | - Andre La Gerche
- Baker Heart & Diabetes Institute, Melbourne, Vic, Australia; St Vincent's Hospital Melbourne, Melbourne, Vic, Australia; Faculty of Medicine, Dentistry & Health Sciences, Melbourne University, Melbourne, Vic, Australia
| | - Peter L Thompson
- Sir Charles Gairdner Hospital, Perth, WA, Australia; University of Western Australia, Perth, WA, Australia; Harry Perkins Institute of Medical Research, Perth, WA, Australia
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2
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Alrawashdeh A, Nehme Z, Williams B, Smith K, Stephenson M, Bernard S, Bray J, Stub D. Factors influencing patient decision delay in activation of emergency medical services for suspected ST-elevation myocardial infarction. Eur J Cardiovasc Nurs 2021; 20:243–251. [PMID: 33611404 DOI: 10.1177/1474515120953737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 06/01/2020] [Accepted: 08/10/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with time delay to emergency medical services for patients with suspected ST-elevation myocardial infarction. METHODS This observational study involved 1994 suspected ST-elevation myocardial infarction patients presenting to the emergency medical services in Melbourne, Australia, between October 2011-January 2014. Factors associated with delays to emergency medical services call of >1 h and emergency medical services self-referral were analyzed using multivariable logistic regression. RESULTS The time of symptom onset was reported for 1819 patients (91.2%), the median symptom onset-to-call time was 52 min (interquartile range=17-176). Of all emergency medical services calls, 17% were referred by healthcare professionals. Compared to self-referred patients, patients who presented to a general practitioner or hospital had higher odds of delay >1 h to emergency medical services activation (adjusted odds ratio 7.76; 95% confidence interval 5.10-11.83; and 8.02; 3.65-17.64, respectively). The other factors associated with emergency medical services call delays of >1 h were living alone, non-English speaking background, a history of substance abuse, less severe symptoms, symptom onset at home and at rest, and self-treatment. Emergency medical services self-referred patients were more likely to be older than 75 years, have a history of ischemic heart disease or revascularization, more severe symptoms, and symptom onset at home, with activity, during the weekends and out-of-hours. CONCLUSION Almost one-fifth of emergency medical services calls for suspected ST-elevation myocardial infarction were healthcare referrals, and this was associated with increased delays. A wide range of factors could influence a patient's decision to directly and rapidly seek emergency medical services. More efforts are needed to educate at-risk populations about early self-referral to the emergency medical services.
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Affiliation(s)
| | - Ziad Nehme
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Brett Williams
- Department of Paramedicine, Monash University, Australia
| | - Karen Smith
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Michael Stephenson
- Department of Paramedicine, Monash University, Australia.,Ambulance Victoria, Australia
| | - Stephen Bernard
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia
| | - Janet Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia
| | - Dion Stub
- Department of Epidemiology and Preventive Medicine, Monash University, Australia.,Alfred Hospital, Australia.,Baker IDI Heart and Diabetes Institute, Australia
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Abdo Ahmed AA, Mohammed Al-Shami A, Jamshed S, Fata Nahas AR, Mohamed Ibrahim MI. Public Awareness of and Action towards Heart Attack Symptoms: An Exploratory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17238982. [PMID: 33276636 PMCID: PMC7729488 DOI: 10.3390/ijerph17238982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/27/2020] [Accepted: 07/03/2020] [Indexed: 11/16/2022]
Abstract
Background: Cardiovascular disease (CVD) is still the leading cause of mortality worldwide, and Malaysia is not an exception in this regard. The current research is an attempt to explore symptom awareness of and necessary actions in response to heart attack (HA) among lay public. Methods: This is a cross-sectional study design, and a survey was conducted from May to July 2018 among general public in Kuantan, Pahang state, Malaysia. Results: A total of 393 respondents recruited. Slightly more than one-fourth of the respondents (26.35%) were aware of HA symptoms like pain and/or discomfort in the jaw, neck, or back, while 71.65% showed awareness only of chest pain or discomfort as symptoms. Only 35.6% reported to call an ambulance if they experience someone suffering from HA symptoms, while 82% recognized ≥1 symptom, and only 11.5% recognized all five HA symptoms. Very few respondents, i.e., 1.3% reported awareness about correct recognition of all five HA symptoms. Respondents who had diabetes and hypercholesteremia were more likely to recognize all five HA symptoms. For those who had excellent awareness of all five HA symptoms, the odds ratio (OR) were significantly higher among single respondents (OR 0.023; 95% CI 0.001–0.594), Malay (OR 0.376; 95% CI 0.193–0.733), and those who received information associated with HA (OR 7.540; 95% CI 2.037–27.914). However, those who were aware that HA requires quick treatment had significantly low odds ratio (OR 0.176; 95% CI 0.044–0.710). Conclusions: The awareness of and action towards the signs and symptoms of HA among the public were poor.
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Affiliation(s)
- Abdullah Abdulmajid Abdo Ahmed
- Department of Pharmacy Practice, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia; (A.A.A.A.); (A.M.A.-S.); (S.J.); (A.R.F.N.)
| | - Abdulkareem Mohammed Al-Shami
- Department of Pharmacy Practice, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia; (A.A.A.A.); (A.M.A.-S.); (S.J.); (A.R.F.N.)
| | - Shazia Jamshed
- Department of Pharmacy Practice, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia; (A.A.A.A.); (A.M.A.-S.); (S.J.); (A.R.F.N.)
- Qualitative Research-Methodological Application in Health Sciences Research Group, Kulliyyah of Pharmacy, International Islamic University Malaysia, Kuatan 25200, Pahang, Malaysia
| | - Abdul Rahman Fata Nahas
- Department of Pharmacy Practice, International Islamic University Malaysia, Kuantan 25200, Pahang, Malaysia; (A.A.A.A.); (A.M.A.-S.); (S.J.); (A.R.F.N.)
| | - Mohamed Izham Mohamed Ibrahim
- Clinical Pharmacy and Practice Department, College of Pharmacy, QU Health, Qatar University, P.O. Box 2713, Doha, Qatar
- Correspondence: ; Tel.: +974-4403-5580; Fax: +974-4403-5551
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Farquharson B, Abhyankar P, Smith K, Dombrowski SU, Treweek S, Dougall N, Williams B, Johnston M. Reducing delay in patients with acute coronary syndrome and other time-critical conditions: a systematic review to identify the behaviour change techniques associated with effective interventions. Open Heart 2019; 6:e000975. [PMID: 30997136 PMCID: PMC6443141 DOI: 10.1136/openhrt-2018-000975] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 11/21/2018] [Indexed: 12/29/2022] Open
Abstract
Background Time to treatment in many conditions, particularly acute coronary syndrome, is critical to reducing mortality. Delay between onset of symptoms and treatment remains a worldwide problem. Reducing patient delay has been particularly challenging. Embedding behaviour change techniques (BCTs) within interventions might lead to shorter delay. Objective To identify which BCTs are associated with reductions in patient delay among people with symptoms or conditions where time to treatment is critical. Methods The data sources were Cochrane Library, MEDLINE, EMBASE, Cumulative Index to Nursing and Allied Health Literature, and PsycINFO. Study eligibility criteria include intervention evaluations (randomised controlled trials, controlled clinical trials and cohort studies) involving adults (aged >18 years) and including an outcome measure of patient delay up to August 2016. Study appraisal and synthesis methods include screening potential studies using a transparent, replicable process. Study characteristics, outcomes and BCTs were extracted from eligible studies. Results From 39 studies (200 538 participants), just over half (n=20) reported a significant reduction in delay. 19 BCTs were identified, plus 5 additional techniques, with a mean of 2 (SD=2.3) BCTs and 2 (SD=0.7) per intervention. No clear pattern between BCTs and effectiveness was found. In studies examining patient delay specifically, three of four studies that included two or more BCTs, in addition to the two most commonly used additional techniques, reported a significant reduction in delay. Conclusions Around half of the interventions to reduce prehospital delay with time-critical symptoms report a significant reduction in delay time. It is not clear what differentiates effective from non-effective interventions, although in relation to patient delay particularly additional use of BCTs might be helpful. Trial registration number CRD42014013106.
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Affiliation(s)
| | - Purva Abhyankar
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Karen Smith
- NHS Tayside School of Nursing & Midwifery, University of Dundee, Dundee, UK
| | | | - Shaun Treweek
- Health Sciences Research Unit, University of Aberdeen, Aberdeen, UK
| | - Nadine Dougall
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Brian Williams
- School of Health & Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Marie Johnston
- Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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5
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Nehme Z, Andrew E, Bernard S, Patsamanis H, Cameron P, Bray JE, Meredith IT, Smith K. Impact of a public awareness campaign on out-of-hospital cardiac arrest incidence and mortality rates. Eur Heart J 2018; 38:1666-1673. [PMID: 28329083 DOI: 10.1093/eurheartj/ehw500] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Accepted: 09/22/2016] [Indexed: 11/14/2022] Open
Abstract
Aims Increased public awareness of the warning signs of a heart attack and the importance of early medical intervention may help to prevent premature deaths from out-of-hospital cardiac arrest (OHCA). We sought to investigate the impact of the Heart Foundation's public awareness campaigns on the monthly incidence of, and deaths from, OHCA in Melbourne, Australia. Methods and results Between July 2005 and June 2015, we included registry data for 25 060 OHCA of presumed cardiac aetiology. Time series models with distributed lags were used to explore the effect of campaign activity on OHCA outcomes. A sensitivity analysis involving segmented regression of the pre-intervention, intervention, and post-intervention time segments was also performed. The mean monthly incidence of, and deaths from, OHCA was 207 and 189 events respectively. After adjustment for temporal trends, campaign activity was associated with a 6.0% [95% confidence interval (CI): 2.8-9.0%; P < 0.001] reduction in the monthly incidence of OHCA, or 11.7% (95% CI: 7.7-15.5%, P < 0.001) with the addition of residual effects in two additional lag months. Similarly, the rate of deaths from OHCA reduced by 6.4% (95% CI: 2.8-10.0%; P = 0.001) during months with campaign activity. Campaign activity had a greater effect in males and patients aged ≥65 years, and reduced the incidence of OHCA in unwitnessed and initial non-shockable arrests. In the segmented regression analysis, the intervention period was associated with a 15.2% (95% CI: 9.2-20.9%; P < 0.001) reduction in the mean monthly incidence and a 16.6% (95% CI: 9.9-22.7%; P < 0.001) reduction in deaths from OHCA. Conclusion A comprehensive mass media campaign targeting the community's awareness of heart attack symptoms was associated with a substantial reduction in the incidence of OHCA and associated deaths.
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Affiliation(s)
- Ziad Nehme
- Department of Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster Victoria 3108, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Emily Andrew
- Department of Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster Victoria 3108, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Stephen Bernard
- Department of Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster Victoria 3108, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Harry Patsamanis
- National Heart Foundation of Australia, Level 12, 500 Collins Street, Melbourne Victoria 3000, Australia
| | - Peter Cameron
- Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia
| | - Ian T Meredith
- Department of Cardiology (MonashHeart), Monash Medical Centre, 246 Clayton Road, Clayton Victoria 3168, Australia
| | - Karen Smith
- Department of Research and Evaluation, Ambulance Victoria, 375 Manningham Road, Doncaster Victoria 3108, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Level 6, 99 Commercial Road, Melbourne Victoria 3004, Australia.,Department of Emergency Medicine, University of Western Australia, 35 Stirling Highway, Crawley Western Australia 6009, Australia
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6
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Duber HC, McNellan CR, Wollum A, Phillips B, Allen K, Brown JC, Bryant M, Guptam RB, Li Y, Majumdar P, Roth GA, Thomson B, Wilson S, Woldeab A, Zhou M, Ng M. Public knowledge of cardiovascular disease and response to acute cardiac events in three cities in China and India. Heart 2017; 104:67-72. [DOI: 10.1136/heartjnl-2017-311388] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2017] [Revised: 06/01/2017] [Accepted: 06/02/2017] [Indexed: 11/04/2022] Open
Abstract
ObjectiveTo inform interventions targeted towards reducing mortality from acute myocardial infarction (AMI) and sudden cardiac arrest in three megacities in China and India, a baseline assessment of public knowledge, attitudes and practices was performed.MethodsA household survey, supplemented by focus group and individual interviews, was used to assess public understanding of cardiovascular disease (CVD) risk factors, AMI symptoms, cardiopulmonary resuscitation (CPR) and automated external defibrillators (AEDs). Additionally, information was collected on emergency service utilisation and associated barriers to care.Results5456 household surveys were completed. Hypertension was most commonly recognised among CVD risk factors in Beijing and Shanghai (68% and 67%, respectively), while behavioural risk factors were most commonly identified in Bangalore (smoking 91%; excessive alcohol consumption 64%). Chest pain/discomfort was reported by at least 60% of respondents in all cities as a symptom of AMI, but 21% of individuals in Bangalore could not name a single symptom. In Beijing, Shanghai and Bangalore, 26%, 15% and 3% of respondents were trained in CPR, respectively. Less than one-quarter of participants in all cities recognised an AED. Finally, emergency service utilisation rates were low, and many individuals expressed concern about the quality of prehospital care.ConclusionsOverall, we found low to modest knowledge of CVD risk factors and AMI symptoms, infrequent CPR training and little understanding of AEDs. Interventions will need to focus on basic principles of CVD and its complications in order for patients to receive timely and appropriate care for acute cardiac events.
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Khan NS, Shehnaz SI, Guruswami GK, Ibrahim SAM, Mustafa SAJ. Knowledge of warning signs, presenting symptoms and risk factors of coronary heart disease among the population of Dubai and Northern Emirates in UAE: a cross-sectional study. Nepal J Epidemiol 2017; 7:670-680. [PMID: 29181228 PMCID: PMC5673244 DOI: 10.3126/nje.v7i2.17973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Revised: 06/08/2017] [Accepted: 06/10/2017] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND To evaluate the level of knowledge regarding warning signs, presenting symptoms and risk factors associated with coronary heart disease (CHD) among population of Dubai and Northern Emirates in UAE. MATERIALS AND METHODS A cross sectional survey of 1367 residents of Dubai and Northern Emirates was conducted using a self-administered questionnaire. RESULTS Respondents were classified into two groups: Young Adult Population (YAP; 18-24 years of age) and General Population (GP; 25 years and older). Majority of participants were males (56.7%) and of South Asian (57.5%) or Middle-Eastern (30.8%) ethnicity. Regarding presenting symptoms of CHD, chest pain was identified by around 80% of population, whereas pain in the left shoulder was recognized by 61% of GP and 44% of YAP. Atypical symptoms were poorly identified. Regarding risk factors, only one-fourth population knew that males were at higher risk compared to premenopausal females. Few knew that the risk increases in females after menopause and that the risk is higher for females who smoke and use oral contraceptives. 62% knew that the survivors of a heart attack are at high risk of recurrences. Except for tobacco smoke, hypercholesterolemia and hypertension, knowledge of other risk factors was not satisfactory. Older adults and females had comparatively higher level of knowledge. CONCLUSION Knowledge level of many of the symptoms and risk factors of CHD is unsatisfactory. There is, therefore, a need to increase the awareness in the population of UAE. The knowledge gaps identified through this study can be addressed through health campaigns to increase the awareness about warning signs, symptoms and modifiable risk factors. .
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Affiliation(s)
- Nelofar Sami Khan
- Associate Professor, Dept. of Biomedical Sciences, Gulf Medical University P.O.Box 4184, Ajman, UAE.
| | - Syed Ilyas Shehnaz
- Department of Pharmacology, Faculty of medicine, Annamalai University Chidambaram, India
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8
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Nehme Z, Cameron PA, Akram M, Patsamanis H, Bray JE, Meredith IT, Smith K. Effect of a mass media campaign on ambulance use for chest pain. Med J Aust 2017; 206:30-35. [DOI: 10.5694/mja16.00341] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 07/15/2016] [Indexed: 11/17/2022]
Affiliation(s)
- Ziad Nehme
- Ambulance Service of Victoria, Melbourne, VIC
- Monash University, Melbourne, VIC
| | - Peter A Cameron
- Monash University, Melbourne, VIC
- Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University, Ballarat, VIC
| | - Muhammad Akram
- Monash University, Melbourne, VIC
- Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University, Ballarat, VIC
| | | | | | | | - Karen Smith
- Ambulance Service of Victoria, Melbourne, VIC
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9
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Thompson PL, Shilton T. Encouraging early treatment of suspected heart attack: it's OK to call 000. Med J Aust 2017; 206:19. [DOI: 10.5694/mja16.00791] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Accepted: 09/20/2016] [Indexed: 11/17/2022]
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10
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Mol K, Rahel B, Meeder J, van Casteren B, Doevendans P, Cramer M. Delays in the treatment of patients with acute coronary syndrome: Focus on pre-hospital delays and non-ST-elevated myocardial infarction. Int J Cardiol 2016; 221:1061-6. [DOI: 10.1016/j.ijcard.2016.07.082] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Accepted: 07/04/2016] [Indexed: 10/21/2022]
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Bray JE, Stub D, Ngu P, Cartledge S, Straney L, Stewart M, Keech W, Patsamanis H, Shaw J, Finn J. Mass Media Campaigns' Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign. J Am Heart Assoc 2015; 4:JAHA.115.001927. [PMID: 26150478 PMCID: PMC4608076 DOI: 10.1161/jaha.115.001927] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The aim of this study was to examine the awareness of a recent mass media campaign, and its influence on knowledge and prehospital times, in a cohort of acute coronary syndrome (ACS) patients admitted to an Australian hospital. Methods and Results We conducted 199 semistructured interviews with consecutive ACS patients who were aged 35 to 75 years, competent to provide consent, and English speaking. Questions addressed the factors known to predict prehospital delay, awareness of the campaign, and whether it increased knowledge and influenced actions. Multivariable logistic regression was used to examine the association between campaign awareness and a 1-hour delay in deciding to seek medical attention (patient delay) and a 2-hour delay in presenting to hospital (prehospital delay). The median age was 62 years (IQR=53 to 68 years), and 68% (n=136) were male. Awareness of the campaign was reported by 127 (64%) patients, with most of these patients stating the campaign (1) increased their understanding of what is a heart attack (63%), (2) increased their awareness of the signs and symptoms of heart attack (68%), and (3) influenced their actions in response to symptoms (43%). After adjustment for other predictors, awareness of the campaign was significantly associated with patient delay time of ≤1 hour (adjusted odds ratio [AOR]=2.25, 95% CI: 1.03 to 4.91, P=0.04) and prehospital delay time ≤2 hours (AOR=3.11, 95% CI: 1.36 to 7.08, P=0.007). Conclusions Our study showed reasonably high awareness of the warning signs campaign, which was significantly associated with shorter prehospital decision-making and faster presentation to hospital.
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Affiliation(s)
- Janet E Bray
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., S.C., L.S., J.F.) Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.) Prehospital, Resuscitation & Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.)
| | - Dion Stub
- Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.)
| | - Philip Ngu
- Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.)
| | - Susie Cartledge
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., S.C., L.S., J.F.) Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.)
| | - Lahn Straney
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., S.C., L.S., J.F.)
| | - Michelle Stewart
- Heart Foundation, Melbourne, Victoria, Australia (M.S., W.K., H.P.)
| | - Wendy Keech
- Heart Foundation, Melbourne, Victoria, Australia (M.S., W.K., H.P.)
| | - Harry Patsamanis
- Heart Foundation, Melbourne, Victoria, Australia (M.S., W.K., H.P.)
| | - James Shaw
- Alfred Hospital, Melbourne, Victoria, Australia (J.E.B., D.S., P.N., S.C., J.S.)
| | - Judith Finn
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia (J.E.B., S.C., L.S., J.F.) Prehospital, Resuscitation & Emergency Care Research Unit, Curtin University, Perth, Western Australia, Australia (J.E.B., J.F.)
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Sandhu K, Nadar SK. Percutaneous coronary intervention in the elderly. Int J Cardiol 2015; 199:342-55. [PMID: 26241641 DOI: 10.1016/j.ijcard.2015.05.188] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2014] [Revised: 05/07/2015] [Accepted: 05/09/2015] [Indexed: 12/20/2022]
Abstract
Our population dynamics are changing. The number of octogenarians and older people in the general population is increasing and therefore the number of older patients presenting with acute coronary syndrome or stable angina is increasing. This group has a larger burden of coronary disease and also a greater number of concomitant comorbidities when compared to younger patients. Many of the studies assessing percutaneous coronary intervention (PCI) to date have actively excluded octogenarians. However, a number of studies, both retrospective and prospective, are now being undertaken to reflect the, "real" population. Despite being a higher risk group for both elective and emergency PCIs, octogenarians have the greatest to gain in terms of prognosis, symptomatic relief, and arguably more importantly, quality of life. Important future development will include assessment of patient frailty, encouraging early presentation, addressing gender differences on treatment strategies, identification of culprit lesion(s) and vascular access to minimise vascular complications. We are now appreciating that the new frontier is perhaps recognising and risk stratifying those elderly patients who have the most to gain from PCI. This review article summarises the most relevant trials and studies.
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Affiliation(s)
- Kully Sandhu
- Royal Stoke Hospital, University Hospitals of North Midlands, Newcastle Road, Stoke on Trent ST46QG, United Kingdom
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13
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Coventry LL, Bremner AP, Williams TA, Celenza A. The effect of presenting symptoms and patient characteristics on prehospital delay in MI patients presenting to emergency department by ambulance: a cohort study. Heart Lung Circ 2015; 24:943-50. [PMID: 25922230 DOI: 10.1016/j.hlc.2015.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Revised: 02/09/2015] [Accepted: 02/22/2015] [Indexed: 10/23/2022]
Abstract
INTRODUCTION There is little recent information about prehospital delay time for Australian patients with myocardial infarction (MI). OBJECTIVES This study: (1) describes prehospital delay time for patients with MI; (2) identifies variables and presenting symptoms which contribute to the delay. METHODS This retrospective cohort study identified patients with an Emergency Department (ED) discharge diagnosis of MI, transported by ambulance to one of the seven Perth metropolitan EDs, between January 2008 and October 2009. Prehospital delay times were analysed using linear regression models. Non-numeric (word descriptions) of delay time were categorised. RESULTS Of 1,633 patients, symptom onset-time was available for 1,003. For 829 patients with a numeric onset-time, median delay was 2.2hours; decreased delay was associated with age <70 years, presenting with chest pain, and diaphoresis. Increased delay was associated with being with a primary health care provider, and if the patient was at home and if the person who called the ambulance was anyone other than the spouse. For 174 patients with non-numeric onset-times, 37% patients delayed one to three days and 110 (64.0%) patients described their symptoms as intermittent and/or of gradual onset. CONCLUSION Given that prehospital delay times remain longer than is optimal, public awareness of MI symptoms should be enhanced in order to decrease prehospital delay.
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Affiliation(s)
- Linda L Coventry
- School of Population Health, The University of Western Australia, Perth, WA, 6009; Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, WA, 6009; Faculty of Health, Engineering and Science, School of Nursing and Midwifery, Edith Cowan University, Perth, WA, 6027.
| | - Alexandra P Bremner
- School of Population Health, The University of Western Australia, Perth, WA, 6009.
| | - Teresa A Williams
- Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, WA, 6009; St John Ambulance, Western Australia, Perth, WA, 6984; Prehospital, Resuscitation and Emergency Care Research Unit, School of Nursing and Midwifery, Curtin University, Perth, WA, 6845.
| | - Antonio Celenza
- Discipline of Emergency Medicine, School of Primary, Aboriginal and Rural Health Care, The University of Western Australia, Perth, WA, 6009.
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Liu Z, Beaver K, Speed S. Being healthy: a grounded theory study of help seeking behaviour among Chinese elders living in the UK. Int J Qual Stud Health Well-being 2014; 9:24820. [PMID: 25361531 PMCID: PMC4215720 DOI: 10.3402/qhw.v9.24820] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/25/2014] [Indexed: 11/14/2022] Open
Abstract
The health of older people is a priority in many countries as the world's population ages. Attitudes towards help seeking behaviours in older people remain a largely unexplored field of research. This is particularly true for older minority groups where the place that they have migrated to presents both cultural and structural challenges. The UK, like other countries, has an increasingly aging Chinese population about who relatively little is known. This study used a qualitative grounded theory design following the approach of Glaser (1978). Qualitative data were collected using semi-structured interviews with 33 Chinese elders who were aged between 60 and 84, using purposive and theoretical sampling approaches. Data were analysed using the constant comparative method until data saturation occurred and a substantive theory was generated. “Being healthy” (the core category) with four interrelated categories: self-management, normalizing/minimizing, access to health services, and being cured form the theory. The theory was generated around the core explanations provided by participants and Chinese elders’ concerns about health issues they face in their daily life. We also present data about how they direct their health-related activities towards meeting their physical and psychological goals of being healthy. Their differential understanding of diseases and a lack of information about health services were potent predictors of non–help seeking and “self” rather than medical management of their illnesses. This study highlights the need for intervention and health support for Chinese elders.
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Affiliation(s)
- Zhenmi Liu
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK;
| | - Kinta Beaver
- School of Health, University of Central Lancashire, Preston, UK
| | - Shaun Speed
- School of Nursing, Midwifery and Social Work, University of Manchester, Manchester, UK
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15
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Quah JLJ, Yap S, Cheah SO, Ng YY, Goh ES, Doctor N, Leong BSH, Tiah L, Chia MYC, Ong MEH. Knowledge of signs and symptoms of heart attack and stroke among Singapore residents. BIOMED RESEARCH INTERNATIONAL 2014; 2014:572425. [PMID: 24812623 PMCID: PMC4000924 DOI: 10.1155/2014/572425] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Accepted: 03/02/2014] [Indexed: 11/28/2022]
Abstract
AIM To determine the level of knowledge of signs and symptoms of heart attack and stroke in Singapore resident population, in comparison to the global community. METHODS A population based, random sample of 7,840 household addresses was selected from a validated national sampling frame. Each participant was asked eight questions on signs and symptoms of heart attack and 10 questions on stroke. RESULTS The response rate was 65.2% with 4,192 respondents. The level of knowledge for preselected, common signs and symptoms of heart attack and stroke was 57.8% and 57.1%, respectively. The respondents scored a mean of 5.0 (SD 2.4) out of 8 for heart attack, while they scored a mean of 6.8 (SD 2.9) out of 10 for stroke. Respondents who were ≥ 50 years, with lower educational level, and unemployed/retired had the least knowledge about both conditions. The level of knowledge of signs and symptoms of heart attack and stroke in Singapore is comparable to USA and Canada. CONCLUSION We found a comparable knowledge of stroke and heart attack signs and symptoms in the community to countries within the same economic, educational, and healthcare strata. However older persons, those with lower educational level and those who are unemployed/retired, require more public health education efforts.
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Affiliation(s)
- Joy Li Juan Quah
- Yong Loo Lin School of Medicine, National University of Singapore, 10 Medical Drive, Singapore 117597
| | - Susan Yap
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608
| | - Si Oon Cheah
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608
| | - Yih Yng Ng
- Medical Department, Singapore Civil Defence Force, 91 Ubi Avenue 4, Singapore 408827
| | - E. Shaun Goh
- Acute and Emergency Care Centre, Khoo Teck Puat Hospital, 90 Yishun Central, Singapore 768828
| | - Nausheen Doctor
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608
| | - Benjamin Sieu-Hon Leong
- Emergency Medicine Department, National University Hospital, 5 Lower Kent Ridge Rd, Singapore 119074
| | - Ling Tiah
- Accident & Emergency Department, Changi General Hospital, 2 Simei Street 3, Singapore 529889
| | | | - Marcus Eng Hock Ong
- Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore 169608
- Office of Clinical Sciences, Duke-NUS Graduate Medical School, 8 College Road, Singapore 169857
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16
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McKee G, Mooney M, O'Donnell S, O'Brien F, Biddle MJ, Moser DK. Multivariate analysis of predictors of pre-hospital delay in acute coronary syndrome. Int J Cardiol 2013; 168:2706-13. [DOI: 10.1016/j.ijcard.2013.03.022] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 02/01/2013] [Accepted: 03/17/2013] [Indexed: 10/27/2022]
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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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18
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Nguyen HL, Saczynski JS, Gore JM, Goldberg RJ. Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction: a systematic review. Circ Cardiovasc Qual Outcomes 2009; 3:82-92. [PMID: 20123674 DOI: 10.1161/circoutcomes.109.884361] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronary heart disease is the leading cause of morbidity and mortality in American men and women. Although there have been dramatic changes in the management of patients hospitalized with acute myocardial infarction (AMI) over the past several decades, a considerable proportion of patients with AMI continue to delay seeking medical care in a timely manner. This review provides an overview of the published literature that has examined age and sex differences in extent of prehospital delay in patients hospitalized with AMI. METHODS AND RESULTS A systematic review of the literature from 1960 to 2008, including publications that provided data on duration of prehospital delay in patients hospitalized with AMI, was conducted. A total of 44 articles (42 studies) were included in the present analysis. The majority of studies showed that in patients hospitalized with AMI, women and older persons were more likely to arrive at the hospital later than men and younger persons. Several factors associated with duration of prehospital delay, including sociodemographic, medical history, clinical, and contextual characteristics differed according to sex. CONCLUSIONS The elderly and women were more likely to exhibit longer delays in seeking medical care after the development of symptoms suggestive of AMI compared with other groups. Further research is needed to more fully understand the reasons for delay in these vulnerable groups.
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Affiliation(s)
- Hoa L Nguyen
- Department of Medicine, Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA 01605, USA
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19
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Sullivan MD, Ciechanowski PS, Russo JE, Soine LA, Jordan-Keith K, Ting HH, Caldwell JH. Understanding Why Patients Delay Seeking Care for Acute Coronary Syndromes. Circ Cardiovasc Qual Outcomes 2009; 2:148-54. [DOI: 10.1161/circoutcomes.108.825471] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background—
Better insight into the psychosocial factors associated with prehospital delays in seeking care for acute coronary syndromes is needed to inform the design of future interventions. Delay in presenting for care after the onset of symptoms is common, limits the potential benefit of acute reperfusion, and has not been reduced by interventions tested thus far.
Methods and Results—
Seven hundred ninety-six patients with suspected ischemic heart disease scheduled for clinically indicated imaging stress tests completed questionnaires concerning psychological distress and attachment styles (worthiness to receive care, trustworthiness of others to provide care). The primary dependent variable for this study was response to a question from the rapid early action for coronary treatment trial concerning intention to “wait until very sure” before seeking care for a possible “heart attack.” Responses to this question were strongly associated with actual emergency department-reported and self-reported care delay in the rapid early action for coronary treatment trial. In multivariable ordinal regression models, a more negative view of the trustworthiness of others, greater physical limitations from angina, and no previous revascularization were independently associated with increased intention to wait to seek care for a myocardial infarction. Intention to wait was not associated with inducible ischemia or self-perceived risk of myocardial infarction.
Conclusions—
Intention to delay seeking care for acute coronary syndromes is associated with a patient’s view of the trustworthiness of others, previous experience with revascularization, and functional limitations, even after adjustment for objective and perceived acute coronary syndromes risk. These findings provide insight into novel factors contributing to longer delay times and may inform future interventions to reduce delay time.
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Affiliation(s)
- Mark D. Sullivan
- From the Department of Psychiatry and Behavioral Sciences (M.D.S., P.S.C., J.E.R.), Division of Cardiology (L.A.S., J.H.C.), Department of Medicine, and Department of Radiology (L.A.S.), University of Washington, Seattle; the Department of Cardiology (K.J.-K.), VA Puget Sound Health Care System, Seattle, Wash; and Knowledge and Encounter Research Unit (H.H.T.), Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Paul S. Ciechanowski
- From the Department of Psychiatry and Behavioral Sciences (M.D.S., P.S.C., J.E.R.), Division of Cardiology (L.A.S., J.H.C.), Department of Medicine, and Department of Radiology (L.A.S.), University of Washington, Seattle; the Department of Cardiology (K.J.-K.), VA Puget Sound Health Care System, Seattle, Wash; and Knowledge and Encounter Research Unit (H.H.T.), Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Joan E. Russo
- From the Department of Psychiatry and Behavioral Sciences (M.D.S., P.S.C., J.E.R.), Division of Cardiology (L.A.S., J.H.C.), Department of Medicine, and Department of Radiology (L.A.S.), University of Washington, Seattle; the Department of Cardiology (K.J.-K.), VA Puget Sound Health Care System, Seattle, Wash; and Knowledge and Encounter Research Unit (H.H.T.), Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Laurie A. Soine
- From the Department of Psychiatry and Behavioral Sciences (M.D.S., P.S.C., J.E.R.), Division of Cardiology (L.A.S., J.H.C.), Department of Medicine, and Department of Radiology (L.A.S.), University of Washington, Seattle; the Department of Cardiology (K.J.-K.), VA Puget Sound Health Care System, Seattle, Wash; and Knowledge and Encounter Research Unit (H.H.T.), Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Kier Jordan-Keith
- From the Department of Psychiatry and Behavioral Sciences (M.D.S., P.S.C., J.E.R.), Division of Cardiology (L.A.S., J.H.C.), Department of Medicine, and Department of Radiology (L.A.S.), University of Washington, Seattle; the Department of Cardiology (K.J.-K.), VA Puget Sound Health Care System, Seattle, Wash; and Knowledge and Encounter Research Unit (H.H.T.), Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - Henry H. Ting
- From the Department of Psychiatry and Behavioral Sciences (M.D.S., P.S.C., J.E.R.), Division of Cardiology (L.A.S., J.H.C.), Department of Medicine, and Department of Radiology (L.A.S.), University of Washington, Seattle; the Department of Cardiology (K.J.-K.), VA Puget Sound Health Care System, Seattle, Wash; and Knowledge and Encounter Research Unit (H.H.T.), Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
| | - James H. Caldwell
- From the Department of Psychiatry and Behavioral Sciences (M.D.S., P.S.C., J.E.R.), Division of Cardiology (L.A.S., J.H.C.), Department of Medicine, and Department of Radiology (L.A.S.), University of Washington, Seattle; the Department of Cardiology (K.J.-K.), VA Puget Sound Health Care System, Seattle, Wash; and Knowledge and Encounter Research Unit (H.H.T.), Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minn
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20
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Tonkin AM, Chen L. Where on the Healthcare Continuum Should We Invest? The Case for Primary Care? Heart Lung Circ 2009; 18:108-13. [DOI: 10.1016/j.hlc.2008.11.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ratner PA, Johnson JL, Mackay M, Tu AW, Hossain S. Knowledge of “Heart Attack” Symptoms in a Canadian Urban Community. Clin Med Cardiol 2008. [DOI: 10.4137/cmc.s709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Pamela A. Ratner
- NEXUS and School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joy L. Johnson
- NEXUS and School of Nursing, University of British Columbia, Vancouver, British Columbia, Canada
| | - Martha Mackay
- School of Nursing, University of British Columbia & Clinical Nurse Specialist, Cardiology, Heart Centre, St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Andrew W. Tu
- British Columbia Centre for Disease Control, Vancouver, British Columbia, Canada
| | - Shahadut Hossain
- Research Satistician, NEXUS, University of British Columbia, Vancouver, British Columbia, Canada
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22
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Finn JC, Bett JHN, Shilton TR, Cunningham C, Thompson PL. Patient delay in responding to symptoms of possible heart attack: can we reduce time to care? Med J Aust 2007; 187:293-8. [PMID: 17767436 DOI: 10.5694/j.1326-5377.2007.tb01247.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2007] [Accepted: 06/07/2007] [Indexed: 11/17/2022]
Abstract
In Australia, many deaths and significant cardiac disability result from delayed response to symptoms of heart attack. Although delays due to transport and initiation of reperfusion therapy in hospital may contribute to late treatment, the major component of delay is the time patients take in deciding to seek help. A critical examination of campaigns to shorten patient delay concludes that they were based on a factual, short-term, non-targeted approach that included education and mass media strategies. They achieved equivocal results. One randomised controlled trial has been conducted. Although this showed an improved understanding of heart attack symptoms, it did not shorten pre-hospital delays. The implications of these findings are that future campaigns to shorten patient delay are likely to be more effective if they address the psychosocial and behavioural blocks to action, are ongoing rather than short term, and focus on people at highest risk, including those with known or high risk of coronary heart disease, those in rural locations, and Indigenous Australians. The National Heart Foundation of Australia proposes a comprehensive strategy to incorporate this approach into its future campaigns to reduce patient delay for suspected heart attack.
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Affiliation(s)
- Judith C Finn
- Centre for Nursing Research, Sir Charles Gairdner Hospital, and School of Population Health, University of Western Australia, Perth, WA, Australia
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Abstract
BACKGROUND AND PURPOSE Television advertising has been associated with significant increases in the knowledge of the warning signs of stroke among Ontarians aged 45 and older. However, to date there has been little data on the relationship between knowledge of the warning signs of stroke and behavior. METHODS Data on presentation to regional and enhanced district stroke center emergency departments were obtained from the Registry of the Canadian Stroke Network for a 31-month period between mid 2003 and the beginning of 2006. Public opinion polling was used to track knowledge of the warning signs of stroke among Ontarians aged 45 and older. RESULTS The public's awareness of the warning signs of stroke increased during 2003 to 2005, decreasing in 2006 after a 5-month advertising blackout. There was a significant increase in the mean number of emergency department visits for stroke over the study period. A campaign effect independent of year was observed for total presentations, presentation within 5 hours of last seen normal, and presentation within 2.5 hours. For TIAs there was a strong campaign effect but no change in the number of presentations by year. CONCLUSIONS Continuous advertising may be required to build and sustain public awareness of the warning signs of stroke. There are many factors that may influence presentation for stroke and awareness of the warning signs may be only one. However, results of this study suggest there may be an important correlation between the advertising and emergency department presentations with stroke, particularly for TIAs.
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