Acute myocardial infarction: are there missed opportunities for reperfusion?

Gaylani, Nadia El; Weston, C; Griffith, K.; Wong, P. S. C.; Norris, R. M.; Penny, W. J.

doi:10.1097/00019501-199809110-00008

Cited by 8 publications

(5 citation statements)

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“…Other physical and mental vestiges of military service such as physical disability or substance abuse, may further contribute to self-isolation among Veterans. An estimated quarter to a third of VHA users live alone [23]. Despite these concerns, we did not find an association of living alone and late presentation among Veterans.…”

Section: Discussioncontrasting

confidence: 70%

“…Despite these concerns, we did not find an association of living alone and late presentation among Veterans. This may be explained in part by findings reported by Guzman et al that older Veterans who live alone actually have increased outpatient service utilization suggesting that Veterans living alone may seek out social support through health care encounters [23]. This finding of increased outpatient service utilization suggests both a risk and a benefit for late presentation among Veterans.…”

Section: Discussionmentioning

confidence: 97%

See 1 more Smart Citation

Factors associated with presenting >12 hours after symptom onset of acute myocardial infarction among Veteran men

McDermott

Maynard

Trivedi

et al. 2012

BMC Cardiovasc Disord

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BackgroundApproximately 2/3 of Veterans admitting to Veterans Health Administration (VHA) facilities present >12 hours after symptom onset of acute myocardial infarction (AMI) (“late presenters”). Veterans admitted to VHA facilities with AMI may delay hospital presentation for different reasons compared to their general population counter parts. Despite the large descriptive literature on factors associated with delayed presentation in the general population, the literature describing these factors among the Veteran AMI population is limited. The purpose of this analysis is to identify predictors of late presentation in the Veteran population presenting with AMI to VHA facilities. Identifying predictors will help inform and target interventions for Veterans at a high risk of late presentation.MethodsIn our cross-sectional study, we analyzed a cohort of 335 male Veterans from nine VHA facilities with physician diagnosed AMI between April 2005 and December 2006. We compared demographics, presentation characteristics, medical history, perceptions of health, and access to health care between early and late presenting Veterans. We used standard descriptive statistics for bivariate comparisons and multivariate logistic regression to identify independent predictors of late presentation.ResultsOur cohort was an average of 64 ± 10 years old and was 88% white. Sixty-eight percent of our cohort were late presenters. Bivariate comparisons found that fewer late presenters had attended at least some college or vocational school (late 53% vs. early 66%, p = 0.02). Multivariate analysis showed that presentation with ST-elevation myocardial infarction (STEMI) was associated with early presentation (OR = 0.4 95%CI [0.2, 0.9]) and ≥2 angina episodes in the prior 24 hours (versus 0-1 episode) was associated with late presentation (OR = 7.5 95%CI [3.6,15.6]).ConclusionsA significant majority of Veterans presenting to VHA facilities with AMI were late presenters. We found few differences between early and late presenters. Having a STEMI was independently associated with early presentation and reporting ≥2 angina episodes in the 24 hours prior to hospital admission was independently associated with late presentation. These independent predictors of early and late presentation are similar to what has been reported for the general population. Despite these similarities to the general population, there may be untapped opportunities for patient education within the VHA to decrease late presentation.

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Section: Discussioncontrasting

confidence: 70%

Section: Discussionmentioning

confidence: 97%

Factors associated with presenting >12 hours after symptom onset of acute myocardial infarction among Veteran men

McDermott

Maynard

Trivedi

et al. 2012

BMC Cardiovasc Disord

View full text Add to dashboard Cite

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“…Also, in the United States, [3][4][5][6][7][8][9][10][11] Australia, 12) Canada, 13) the United Kingdom, [14][15][16][17] France, [18][19][20] Switzerland, 21,22) Israel, 23,24) Austria, 25) Spain, 26) Portugal, [27][28][29] Italy, [30][31][32] Finland, 33) Sweden, 34) Germany, [35][36][37][38][39] Denmark, 40,41) the Netherlands [42][43][44] and in Belgium, [45][46][47] there is controversy about the preferential use of thrombolytics and/or rescue PTCA and stenting. Up to now it is not known which therapy provides the best results in the longterm with total patency or TIMI 3 patency.…”

mentioning

confidence: 99%

Changes in Mortality of Acute Myocardial Infarction as a Function of a Changing Treatment during the last Two Decades

Claessens

et al. 2000

Jpn Heart J

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SUMMARYForty years ago, after the establishment of coronary care units, a significant decrease in mortality of acute myocardial infarction was noted. Twenty years ago, the breakthrough of thrombolysis realized once again a significant decrease in mortality. In this study we compare, in a rather small community hospital, the mortality and safety of thrombolytic therapy in acute myocardial infarction with a more conventional, conservative medical therapy.We examined all cases of acute myocardial infarction between 1978 up to 1998 inclusive, concerning treatment and mortality rate after a six month period. To be included in the study, acute myocardial infarction had to fulfill particular inclusion criteria. A total of 1863 cases of acute myocardial infarction were included.The mortality rate of patients with acute myocardial infarction treated with thrombolytic agents was strikingly lower and statistically very significantly different (p < 0.001) in comparison with the mortality rate of patients treated with heparin or coumarine derivatives.The mortality rate dropped from 10.57% in the coumarine group and from 14.95% in the heparin group to 5.41% in the alteplase group, to 4.95% in the anistreplase group and 4.00% in the streptokinase subgroup.The complications directly connected to the treatment did not seem to be different between the five groups, and they were also not more frequent by using thrombolytic agents.In the last 20 years, better preventive measures (life habits, diet, medication) and trials to better control the risk factors have not influenced greatly the average amount of cholesterol in patients with an acute myocardial infarction. Also the percentage of patients with high blood pressure has hardly decreased over the last 20 years.The mortality associated with acute myocardial infarction has decreased significantly with the use of thrombolytics. In most cases, thrombolytics are administered routinely and safely. In this way, they are the first choice therapy for myocardial infarction in smaller hospitals.

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“…The UK Heart Attack Study Investigators reported a 52% rate of thrombolytic therapy in 2,439 patients under the age of 76 years. 21 A Norwegian multihospital study reported a 32% thrombolytic rate for AMI patients of all ages, despite 50% being eligible for thrombolytic therapy. 22 The National Registry of Myocardial Infarction (NRMI) investigators reported that in participating U.S. hospitals from 1990 to 1993, 35% of AMI patients received thrombolytic therapy.…”

Section: Limitations and Future Questionsmentioning

confidence: 99%

Impact of Community Intervention to Reduce Patient Delay Time on Use of Reperfusion Therapy for Acute Myocardial Infarction Rapid Early Action for Coronary Treatment (REACT) Trial

Hedges

Feldman

Bittner

et al. 2000

Academic Emergency Medicine

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Abstract. Background: Reperfusion therapy for acute myocardial infarction (AMI) is a time-dependent intervention that can reduce infarct-related morbidity and mortality. Out-of-hospital patient delay from symptom onset until emergency department (ED) presentation may reduce the expected benefit of reperfusion therapy. Objective: To determine the impact of a community educational intervention to reduce patient delay time on the use of reperfusion therapy for AMI. Methods: This was a randomized, controlled community-based trial to enhance patient recognition of AMI symptoms and encourage early ED presentation with resultant increased reperfusion therapy rates for AMI. The study took place in 44 hospitals in 20 pair-matched communities in five U.S. geographic regions. Eligible study subjects were noninstitutionalized patients without chest injury (aged Ն30 years) who were admitted to participating hospitals and who received a hospital discharge diagnosis of AMI (ICD 410); n = 4,885. For outcome assessment, patients were excluded if they were without survival data (n = 402), enrolled in thrombolytic trials (n = 61), receiving reperfusion therapy >12 hours after ED arrival (n = 628), or missing symptom onset or reperfusion times (n = 781). The applied intervention was an educational program targeting community organizations and the general public, high-risk patients, and health professionals in target communities. The primary outcome was a change in the proportion of AMI patients receiving early reperfusion therapy (i.e., within one hour of ED arrival or within six hours of symptom onset). Trends in reperfusion therapy rates were determined after adjustment for patient demographics, presenting blood pressure, cardiac history, and insurance status. Four-month baseline was compared with the 18-month intervention period. Results: Of 3,013 selected AMI patients, 40% received reperfusion therapy. Eighteen percent received therapy within one hour of ED arrival (46% of treated patients), and 32% within six hours of symptom onset (80% of treated patients). No significant difference in the trends in reperfusion therapy rates was attributable to the intervention, although increases in early reperfusion therapy rates were noted during the first six months of the intervention. A significant association of early reperfusion therapy use with ambulance use was identified. Conclusions: Community-wide educational efforts to enhance patient response to AMI symptoms may not translate into sustained changes in reperfusion practices. However, an increased odds for early reperfusion therapy use during the initiation of the intervention and the association of early therapy with ambulance use suggest that reperfusion therapy rates can be enhanced.

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Acute myocardial infarction: are there missed opportunities for reperfusion?

Cited by 8 publications

References 0 publications

Factors associated with presenting >12 hours after symptom onset of acute myocardial infarction among Veteran men

Factors associated with presenting >12 hours after symptom onset of acute myocardial infarction among Veteran men

Changes in Mortality of Acute Myocardial Infarction as a Function of a Changing Treatment during the last Two Decades

Impact of Community Intervention to Reduce Patient Delay Time on Use of Reperfusion Therapy for Acute Myocardial Infarction Rapid Early Action for Coronary Treatment (REACT) Trial

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