Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction

Ottesen, Michael; Køber, Lars; Jørgensen, Stig; Torp-Pedersen, C.

doi:10.1093/oxfordjournals.eurheartj.a014876

Cited by 89 publications

(57 citation statements)

References 29 publications

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“…Whereas the overall median duration of prehospital delay of 2 hours, and mean of 3.7 hours, observed in our study were comparable with observations from several previous studies on elderly patients in the community setting,7, 8, 9 they were generally lower in comparison with the findings from several international studies, where average delay times in the setting of AMI have ranged from 1.6 to 42.4 hours and median delays have ranged from 1.7 to 8 hours 22, 26, 27. However, mean and median delay times observed among elderly patients in our study were notably longer compared with elderly patients enrolled in clinical trials of fibrinolytic agents, where patients 75 years and older were typically excluded and patients also had to satisfy additional inclusion criteria 28.…”

Section: Discussionsupporting

confidence: 90%

Decade Long Trends (2001–2011) in Duration of Pre‐Hospital Delay Among Elderly Patients Hospitalized for an Acute Myocardial Infarction

Makam

Erskine

Yarzebski

et al. 2016

JAHA

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BackgroundEarly intervention with medical and/or coronary revascularization treatment approaches remains the cornerstone of the management of patients hospitalized with acute myocardial infarction (AMI). However, several patient groups, especially the elderly, are known to delay seeking prompt medical care after onset of AMI‐associated symptoms. Current trends, and factors associated with prolonged prehospital delay among elderly patients hospitalized with AMI, are incompletely understood.Methods and ResultsData from a population‐based study of patients hospitalized at all 11 medical centers in central Massachusetts with a confirmed AMI on a biennial basis between 2001 and 2011 were analyzed. Information about duration of prehospital delay after onset of acute coronary symptoms was abstracted from hospital medical records. In patients 65 years and older, the overall median duration of prehospital delay was 2.0 hours, with corresponding median delays of 2.0, 2.1, and 2.0 hours in those aged 65 to 74 years, 75 to 84 years, and in patients 85 years and older, respectively. There were no significant changes over time in median delay times in each of the age strata examined in both crude and multivariable adjusted analyses. A limited number of patient characteristics were associated with prolonged delay in this patient population.ConclusionsThe results of this community‐wide study demonstrate that delay in seeking prompt medical care continues to be a significant problem among elderly patients hospitalized with AMI. The lack of improvement in the timeliness of patients’ care‐seeking behavior during the years under study remains of considerable clinical and public health concern.

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Section: Discussionsupporting

confidence: 90%

Decade Long Trends (2001–2011) in Duration of Pre‐Hospital Delay Among Elderly Patients Hospitalized for an Acute Myocardial Infarction

Makam

Erskine

Yarzebski

et al. 2016

JAHA

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“…[3][4][5][6][7][8][9][10] However, the evidence for a weekend effect is not well established for people admitted with PE. Therefore, we carried out the present study to determine whether people admitted with PE on the weekend have worse outcomes than those admitted during the week.…”

Section: Original Research Pulmonary Vascular Diseasementioning

confidence: 99%

Pulmonary Embolism

Nanchal

Kumar

Taneja

et al. 2012

Chest

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Pulmonary embolism (PE) is a common, often fatal, acute medical condition for which timely therapy can be life saving. The average annual incidence of acute PE in the United States is about 110 in 100,000 adults. The case fatality rate in the years prior to the introduction of anticoagulant therapy exceeded 30%; current estimates of case fatality are , 10%. 1,2 The accurate diagnosis of PE relies on clinical acumen and timely use of appropriate diagnostic studies. Indi viduals with PE who present with shock or severe respiratory failure or who have limited cardiopul monary reserve benefi t from prompt use of complex therapies, such as mechanical ventilation, vasopressor infusion, inferior vena cava (IVC) fi lter placement, and thrombolysis.Previous studies of patients admitted with similarly time-sensitive conditions suggested that weekend admission increases the risk of poor outcomes. 3-10 However, the evidence for a weekend effect is not well established for people admitted with PE. Therefore, we carried out the present study to determine whether people admitted with PE on the weekend have worse outcomes than those admitted during the week. To better understand such a phenomenon, we sought to Background: Pulmonary embolism is a common, often fatal condition that requires timely recognition and rapid institution of therapy. Previous studies have documented worse outcomes for weekend admissions for a variety of time-sensitive medical conditions. This phenomenon has not been clearly demonstrated for pulmonary embolism. Methods: We used the Healthcare Cost and Utilization Project Nationwide Inpatient Sample for the years 2000 to 2008 to identify people with a principal discharge diagnosis of pulmonary embolism. We classifi ed admissions as weekend if they occurred between midnight Friday and midnight Sunday. We compared all-cause in-hospital mortality between weekend and weekday admissions and investigated the timing of inferior vena cava (IVC) fi lter placement and thrombolytic infusion as potential explanations for differences in mortality. Results: Unadjusted mortality was higher for weekend admissions than weekday admissions (OR, 1.19; 95% CI, 1.13-1.24). This increase in mortality remained statistically signifi cant after controlling for potential confounding variables (OR, 1.17; 95% CI, 1.11-1.22). Among patients who received an IVC fi lter, a larger proportion of those admitted on a weekday than on the weekend received it on their fi rst hospital day (38% vs 29%, P , .001). The timing of thrombolytic therapy did not differ between weekday and weekend admissions. Conclusions: Weekend admissions for pulmonary embolism were associated with higher mortality than weekday admissions. Our fi nding that IVC fi lter placement occurred later in the hospital course for patients admitted on weekends with pulmonary embolism suggests differences in the timeliness of diagnosis and treatment between weekday and weekend admissions. Regardless of cause, physicians should be aware that weekend admissions for pulmonary embolis...

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“…Although the precise incidence of pain in ACS is unknown, the majority of patients with AMI likely have pain or discomfort. 124 In contrast, pain is associated with only 8.7% of anterior circulation ischemic stroke cases and 15% of posterior circulation ischemic stroke cases. 125 Pain is a motivating symptom.…”

mentioning

confidence: 99%

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

Moser¹,

et al. 2006

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Abstract-Patient delay in seeking treatment for acute coronary syndrome and stroke symptoms is the major factor limiting delivery of definitive treatment in these conditions. Despite decades of research and public education campaigns aimed at decreasing patient delay times, most patients still do not seek treatment in a timely manner. In this scientific statement, we summarize the evidence that (1) demonstrates the benefits of early treatment, (2) describes the extent of the problem of patient delay, (3) identifies the factors related to patient delay in seeking timely treatment, and (4) reveals the inadequacies of our current approaches to decreasing patient delay. Finally, we offer suggestions for clinical practice and future research. Key Words: AHA Scientific Statements Ⅲ acute coronary syndrome Ⅲ stroke Ⅲ delivery of health care D espite major advances in identifying effective treatments for heart attack and stroke, there are substantial difficulties in applying these treatments to care. The weak link in the chain of events leading to prompt and effective treatment is patient delay in seeking care. More than 50% of the 1.2 million people who suffer an acute myocardial infarction (AMI) or coronary death each year in the United States die in an emergency department (ED) or before reaching a hospital within an hour of symptom onset. 1 About 700 000 individuals will have a stroke each year, 167 000 of those who have strokes will die, and more will suffer a major disability. 1 Of the stroke deaths that occur each year, almost half occur before the patient reaches the hospital. 2 Many of these deaths and significant disability could be prevented if patients received earlier treatment. 1,3 Although the benefits of early treatment of heart attack and stroke are clear, only a minority of eligible patients receive optimally timed treatment for their symptoms because of delay in seeking care. The development and use of appropriate interventions to decrease treatment-seeking delay by patients could produce important gains in reducing death and disability from heart attack and stroke. Unfortunately, efforts to date to develop effective interventions have met with disappointing results. 4 -6 Accordingly, the purpose of this statement is to summarize the evidence that demonstrates the benefits of early treatment, 1,2 describes the extent of the problem of patient delay, 3 identifies the factors related to patient delay in seeking timely treatment, and reveals the inadequacies of our current approaches to decreasing patient delay. 4 Finally, we offer suggestions for clinical practice and future research. Benefits of Early TreatmentThe burden of cardiovascular disease is growing worldwide. Ischemic heart disease is the No. 1 cause of death in the The findings and conclusions in this scientific statement are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention and the National Heart, Lung, and Blood Institute.The American Heart Association makes every effort to av...

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Determinants of delay between symptoms and hospital admission in 5978 patients with acute myocardial infarction

Cited by 89 publications

References 29 publications

Decade Long Trends (2001–2011) in Duration of Pre‐Hospital Delay Among Elderly Patients Hospitalized for an Acute Myocardial Infarction

Decade Long Trends (2001–2011) in Duration of Pre‐Hospital Delay Among Elderly Patients Hospitalized for an Acute Myocardial Infarction

Pulmonary Embolism

Reducing Delay in Seeking Treatment by Patients With Acute Coronary Syndrome and Stroke

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