The aim of this study was interpret the existential construct of family caring following Acute Coronary Syndrome. Family support is known to have a positive impact on recovery and adjustment after cardiac events. Few studies provide philosophically-based, interpretative explorations of carer experience following a spouse's ischaemic event. As carer experiences, behaviours and meaning-making may impact on the quality of the support they provide to patients, further understanding could improve both patient outcomes and family experience. Fourteen spouses of people experiencing Acute Coronary Syndrome in Sydney, Australia were engaged in a single, semi-structured interview. Interviews were audio-recorded and transcribed verbatim. Data were analysed using hermeneutic interpretation within a Heideggerian phenomenological framework. Acute Coronary Syndrome disrupts lived temporality, and the projected potential for carers' being-alongside. Carers experienced an existential uncertainty that arose from difficulty in diagnosis, and situated fear as an attuned, being-towards-death. They constructed protective strategies to insulate their partner and themselves from further stress and risk, however, unclear boundaries for protection heightened carer anxiety. The existential structure of care included one of two possible Heideggerian modes: leaping-in care was a dominating mode that required a high level of carer vigilance; leaping-ahead care was a metaphorical walking alongside, as carers gave back control, freeing opportunities for the person to 'own' care. Supporting carers through the intensive phase of leaping-in care, and equipping them for informed leaping-ahead care should be a focus in both the acute and post-discharge care phases.
60.5%; p=0.01], however there was no difference in proportion of bystanders using an AED by area [w10% of bystander-witnessed arrests]. A significantly greater proportion of all EMS-attended OHCA patient cohort survived to reach the hospital in urban areas [12.1% vs 8.5%; p,0.001]; [27.2% v/s 19.6%; p,0.001] in bystander-witnessed cohort. Conclusions: More than one third of OHCA cases witnessed by a bystander in NSW failed to receive CPR. AEDs were used only in a minority. Regional areas have greater risk and worse survival outcomes from OHCA. Strategies are needed to increase bystander response to OHCA particularly in regional areas.
s S75statin were prescribed for 92%, 84% and 91% of patients respectively at discharge. At one month, 93 per cent of patients survived without a recurrent myocardial infarction (MI). MACE were observed in 22% (n = 50) at one year; however, majority of those were due to hospital representation from cardiovascular causes other than death and ACS.Conclusion: Majority of patients were prescribed guideline directed therapy upon discharge; however, the timings of administration and adherence to recommendations requires further improvement. http://dx.
Background:The role of computed tomography coronary angiography (CTCA) in the setting of Rapid Access Chest Pain Clinics (RACPC) remains controversial Aims: To characterise CTCA use, and to determine if CTCA altered management in a cohort of patients referred to a tertiary rapid access chest pain clinic (RACPC).Methods: A retrospective analysis was performed on all patients presenting to a tertiary RACPC between 2008-2016 who underwent a CTCA. Patients were referred to the RACPC following an emergency department assessment as low risk chest pain, with discharge and outpatient exercise ECG prior to clinic review.Results: 1,120 patients presented to the clinic, of which 131 underwent CTCA, all after 2011 and increasingly since then. No patient had a prior history of ischaemic heart disease. 64 patients (49%) had a normal CTCA, 37% (49pts) had minimal to mild stenosis (1-49%), 4% (5pts) moderate stenosis (50-69%), 8% (10pts) severe stenosis (70-99%) and 2% (3pts) had no stenosis, but mild coronary calcification. In patients with minimal to mild stenosis 62% (n = 30) and 67% (n = 33) were recommended anti-platelet and statin therapy respectively, compared to no new therapies recommended for those not undergoing CTCA. In the moderate and severe stenoses groups all had statin recommended with 93% (n = 14) recommended antiplatelet therapy with 67% (n = 10) proceeding to angiography and 60% (n = 6) requiring revascularisation.Conclusion: CTCA is increasingly being used in a RACPC setting, and is increasingly altering management in patients, principally by more aggressive use of antiplatelet and statin therapy in patients with mild coronary artery disease.
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