Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome

Cullen, Louise; Greenslade, Jaimi; Menzies, Louven; Leong, Ashley; Than, Martin; Pemberton, Christopher J.; Aldous, Sally; Pickering, John W.; Dalton, Emily; Crosling, B.; Foreman, Rachelle; Parsonage, William

doi:10.1136/emermed-2015-204978

Cited by 14 publications

(9 citation statements)

References 29 publications

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“…In another study, it has been shown that up to 33% of STEMI patients would wait > 12 h to seek medical care (20). Many other studies just simply reported the average time of delay (in minutes) (24)(25)(26). Compared to our data, we found that only 14% of ACS patients waited for > 12 h. It is worth noting that we did not stratify this group based on acute MI subtype due to sample size issues.…”

Section: Prevalence Of Delay In Seeking Carecontrasting

confidence: 83%

Prevalence and Predictors of Delay in Seeking Emergency Care in Patients Who Call 9-1-1 for Chest Pain

Frisch

Faramand²,

Li³

et al. 2019

The Journal of Emergency Medicine

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Background: Delay in seeking medical treatment for suspected acute coronary syndrome can lead to negative patient outcomes. Objective: Our aim was to evaluate the prevalence and predictors of delay in seeking care in high-risk chest pain patients with or without acute coronary syndrome (ACS). Methods: This was a secondary analysis of an observational cohort study of patients transported by Emergency Medical Services for a chief complaint of chest pain. Important demographic and clinical characteristics were extracted from electronic health records. Two independent reviewers adjudicated the presence of ACS. Logistic regression was used to model the predictors of delay in seeking care. Results: The final sample included 743 patients (99% non-Hispanic). Overall, 24% presented > 12 h from onset of symptoms. Among those with ACS (n = 115), 14% presented > 12 h after onset of symptoms. Race, smoking, diabetes, and related symptoms were associated with delayed seeking behavior. In multivariate analysis, non-Caucasian race (black or others) was the only independent predictor of > 12 h delay in seeking care (odds ratio 1.4; 95% confidence interval 1.0-1.9). Conclusions: One in four patients with chest pain, including 14% of those with ACS, wait more than 12 h before seeking care. Compared to non-blacks, black patients are 40% more likely to delay seeking care > 12 h.

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Section: Prevalence Of Delay In Seeking Carecontrasting

confidence: 83%

Prevalence and Predictors of Delay in Seeking Emergency Care in Patients Who Call 9-1-1 for Chest Pain

Frisch

Faramand²,

Li³

et al. 2019

The Journal of Emergency Medicine

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“…In Iceland, two to ten per cent of unexplained chest pain patients were diagnosed with CVD within 1 year . In a study of emergency department admissions of acute non‐coronary chest pain patients, five per cent of the patients developed an adverse CVD event over the first year . Among patients seen in rapid access chest pain clinics in England, 32% of CHD deaths (an average of 2.6 years from discharge) were to non‐cardiac chest pain patients .…”

Section: Discussionmentioning

confidence: 99%

Hospitalised patients with unexplained chest pain: incidence and prognosis

et al. 2019

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Egeland GM, Akerkar R, Kv ale R, Sulo G, Tell GS, Bakken IJ, Ebbing M (). Hospitalised patients with unexplained chest pain: incidence and prognosis. J Intern Med 2019; 286: 562-572.Background. The prognosis of unexplained chest pain patients provides valuable information for evaluation of health services.Objective. To examine prognosis of unexplained chest pain.Methods. Using data from in-and outpatient hospital visits in Norway of patients discharged with a main diagnosis of unexplained chest pain (ICD-10: R072-R074) in 2010-2012, the 1-year incidence of coronary heart disease (CHD), any cardio-vascular disease (CVD) and mortality was evaluated. Cases with prior 2-year history of CVD or chest pain were excluded. Cox proportional hazards evaluated outcomes by patient characteristics and standardized mortality ratios evaluated observed versus expected mortality.Results. Of 59 569 patients identified (20-89 years of age), the majority (86%) were referred to hospital by out-of-hours emergency care centres. Subsequent CHD was noted for 12.5%, 19.5% and 25.0% of men and 7.2%, 11.0%, 14.0% of women aged 45-64, 65-74 and 75-89 years, respectively. The per cent of deaths attributed to CVD were greatest within the first 2 months of postdischarge. Total mortality rates (per 1000 person-years) were 6.6 in men and 4.7 in women aged 45-64 and 69.2 in men and 39.5 in women aged 75-89 years. Relative to the general population, mortality was 53% and 45% higher for men and women under 65 years of age, respectively, attributed primarily to non-CVD causes.Conclusion. Patients in Norway discharged with unexplained chest pain are an at-risk group in terms of incident CHD, any CVD and mortality, including non-CVD mortality during the first-year postdischarge. The results suggest that unexplained chest pain patients may benefit from greater healthcare coordination between medical disciplines.

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“…Therefore, the time it takes for the patient to realize the seriousness of the problem and seek medical attention – called pre‐hospital decision delay – can determine survival and subsequent recovery (Moser et al , ). Longer delays have been shown to predict worse patient outcomes one year after the cardiac event, including death or recurrent myocardial infarction (Cullen et al , ; De Luca, Suryapranata, Ottervanger, & Antman, ), and each half an hour of delay reduces patients’ life expectancy by about one year (Rawles, ).…”

Section: Introductionmentioning

confidence: 99%

Psychosocial markers of pre‐hospital decision delay and psychological distress in acute coronary syndrome patients

Arrebola‐Moreno

Petrova

Garrido

et al. 2020

British J Health Psychol

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Objectives. Both pre-hospital decision delaythe time patients wait before seeking medical attention after symptoms have startedand high psychological distress after the cardiac episode predict poor prognosis of patients with acute coronary syndromes (ACS). We aimed to identify psychosocial markers of these prognostic factors. Design.A cross-sectional study of 102 consecutive, clinically stable ACS survivors.Methods. Participants completed a questionnaire measuring pre-hospital decision delay, psychological distress, and several known psychosocial factors related to cardiovascular health: type D personality, resilience, social support, and concerns during the cardiac event. Multiple linear regression and mediation analyses were conducted.Results. Type D personality and fewer concerns about the serious consequences of delaying help-seeking were related to more psychological distress post-ACS, and these relationships were mediated by longer pre-hospital decision delay. In contrast, resilience was related to lower psychological distress. Social support and social concerns about help-seeking were not related to the outcome variables.Conclusions. Type D personality may be a risk factor for more delayed help-seeking for an ACS and higher psychological distress after the cardiac event. Resilience, in contrast, emerged as a potential protective factor of patients' mental health after the cardiac event. Pre-hospital decision delay was related to thinking about serious consequences (e.g., complications, protecting one's family) but not about social concerns (e.g., wasting other people's time) during the cardiac episode.

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Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome

Cited by 14 publications

References 29 publications

Prevalence and Predictors of Delay in Seeking Emergency Care in Patients Who Call 9-1-1 for Chest Pain

Prevalence and Predictors of Delay in Seeking Emergency Care in Patients Who Call 9-1-1 for Chest Pain

Hospitalised patients with unexplained chest pain: incidence and prognosis

Psychosocial markers of pre‐hospital decision delay and psychological distress in acute coronary syndrome patients

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