Differences in symptoms and pre-hospital delay among acute myocardial infarction patients according to ST-segment elevation on electrocardiogram

Fu, Rui; Song, Chenxi; Dou, Kefei; Yang, Jingang; Gao, Xiaojin; Liu, Qianqian; Xu, Han; Yang, Yuejin

doi:10.1097/cm9.0000000000000122

Cited by 18 publications

(13 citation statements)

References 24 publications

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“…As Italy was affected early on by the global pandemic, a reduction in healthcare seeking was not suspected by health authorities and no specific public information campaign was performed, and not in the Marche region either. Previous studies reported in NSTEMI/unstable angina more atypical symptoms and a prolonged time to medical attention compared with STEMI 15,16 . In the Marche region, people may therefore have reduced healthcare seeking only in those cases of less typical symptoms and may have preserved the will of medical advice when typical chest pain was present.…”

Section: Discussionmentioning

confidence: 93%

Reduction in acute coronary syndromes during coronavirus disease 2019 global pandemic: data from the Marche region of Italy

Flori¹,

Marinucci

Gabrielli

et al. 2020

Journal of Cardiovascular Medicine

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Aims During the novel severe acute respiratory syndrome coronavirus 2 (coronavirus disease 2019) pandemic, a worldwide reduction in total acute coronary syndrome (ACS) has been reported. In early 2020, Italy became the most affected country and national lockdown was declared early on in March. We described trends in ACS from all the Marche coronary catheterization laboratories (CCL) during the global pandemic. Methods Retrospective study of all consecutive patients admitted to the four regional CCL. The coronavirus disease 2019 period (20 February 2020 to 15 April 2020) was compared with the interyear control period (1 January 2020 to 19 February 2020) and to the intrayear control period (20 February 2019 to 15 April 2019). All patients with an initial diagnosis of ACS were included in the analysis, and further stratified into ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI)/unstable angina. Results A total of 1239 patients were enrolled. Daily incidence of ACS was 6.1, 6.3 and 4.5 for the interyear control period, the intrayear control period and the case period, respectively. There was no difference in overall STEMI daily incidence while NSTEMI/unstable angina fell from 3.6 and 3.3–1.8 during the case period (P = 0.01). Incidence rate ratios were significantly lower when the case period was compared with the intrayear control period (incidence rate ratios: 0.49, 95% confidence interval 0.41–0.59, P = 0.001) and the interyear control period (incidence rate ratios: 0.67, 95% confidence interval 0.50–0.90, P = 0.008). Conclusion During the global pandemic there was a significant reduction in total ACS and NSTEMI in the Marche region. Unlike previous reports, there was no difference in overall access to CCL for STEMI during the same period.

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Section: Discussionmentioning

confidence: 93%

Reduction in acute coronary syndromes during coronavirus disease 2019 global pandemic: data from the Marche region of Italy

Flori¹,

Marinucci

Gabrielli

et al. 2020

Journal of Cardiovascular Medicine

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“…Patients with poor awareness of symptoms can easily underestimate the severity of their disease and delay seeking treatment. In our results, we found that NSTEML patients have longer DT, which may be related to the fact that these patients often experience atypical symptoms (33). Longer DT is also associated with low patient numeracy (34), possibly because numeracy skills help patients evaluate risk and integrate available information more precisely into decision-making models (35).…”

Section: Discussionmentioning

confidence: 84%

Effect of Health Literacy on Decision Delay in Patients With Acute Myocardial Infarction

Fan

Yang

Yin

et al. 2021

Front. Cardiovasc. Med.

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Background: Health literacy (HL) is a risk factor for adverse outcomes in patients with cardiovascular disease, and shorter pre-hospital delay time is crucial for successful treatment of acute myocardial infraction (AMI) patients. Most previous studies focused on the influencing factors of pre-hospital delay but ignore the essential contribution of decision delay.Aims: Therefore, the purpose of this study was to explore the effect of HL on decision delay.Methods: Continuously included AMI patients admitted to a grade A class three hospital in Chongqing. HL level was assessed using Brief Health Literacy Screen and categorized as adequate or inadequate. Mann-Whitney U-test and Chi-square test were used to compare the differences between groups, and binary logistic regression was used to analyze the association between HL and decision delay.Results: A total of 217 AMI patients were enrolled in this study, including 166 males (76.5%) and 51 females (23.5%), with the median age was 68 years old; 135 (62.2%) patients had delayed decision-making while 82 (37.8%) did not; 157 (72.7%) patients had inadequate HL and 59 (27.3%) had adequate HL. The total HL score of non-delayed group was higher than that in delayed group (9.22 vs. 7.02, P < 0.000).Conclusion: After adjusting for covariates, HL was significantly negatively associated with decision time. AMI patients with inadequate HL were more likely to delay seeking timely medical care.

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“…The awareness of the high risk of AMI played a signi cant role in patient delay, for example, attributing the symptoms to other conditions, fear of disturbing others, judge that the symptoms are a false alarm, lack of knowledge of the importance of quick action and so on [17]. As for system delay, pre-hospital transfer delay accounts for a major problem, for example, patients living in rural areas were diagnosed with AMI and usually experienced longer retention at local healthcare institutes rather than quick transfer to PCI capable hospital[18] [19]. Therefore, except for advanced treatments, setting up an effective regional network reducing PDT and SDT to decrease reperfusion delay is highly necessary.…”

Section: Discussionmentioning

confidence: 99%

Rationale and design of reGional network for Acute Myocardial Infarction (GAMI): protocol for a Prospective Cluster-randomized Intervention study of STEMI management

Liu

et al. 2021

Preprint

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BackgroundTimely revascularization is essential for ST-segment elevation myocardial infarction (STEMI) patients to reduced mortality rate. However, it's seldom achieved due to patient and medical system-level barriers in China, especially in the rural area. It's needed to establish a regionally coordinated network to promote the early revascularization rate for STEMI patients.MethodsRegional network for Acute Myocardial Infarction (GAMI) is a multi-center, prospective, intervention study with regional intervention. It was carried out in 8 centers by 1:1 cluster randomization in south China with diverse economic and medical levels since 2016. The regional intervention were carried out in the intervention centers, which consisted of intensive public education and regional network construction for STEMI treatment, including community and online propaganda to raised patients' awareness of the treatment for STEMI and establishment of regional clinic-EMS-PCI transfer network for timely primary revascularization. Consecutive acute STEMI patients were enrolled for assessment of regional intervention according to the key performance indicators. The primary study endpoint was reperfusion rate, and secondary endpoints included change of pre-hospital delay, changes of in-hospital delay time and in-hospital outcomes. All patients were followed up for more than 1 year.DiscussionThe GAMI study is a prospective cluster-randomized intervention study, which would provide helpful evaluation of the effectiveness of enhanced public education and regional network construction on regional STEMI treatmentTrial registration: Clinical Trials, NCT03928119. Registered , 25 April, 2019， https://clinicaltrials.gov/ct2/show/NCT03928119?id=NCT03928119&draw=2&rank=1

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Differences in symptoms and pre-hospital delay among acute myocardial infarction patients according to ST-segment elevation on electrocardiogram

Cited by 18 publications

References 24 publications

Reduction in acute coronary syndromes during coronavirus disease 2019 global pandemic: data from the Marche region of Italy

Reduction in acute coronary syndromes during coronavirus disease 2019 global pandemic: data from the Marche region of Italy

Effect of Health Literacy on Decision Delay in Patients With Acute Myocardial Infarction

Rationale and design of reGional network for Acute Myocardial Infarction (GAMI): protocol for a Prospective Cluster-randomized Intervention study of STEMI management

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