Duration of, and Temporal Trends (1994-1997) in, Prehospital Delay in Patients With Acute Myocardial Infarction

Goldberg, Robert J.; Gurwitz, Jerry H.; Gore, Joel M.

doi:10.1001/archinte.159.18.2141

Cited by 144 publications

(130 citation statements)

References 19 publications

(24 reference statements)

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“…As might be expected, patients reporting more acute symptoms 58 and those in cardiogenic shock exhibit shorter delays before seeking care than those with less severe symptomatology. 13,42,50,56,[77][78][79] Patients who assess their symptoms as relatively benign are more likely to delay the care-seeking process.…”

Section: Clinical Factorssupporting

confidence: 52%

“…77 In general, chronic health conditions such as diabetes, hypertension, and high cholesterol, as well as high-risk behaviors such as smoking, are associated with additional delay in seeking treatment. 43 A history of heart failure or angina also appears to delay care seeking.As might be expected, patients reporting more acute symptoms 58 and those in cardiogenic shock exhibit shorter delays before seeking care than those with less severe symptomatology. 13,42,50,56,[77][78][79] Patients who assess their symptoms as relatively benign are more likely to delay the care-seeking process.…”

supporting

confidence: 52%

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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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Section: Clinical Factorssupporting

confidence: 52%

supporting

confidence: 52%

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

Moser¹,

et al. 2006

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“…19 Women are also more likely than men to delay seeking medical care after an acute MI. 20 One possible explanation for the prolonged delay is that women with acute MI have more transient chest pain, so hospital admission rates for ongoing angina are lower. 21 Sex and racial disparities also exist in the treatment patients receive after an MI.…”

Section: Cardiovascular Diseasementioning

confidence: 99%

Health disparities: A barrier to high-quality care

Mullins

Blatt²,

Gbarayor³

et al. 2005

American Journal of Health-System Pharmacy

104

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Purpose-Disparities in the treatment of cardiovascular disease, diabetes mellitus, and cancer among the sexes and racial groups and possible interventions are discussed.Summary-The ongoing process to identify and reduce health disparities has engaged numerous federal agencies as they monitor the nation's progress toward policy-driven and health-related objectives. Cardiovascular disease disproportionately affects minority groups and is the leading cause of death among women in the United States, and both groups receive suboptimal care for the disease. Disparities in the treatment of diabetes mellitus in African Americans, women, patients with less than a high school education, and the elderly have been found. Many minority groups continue to suffer disproportionately from cancer. Racial disparities also exist in cancer screening and treatment. Minorities are underrepresented in clinical trials for multiple reasons, many of which may be related to cultural beliefs. At all levels of coinsurance, the poor are less likely to seek preventive care. Adherence to national screening and treatment guidelines, clinical trial recruitment and participation, addressing language and geographic barriers, and increasing access to insurance are part of the coordinated efforts required to reduce health disparities. Because pharmacists influence patients' health status directly through pharmaceutical care and indirectly by engaging patients in their treatment, it is essential for pharmacists to be able to provide culturally competent care.Conclusion-Despite significant efforts over the past several years, health disparities continue to exist, particularly among minority groups. Interventions aimed at eliminating these disparities should include ensuring cultural competence among health care providers and improving health literacy among patients.

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“…69,70,71,72,77 The descriptive summary of all included studies is available as Appendix V. All selected studies were classified as level 3 and 4 (level 3 clevel 4b) according to the JBI Levels of Evidence for Effectiveness (Appendix VIII).…”

Section: Methodological Qualitymentioning

confidence: 99%

“…77 The mean age of participants of the ten reviewed studies varied from 59 73 Data source and study size Data from the ten included studies were collected from large databases and large university hospitals. Eight studies included participants from databases at a national level, including the Myocardial Ischaemic National Audit Project (MINAP) 76 , National Registry of Myocardial Infarction (NRMI) 68,69,74 , British Cardiovascular Intervention Society (BCIS) 77 , Atherosclerosis Risk in Community (ARIC) 71 , the Cooperative Cardiovascular Project 72 and Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation (CRUSADE). 75 The remaining two studies 70,73 included participant from local hospitals.…”

Section: Description Of Studiesmentioning

confidence: 99%

The association between ethnicity and delay in seeking medical care for chest pain

Wechkunanukul¹,

Grantham²,

Damarell³

et al. 2016

JBI Database of Systematic Reviews and Implementation Reports

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Duration of, and Temporal Trends (1994-1997) in, Prehospital Delay in Patients With Acute Myocardial Infarction

Abstract: Background: Extent of delay in seeking medical care in persons with acute myocardial infarction (AMI) is receiving increasing attention, given the time-dependent benefits associated with early administration of coronary reperfusion therapy.

Cited by 144 publications

References 19 publications

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

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

Health disparities: A barrier to high-quality care

The association between ethnicity and delay in seeking medical care for chest pain

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