Inconsistent measurement of acute coronary syndrome patients’ pre-hospital delay in research: A review of the literature

Mackay, Martha; Ratner, Pamela A.; Nguyen, Michelle; Percy, Myra E.; Galdas, Paul; Grunau, Gilat

doi:10.1177/1474515114524866

Cited by 30 publications

(27 citation statements)

References 129 publications

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“…However, when we compared our times with those in earlier Australian reports of patient and total prehospital delay, we saw no reduction over the last 2 decades. This may be explained by differences in the definitions of the timeframes and starting points between studies . We did note an upward trend in Australian data for the percentage of patients who (1) decided to seek medical attention within 1 hour (38% in 1988, 42% in 1989 precampaign, 45% in 1989 postcampaign, to 47% in our 2013‐2014 study) and (2) who presented to hospital within 2 hours of symptom onset (28% in 1995 to 34% in our study).…”

Section: Discussionmentioning

confidence: 56%

Mass Media Campaigns’ Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign

Bray

Stub

Ngu

et al. 2015

JAHA

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BackgroundThe aim of this study was to examine the awareness of a recent mass media campaign, and its influence on knowledge and prehospital times, in a cohort of acute coronary syndrome (ACS) patients admitted to an Australian hospital.Methods and ResultsWe conducted 199 semistructured interviews with consecutive ACS patients who were aged 35 to 75 years, competent to provide consent, and English speaking. Questions addressed the factors known to predict prehospital delay, awareness of the campaign, and whether it increased knowledge and influenced actions. Multivariable logistic regression was used to examine the association between campaign awareness and a 1-hour delay in deciding to seek medical attention (patient delay) and a 2-hour delay in presenting to hospital (prehospital delay). The median age was 62 years (IQR=53 to 68 years), and 68% (n=136) were male. Awareness of the campaign was reported by 127 (64%) patients, with most of these patients stating the campaign (1) increased their understanding of what is a heart attack (63%), (2) increased their awareness of the signs and symptoms of heart attack (68%), and (3) influenced their actions in response to symptoms (43%). After adjustment for other predictors, awareness of the campaign was significantly associated with patient delay time of ≤1 hour (adjusted odds ratio [AOR]=2.25, 95% CI: 1.03 to 4.91, P=0.04) and prehospital delay time ≤2 hours (AOR=3.11, 95% CI: 1.36 to 7.08, P=0.007).ConclusionsOur study showed reasonably high awareness of the warning signs campaign, which was significantly associated with shorter prehospital decision-making and faster presentation to hospital.

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Section: Discussionmentioning

confidence: 56%

Mass Media Campaigns’ Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign

Bray

Stub

Ngu

et al. 2015

JAHA

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“…However, no studies linked patient related delay as an inhibiting factor in achieving RT within 120 min. Acute symptom onset to 12‐lead ECG is an unreliable variable because the exact timing of acute symptom onset can be difficult to recall for patients (Koul et al, ; Mackay et al, ). We defined acute symptom onset as the time the patient decided immediate medical attention was needed.…”

Section: Discussionmentioning

confidence: 99%

No time to delay reperfusion: A cross‐sectional study of primary percutaneous coronary intervention times

Roe

Banka

Mooney

2019

Journal of Clinical Nursing

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Aims and objectives:To establish and report cross-sectional data of reperfusion times for emergency primary percutaneous coronary interventions (PPCI) and to examine factors associated with times to reperfusion.Background: Rapid coronary reperfusion can salvage myocardial tissue, preserve left ventricular function and reduce mortality. PPCI is the gold standard of management.Researchers have reported on international median reperfusion times, but this is the first Irish study to do so.Methods: This observational, prospective, cross-sectional study included patients diagnosed with ST-segment elevation myocardial infarction (STEMI) and admitted for emergency PPCI. Descriptive and inferential statistics were used. The study was ethically approved. We adopted the STROBE guidelines.Results: All patients (N = 133) who met the inclusion criteria were included initially.Of these, 105 (79%) were diagnosed with STEMI and received emergency PPCI. The majority of STEMIs were diagnosed by paramedics and most (67%) were reperfused within 120 min, with a median time of 96 min. The results suggested that younger patients achieved timelier PPCI and source of referral was also significant in that more of those transferred directly to the coronary catheterisation laboratory achieved reperfusion within 120 min, compared with those who presented to the emergency department. Conclusion:A timely reperfusion service is achieved for the majority. Attention is needed in respect of the ageing and those admitted directly to the emergency departments with STEMI.Relevance to clinical practice: Further international research is recommended to compare current reperfusion times against guidelines and to identify areas for improvement. Clinicians should be mindful of the importance of rapid reperfusion and the implications of its delay for patients with STEMI. Those presenting to emergency departments with chest pain should be prioritised. K E Y W O R D Sheart attack, myocardial infarction, primary percutaneous coronary intervention, reperfusion time, ST-elevation myocardial infarction

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“…The prehospital interval between symptom onset and initiation of treatment can be divided into two intervals: patient-related and system-related. Overall, the prehospital interval includes the time from symptom onset to arrival at a hospital or similar healthcare facility (Mackay et al, 2014). Mackay et al (2014) conceptualized treatment seeking to include the portion within the prehospital interval that is specifically attributable to the patient's decisions and actions, and does not include prehospital system delays (e.g., emergency medical systems).…”

Section: Methodsmentioning

confidence: 99%

“…In addition, and perhaps the greatest benefit, obtaining ethnicity data through self-report. Lastly, I believe the data collected about treatment seeking allowed us to accurately define the time of symptom onset and therefore report a discrete time interval (the time from symptom onset to the occurrence of appropriate treatment seeking), which is the recommended format for reporting (Mackay et al, 2014;Moser et al, 2006).…”

Section: Strengthsmentioning

confidence: 99%

“…More consistent use of guideline-based medications within 24 hours of hospital presentation, the use of antiplatelet agents, revascularization procedures, and more sensitive cardiac biomarkers for the detection of myocardial damage, as well as general improvements in care processes have been attributed to the decline in hospital mortality rates for acute myocardial infarction (AMI) (Peterson et al, 2008). However, these system-related components represent only a modest portion of the overall duration from symptom onset to reperfusion treatment (Mackay et al, 2014).…”

Section: Chapter One: Introductionmentioning

confidence: 99%

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Ethnicity-based Differences in Treatment-seeking for Symptoms of Acute Coronary Syndrome

Iacoe

Ratner

Wong

et al. 2016

Canadian Journal of Cardiology

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Background: Patient-related delays in acquiring medical care for symptoms of acute coronary syndrome (ACS) remain unacceptably long despite campaigns aimed at raising awareness of the importance of timely presentation to an urgent care facility. Patients who delay seeking treatment for ACS often experience delays in treatment initiation, which can lead to poorer outcomes. Many sociodemographic characteristics associated with treatment-seeking delay are known, however ethnicity and how it relates to delay, have not been extensively evaluated. Objective: The purpose of this study was to explore ethnicity-based factors to determine how they relate to the treatment-seeking decisions of patients experiencing symptoms of ACS. Method: Data for this descriptive study were collected for the Acute Coronary Syndrome Care in Emergency Departments ("ASCEND") study. The ASCEND study is a prospective, observational study in which patients presenting to hospital emergency departments and triaged as having symptoms suggestive of ACS are identified. The primary outcome of this study, the patients' time-to-treatment interval, was defined as the time between the occurrences of symptom onset and appropriate treatment seeking. The predictor variable, ethnicity, was measured with the self-reported data and categorized as Chinese, South Asian, or "Other" ethnic groups. Univariate and multivariate analyses were used along with nonparametric testing. Results: The study sample consisted of 401 participants; 30 Chinese, 102 South Asian, and 269 participants who were characterized as "Other". The median time-to-treatment-seeking interval, for the total sample, was 180 minutes (IQR = 1,170 minutes). A Kruskal-Wallis test iii demonstrated no statistically significant differences in the time-to-treatment intervals by ethnicity; however, the sample may not have provided sufficient statistical power to detect a difference. No ethnic differences were found in the participants' reasons for employing the coping strategies or actions that led to their treatment-seeking delay. A statistically significant relationship was found between ethnicity and the actions taken by the participants in response to their symptoms of ACS. The South Asian participants were most likely to call for the help of a family member, co-worker or stranger nearby, or telephoned a family member, which likely prolonged the time it took to obtain medical care. iv Preface This thesis is based on data from the Acute Coronary Syndrome Care in Emergency Departments ("ASCEND") study, a prospective, observational study (Dr. Martha Mackay is the principal investigator). None of the text of the thesis is taken from previously published manuscripts. The study was approved by the University of British Columbia, Providence Health Care Research Ethics Boards (REB) (certificate UBC-PHC #H13-00617).

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Inconsistent measurement of acute coronary syndrome patients’ pre-hospital delay in research: A review of the literature

Cited by 30 publications

References 129 publications

Mass Media Campaigns’ Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign

Mass Media Campaigns’ Influence on Prehospital Behavior for Acute Coronary Syndromes: An Evaluation of the Australian Heart Foundation's Warning Signs Campaign

No time to delay reperfusion: A cross‐sectional study of primary percutaneous coronary intervention times

Ethnicity-based Differences in Treatment-seeking for Symptoms of Acute Coronary Syndrome

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