Management of myocardial infarction: implications for current policy derived from the Nottingham Heart Attack Register.

Rowley, J M; Mounser, Patricia; Harrison, E A; Skene, Allan M.; Hampton, John R.

doi:10.1136/hrt.67.3.255

Cited by 40 publications

(15 citation statements)

References 12 publications

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“…Dubayova et al 34 reported from their systematic review that intensity of fear was associated with earlier help-seeking. Classic studies from Nottingham, United Kingdom, 35 and Rotterdam, the Netherlands 36 reported significantly longer delays in hospitalization and initiation of reperfusion therapies when patients sought advice from their primary care physician rather than calling an ambulance.…”

Section: Discussionmentioning

confidence: 97%

Decisions and Delays Within Stroke Patients’ Route to the Hospital: A Qualitative Study

Mellor

Bailey

Sheppard

et al. 2015

Annals of Emergency Medicine

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Section: Discussionmentioning

confidence: 97%

Decisions and Delays Within Stroke Patients’ Route to the Hospital: A Qualitative Study

Mellor

Bailey

Sheppard

et al. 2015

Annals of Emergency Medicine

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“…Previous studies have suggested that a patients decision to call physician increases the delay to hospital admission. 15,16 These, along with self treatment with rest or medication and an extended process of decision making in which the patient seeks the help of a physician or family member before obtaining hospital care contributes to prolong delay in seeking hospital care. We did not find any significant difference between early and late presenters regarding presence of co-morbidities, such as stroke, DM, hypertension and smoking.…”

Section: Discussionmentioning

confidence: 99%

Delayed Presentation of Patients with Acute Myocardial Infarction in Chittagong Medical College Hospital

Das¹,

Ghafur

Mollah

et al. 2016

Cardiovasc. j.

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Background: Delay between onset of symptoms and hospital presentation is a critical factor in determining the management strategy and subsequent outcome. Objective of the study was to identify predictors of late presentation in patients with acute myocardial infarction (AMI) and target interventions for those at high risk of late presentation.Methods: In our cross sectional study we prospectively analyzed a cohort of 1032 AMI patients for 1 year (August, 2014 to July, 2015). Demographic factors, clinical characteristics, perception of health and access to health care were compared between early (within 12 hours of symptom onset) and late presenters (>12 hours of symptom onset). Bivariate comparison and multivariate logistic regression were done to identify independent predictors of late presentation .Odds ratio and 95% confidence intervals were calculated directly from the estimated regression coefficient.Results: Of the total 1032 patients 385 (37.3%) were early presenters and 647 (62.7%) were late presenters. Mean time interval between onset of symptom and presentation to hospital were 6.85±8.06 hrs (range 1.5 to 12 hrs) in early and 37.88±25.13 hrs (range 13 to 120 hrs) in late presenters. Bivariate comparison found that in the late presentation group was higher age group patients and employed citizens, had ? one angina episode over past 4 weeks, was unable to use emergency medical transport, had no nearby ECG facilities and misinterpreted chest pain as peptic ulcer disease (PUD). Multivariate analysis showed older age ?65 yrs, traveling long distance ?50 miles from home residence, reporting one or more angina episode over past 4 weeks, attending PHC/clinic and misinterpreting chest pain as PUD were associated with late presentation.Conclusion: A significant majority of patients with AMI were late presenters. Misinterpreting chest pain as PUD was responsible for the delay in the majority. Reporting ?1 angina episodes over past 4 weeks was also independently associated with late presentation. Lack of emergency medical transport and traveling long distance were also significantly associated with the late presenters. Patient education, appropriate utilization of existing resources and use of tele-electrocardiography that allows transmission of ECG signal to a medical control officer may decrease late presentation and improve outcome.Cardiovasc. j. 2016; 9(1): 3-8

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“…It is well established that this approach increases prehospital delay in AMI [19, 20, 21, 22]. Improved patient and population education may help to increase direct access of AMI patients to the emergency medical system.…”

Section: Discussionmentioning

confidence: 99%

Factors Predisposing to a Nonadmission of Patients with Acute Myocardial Infarction

Kentsch

Rodemerk²,

Münzel³

et al. 2002

Cardiology

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Among patients presenting at the hospital with an acute myocardial infarction (AMI), about 2–6% are mistakenly discharged by emergency physicians. The relevance of diagnostic problems in the prehospital period of an AMI is unknown. We prospectively studied 421 patients seen by a primary care physician in the prehospital period of an AMI. Using a standardized interview, data were obtained to identify factors determining nonadmission. Of 421 AMI patients, 327 (77.7%) were directly admitted to hospital after examination by the physician, whereas 94 (22.3%) were not admitted. The median prehospital delay was 240 min in admitted and 2,200 min in nonadmitted patients. Using a stepwise logistic regression model, the following factors were identified as independent contributors to nonadmission: the patient not being much affected by the symptoms (2.48; 1.40–4.39), improvement of symptoms (2.59; 1.46–4.59), the patient not thinking to suffer an AMI (2.33; 1.28–4.17) and the patient being unable to imagine having a heart disease (1.93; 1.07–3.46). Conclusion: Nonadmission of AMI patients by health care professionals is a common problem. Several aspects of AMI presentation including the often limited intensity of symptoms and the variability of the clinical course may have to be re-emphasized by cardiologists. Taking a very careful history and being circumspect about the patient’s interpretation of symptoms still are the keys to a correct diagnosis of AMI.

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Management of myocardial infarction: implications for current policy derived from the Nottingham Heart Attack Register.

Abstract: Objective

Cited by 40 publications

References 12 publications

Decisions and Delays Within Stroke Patients’ Route to the Hospital: A Qualitative Study

Decisions and Delays Within Stroke Patients’ Route to the Hospital: A Qualitative Study

Delayed Presentation of Patients with Acute Myocardial Infarction in Chittagong Medical College Hospital

Factors Predisposing to a Nonadmission of Patients with Acute Myocardial Infarction

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