Symptom clusters and treatment time delay in Korean patients with ST-elevation myocardial infarction on admission

Abstract

Most patients with acute myocardial infarction (AMI) experience more than one symptom at onset. Although symptoms are an important early indicator, patients and physicians may have difficulty interpreting symptoms and detecting AMI at an early stage. This study aimed to identify symptom clusters among Korean patients with ST-elevation myocardial infarction (STEMI), to examine the relationship between symptom clusters and patient-related variables, and to investigate the influence of symptom clusters on treatment time delay (decision time [DT], onset-to-balloon time [OTB]). This was a prospective multicenter study with a descriptive design that used face-to-face interviews. A total of 342 patients with STEMI were included in this study. To identify symptom clusters, two-step cluster analysis was performed using SPSS software. Multinomial logistic regression to explore factors related to each cluster and multiple logistic regression to determine the effect of symptom clusters on treatment time delay were conducted. Three symptom clusters were identified: cluster 1 (classic MI; characterized by chest pain); cluster 2 (stress symptoms; sweating and chest pain); and cluster 3 (multiple symptoms; dizziness, sweating, chest pain, weakness, and dyspnea). Compared with patients in clusters 2 and 3, those in cluster 1 were more likely to have diabetes or prior MI. Patients in clusters 2 and 3, who predominantly showed other symptoms in addition to chest pain, had a significantly shorter DT and OTB than those in cluster 1. In conclusion, to decrease treatment time delay, it seems important that patients and clinicians recognize symptom clusters, rather than relying on chest pain alone. Further research is necessary to translate our findings into clinical practice and to improve patient education and public education campaigns.

Association of Symptoms and Mode of Transportation to Emergency Department in Patients With Acute Coronary Syndrome

“…The fact that the classic ACS symptom cluster in combination with other symptom clusters was associated with a higher adjusted odds of using EMS supports the hypothesis that it takes more than "just angina" to cross the threshold to be "serious enough" to get patients with a history of ACS to seek care as compared with those without preexisting angina. [38][39][40] These findings suggest that it takes more than correct symptom attribution of having symptoms with a cardiac etiology to necessitate EMS use. Although correct symptom interpretation in patients experiencing their first ACS event has been shown to be associated with higher odds of using EMS, 5 this is not always the case for patients with recurrent events.…”

“…Investigators from prior studies have hypothesized that some patients with a history of ACS "wait and see" to avoid "going too quickly" labeling symptoms as their "typical angina" with the expectations that symptoms will resolve with rest or NTG. 24,26,39 Even if symptoms do not resolve in a timely manner, they may still select another mode of transportation to the hospital, based on appraising the situation as a lower level of illness threat 28 because of event familiarity. 12,24 Alternatively, other patients with a history of angina may promptly recognize and interpret symptoms accurately, yet falsely believe private transportation gets them to the hospital faster.…”

“…It is thus plausible that patients in our sample, with a history of ACS or ischemic heart disease, may have grown accustomed to angina as a “familiar event,” 26 something that is bothersome, yet not unbearable. Investigators from prior studies have hypothesized that some patients with a history of ACS “wait and see” to avoid “going too quickly” labeling symptoms as their “typical angina” with the expectations that symptoms will resolve with rest or NTG 24,26,39 . Even if symptoms do not resolve in a timely manner, they may still select another mode of transportation to the hospital, based on appraising the situation as a lower level of illness threat 28 because of event familiarity 12,24 .…”

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

“…The prevalence of delay varied in these patients according to time. For instance, it has been reported that the majority of STEMI patients (59%) presented within 6 h of symptom onset and only 25% of patients waited > 60 min (22,23). In another study, it has been shown that up to 33% of STEMI patients would wait > 12 h to seek medical care (20).…”

Symptom clusters and unplanned hospital readmission in Chinese patients with acute myocardial infarction on admission

“…The symptoms of AMI are varied, and multiple symptoms often coexist, creating a negative symptom cluster synergy between symptoms. Compared with single symptoms, symptom clusters can increase the burden of disease in AMI patients, decrease their adherence to treatment, and have a serious negative impact on their quality of life and health status (15)(16)(17). The results of related studies have shown that symptom clusters in AMI patients can have a serious impact on functional status, readmission rates for cardiovascular events, and all-cause mortality (18).…”