The effect of health care provider consultation on acute coronary syndrome care-seeking delay

Alonzo, Angelo

doi:10.1016/j.hrtlng.2007.05.002

Cited by 12 publications

(17 citation statements)

References 56 publications

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“…In Europe and Australia, the figures often reach more than 50% [80,128-130], whereas in the United States the figures are often around 50% or lower [131-133]. In 4 USA communities the use of EMS increased from 37% in 1987 to 44% in 2000 (p < 0.0001) [25].…”

Section: The Reviewmentioning

confidence: 99%

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Herlitz

Wireklint-Sundström

Bång

et al. 2010

Scand J Trauma Resusc Emerg Med

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BackgroundThe two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably.In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count.This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase.MethodA literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.ResultsIn both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women).With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably.In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke.ConclusionBoth in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.

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Section: The Reviewmentioning

confidence: 99%

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Herlitz

Wireklint-Sundström

Bång

et al. 2010

Scand J Trauma Resusc Emerg Med

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“…Half of the articles reviewed did not report using a conceptual framework to define the variables of interest in their studies [16,19,20,22,26,[28][29][30][31][32][33][34][35]. Of the ones that reported using a conceptual framework, eight [18,21,23,25,[36][37][38][39] have used Leventhal's model [40].…”

Section: Theoretical Framework Utilizedmentioning

confidence: 99%

“…O'Donnell et al [42] reported that those who drove themselves to the hospital also arrived significantly early. However, calling [28,29,33,42], or visiting [21,22,43] the primary care provider (PCP) was associated with significant delay. Alonzo [33] reported that the median pre-hospital delay for those who called their PCP was 4 times longer than non-callers.…”

Section: Behavioral Factorsmentioning

confidence: 99%

Predictors of pre-hospital delay among patients with acute myocardial infarction

Khraim

Carey

2009

Patient Education and Counseling

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“…Several determinants are associated with pre-hospital delay, including low socio-economic status, female gender, co-morbidities (e.g., diabetes and coronary disease), the patient’s cognitive and emotional status, and determinants related to the healthcare provider [ 17 , 18 ]. In some reports, patients with primary care as the first medical contact (FMC) have an increased pre-hospital delay [ 7 , 19 – 21 ], often with less severe cardiac events than other patients [ 22 ]. Primary care clinics and telephone counselling services are frequently the FMC for patients with a suspected MI [ 7 , 21 ], as symptoms related to MI often are not identified as cardiac [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

“…Pre-hospital delay in MI is related to the context [ 22 , 27 ], and research on this issue should be based on data-sets that include relevant socio-demographic and healthcare-related data. The northern Swedish setting is characterised by long distances to the hospital, an aged population, and low to average education level.…”

Section: Introductionmentioning

confidence: 99%

Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population

Nilsson

Mooe

Söderström

et al. 2016

BMC Cardiovasc Disord

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BackgroundIn myocardial infarction (MI), pre-hospital delay is associated with increased mortality and decreased possibility of revascularisation. We assessed pre-hospital delay in patients with first time MI in a northern Swedish population and identified determinants of a pre-hospital delay ≥ 2 h.MethodsA total of 89 women (mean age 72.6 years) and 176 men (mean age 65.8 years) from a secondary prevention study were enrolled in an observational study after first time MI between November 2009 and March 2012. Total pre-hospital delay was defined as the time from the onset of symptoms suggestive of MI to admission to the hospital. Decision time was defined as the time from the onset of symptoms until the call to Emergency Medical Services (EMS). The time of symptom onset was assessed during the episode of care, and the time of call to EMS and admission to the hospital was based on recorded data. The first medical contact was determined from a mailed questionnaire. Determinants associated with pre-hospital delay ≥ 2 h were identified by multivariable logistic regression.ResultsThe median total pre-hospital delay was 5.1 h (IQR 18.1), decision time 3.1 h (IQR 10.4), and transport time 1.2 h (IQR 1.0). The first medical contact was to primary care in 52.3 % of cases (22.3 % as a visit to a general practitioner and 30 % by telephone counselling), 37.3 % called the EMS, and 10.4 % self-referred to the hospital. Determinants of a pre-hospital delay ≥ 2 h were a visit to a general practitioner (OR 10.77, 95 % CI 2.39–48.59), call to primary care telephone counselling (OR 3.82, 95 % CI 1.68–8.68), chest pain as the predominant presenting symptom (OR 0.24, 95 % CI 0.08–0.77), and distance from the hospital (OR 1.03, 95 % CI 1.02–1.04). Among patients with primary care as the first medical contact, 67.0 % had a decision time ≥ 2 h, compared to 44.7 % of patients who called EMS or self-referred (p = 0.002).ConclusionsPre-hospital delay in patients with first time MI is prolonged considerably, particularly when primary care is the first medical contact. Actions to shorten decision time and increase the use of EMS are still necessary.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0271-x) contains supplementary material, which is available to authorized users.

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The effect of health care provider consultation on acute coronary syndrome care-seeking delay

Cited by 12 publications

References 56 publications

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

Predictors of pre-hospital delay among patients with acute myocardial infarction

Pre-hospital delay in patients with first time myocardial infarction: an observational study in a northern Swedish population

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