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Thoughts, actions, and factors associated with prehospital delay in patients with acute coronary syndrome
Örebro University, Department of Clinical Medicine.
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2007 (English)In: Heart & Lung, ISSN 0147-9563, E-ISSN 1527-3288, Vol. 36, no 6, p. 398-409Article in journal (Refereed) Published
Abstract [en]

Objective The objective was to study patients’ interpretations, thoughts, and actions after symptom onset in acute coronary syndrome (ACS) in total and in relation to gender, age, history of coronary artery disease, type of syndrome, and residential area and its influence on prehospital delay. Setting We performed a national survey comprising intensive cardiac care units at 11 hospitals in Sweden. Method A total of 1939 patients with diagnosed ACS and symptom onset outside hospital completed a questionnaire containing standardized questions within 3 days after admission. Results Three-quarters of the patients interpreted their symptoms as cardiac in origin, and the most common reason was that they knew someone who had had an acute myocardial infarction. The majority contacted a family member, whereas only 3% directly called for an ambulance. Interpreting the symptoms as cardiac in origin and severe pain were major reasons for deciding to seek medical care. Approaching someone after symptom onset and the belief that the symptoms were cardiac in origin were factors associated with a shorter prehospital delay, whereas taking medication to relieve pain resulted in the opposite. The reaction pattern was influenced by gender, age, a history of coronary artery disease, and the type of ACS, but to a lesser extent by residential area. Conclusions Interpreting symptoms as cardiac in origin and approaching someone after symptom onset were major reasons for a shorter prehospital delay in ACS.

Place, publisher, year, edition, pages
Amsterdam: Elsevier , 2007. Vol. 36, no 6, p. 398-409
National Category
Medical and Health Sciences Clinical Medicine Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-3375DOI: 10.1016/j.hrtlng.2007.02.001PubMedID: 18005801OAI: oai:DiVA.org:oru-3375DiVA, id: diva2:137672
Available from: 2008-12-03 Created: 2008-12-03 Last updated: 2017-12-14Bibliographically approved
In thesis
1. The initial phase of an acute coronary syndrome: symptoms, patients' response to symptoms and opportunity to reduce time to seek care and to increase ambulance use
Open this publication in new window or tab >>The initial phase of an acute coronary syndrome: symptoms, patients' response to symptoms and opportunity to reduce time to seek care and to increase ambulance use
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

This thesis aims to describe the initial phase of an acute coronary syndrome (ACS) in overall terms from a national perspective and to evaluate the impact of an information campaign designed to inform the public about how to act when suspecting an ACS. A total of 1939 patients at 11 hospitals in Swedenwith diagnosed ACS and symptom onset outside hospital completed a questionnaire(I-IV).In Study V, a questionnaire was completed by 116 patients withACS before the campaign and 122 after it. Register data were followed every year to evaluate ambulance use and emergency department (ED) visits.

With regard to symptoms, patients with ST-elevation ACS (STE-ACS) more frequently had associated symptoms and pain with an abrupt onset reaching maximum intensity within minutes. However, fewer than half the patients with STE-ACS had this type of symptom onset. There were more similarities than differences between genders and differences between age groups were minor (I).

Three-quarters of the patients interpreted the symptoms as cardiac in origin. The majority contacted a family member after symptom onset, whereas few called directly for an ambulance. Approaching someone after symptom onset and the belief that the symptoms were cardiac in origin were factors associated with a shorter pre-hospital delay (II).

Half the patients went to hospital by ambulance. Independent factors for ambulance use were knowledge of the importance of quickly seeking medical care and calling for an ambulance when experiencing chest pain, severe symptoms, abrupt onset of pain, STE-ACS, increasing age and distance to hospital of > 5 km. Reasons for not calling for an ambulance were thinking self-transport would be faster or not being ill enough (III). Pain with abrupt onset, STE-ACS, symptoms such as vertigo or near syncope, experiencing the pain as frightening, interpreting the pain as cardiac in origin and knowledge were major factors associated with a short delay between symptom onset and decision to seek medical care, patient decision time (IV).

The information campaign did not result in a reduction in patient decision time, but it appeared to increase ambulance use and the number of patients seeking the ED for acute chest pain (V).

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2012. p. 75
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 67
Keyword
Acute coronary syndrome, pre-hospital delay, ambulance use, symptoms, decision making
National Category
Medical and Health Sciences Cardiac and Cardiovascular Systems
Research subject
Medicine; Cardiology
Identifiers
urn:nbn:se:oru:diva-21672 (URN)978-91-7668-859-5 (ISBN)
Public defence
2012-03-16, Wilandersalen, Universitetssjukhuset, Örebro, 13:15 (Swedish)
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Supervisors
Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2017-10-17Bibliographically approved

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Thuresson, Marie

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