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Symptoms and type of symptom onset in acute coronary syndrome in relation to ST elevation, sex, age, and a history of diabetes
Örebro University, Department of Clinical Medicine.
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2005 (English)In: American Heart Journal, ISSN 0002-8703, E-ISSN 1097-6744, Vol. 150, no 2, p. 234-242Article in journal (Refereed) Published
Abstract [en]

BACKGROUND:

Various efforts to reduce patient delay in acute coronary syndrome (ACS) have had limited success. One reason might be a misinterpretation of the symptoms of ACS. The aim of this study was therefore to explore the characteristics and severity of symptoms among patients with an ACS in overall terms and in relation to the type of ACS, sex, age, and diabetes.

METHODS:

A total of 1939 patients at 11 hospitals in Sweden answered a questionnaire containing questions relating to the localization and intensity of symptoms, the presence of associated symptoms, the characteristics and experience of pain/symptoms, and the type of symptom onset.

RESULTS:

Patients with ST elevation differed from those without by more frequently having associated symptoms. They had higher pain/discomfort intensity and more frequently had pain with abrupt onset reaching maximum intensity within minutes. However, this type of symptom onset was only seen in less than half the patients with ST elevation and only 1 in 5 fulfilled all the criteria usually associated with a severe heart attack. Women differed from men in a few respects. They more frequently reported pain/discomfort in the neck or jaw and back, vomiting, and scored their pain/discomfort slightly higher than men. Differences between age groups were minor and there was no difference between patients with and without diabetes.

CONCLUSIONS:

The most striking finding was the low proportion of patients with the type of symptoms that are commonly associated with ACS. This is important for the planning of educational campaigns/programs to reduce patient delay.

Place, publisher, year, edition, pages
2005. Vol. 150, no 2, p. 234-242
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
URN: urn:nbn:se:oru:diva-4066DOI: 10.1016/j.ahj.2004.08.035OAI: oai:DiVA.org:oru-4066DiVA, id: diva2:138365
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
Keywords
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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