Reasons Patients With Chest Pain Delay or Do Not Call 911☆,☆☆,★,★★
Section snippets
INTRODUCTION
The use of thrombolytic therapy in patients with suspected acute coronary thrombosis substantially reduces mortality after acute myocardial infarction (AMI).1There is a general consensus that the sooner thrombolytic therapy can be administered after the onset of symptoms, the greater will be the reduction in myocardial damage. Thus a critical component in successful treatment is shortening the interval between the onset of symptoms and arrival at the hospital.
Patient delay (ie, the interval
MATERIALS AND METHODS
An ongoing myocardial infarction surveillance system began on October 1, 1986, in all eight King County, Washington, hospitals with ICU beds. A ninth hospital began operation in May 1987 and was included in the surveillance system at the time. These same hospitals (plus seven Seattle hospitals) took part in the myocardial infarction triage and intervention (MITI) study.4Patients admitted to the cardiac care unit or ICU with a diagnosis of rule-out AMI, chest pain, or angina were identified from
RESULTS
There were 5,206 patients admitted for possible AMI during the 15-month study period, and 2,317 (45%) were interviewed. Of those not interviewed, 25% refused, and the remainder lived outside of King County, lived in nursing homes, or otherwise could not be reached.
Sample Characteristics The average age for the overall patient sample was 62 years, with a range of 21 to 98 years. Fifty-eight percent of the patients interviewed were male, and 42% were female. The ethnic distribution based on
DISCUSSION
To improve chances for survival after an AMI, it is critical that patients respond quickly and appropriately to symptoms. Our study shows that the main obstacle in patient delay appears to be uncertainty about the symptomatology of an AMI. Most patients delayed seeking care because they were confused about how to interpret the symptoms they were experiencing. Perceived barriers to seeking care quickly (eg, cost, inconveniencing the caregiver, embarrassment, etc) appeared to be much less
References (5)
- et al.
Hospital mortality in acute myocardial infarction in the era of reperfusion therapy (the Myocardial Triage and Intervention Project)
Am J Cardiol
(1993) - et al.
Thrombolytic therapy: Current status (second of two parts)
N Engl J Med
(1988)
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2019, Journal of the American College of CardiologyEmergency Medical Services Utilization and Outcomes of Patients with ST-Elevation Myocardial Infarction in Lebanon
2018, Journal of Emergency MedicineFactors influencing delayed hospital presentation in patients with appendicitis: the APPE survey
2017, Journal of Surgical ResearchImplantable Cardiac Rhythm and Hemodynamic Monitors
2016, Clinical Cardiac Pacing, Defibrillation and Resynchronization Therapy
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From the Department of Health Services, School of Public Health and Community Medicine, University of Washington*; the Center for Evaluation of Emergency Medical Services, Emergency Medical Services Division, Seattle-King County, Department of Public Health‡; and the Department of Medicine, University of Washington§, Seattle.
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Support for this study was provided in part by a grant from Genentech, Inc, San Francisco, California.
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Address for reprints: Hendrika Meischke, PhD, Center for Evaluation of Emergency Medical Services, Emergency Medical Services Division, Seattle-King County Department of Public Health, 900 Fourth Avenue, Suite 850, Seattle, Washington 98164
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Reprint no. 47/1/61923