Patient Education to Reduce Prehospital Delay Time in Acute Coronary Syndrome

Background: Prompt treatment of acute coronary syndrome (ACS) has been shown to reduce mortality and morbidity; yet many patients delay seeking care. In order to receive timely care, symptoms of ACS need to be recognized, interpreted, and acted upon. Patients who experience symptoms matching their expectations and those with correct symptom attribution are more likely to use emergency medical services (EMS) as a means of transportation to the hospital. The connection between symptom type and EMS use has not been fully explored. Purpose: To assess if clusters of presenting symptoms are associated with EMS transportation to the emergency department (ED) in patients with ACS and to evaluate if EMS transportation or symptom clusters are associated with prehospital delay time. Methods: A secondary analysis was conducted from the PROMOTION trial, a randomized controlled trial to reduce patient prehospital delay in ACS. Results: Of the 3,522 subjects with coronary artery disease enrolled, 3,087 completed 2-year follow-up. Of these, 331 subjects visited an ED for ACS symptoms during follow-up. Among the 331, 84% (278) had mode of transportation documented; 44% arrived by EMS. Having classic ACS symptoms (chest pain, pressure, or discomfort) in combination with pain symptoms (AOR=2.66, p = 0.011), classic ACS symptoms in combination with stress symptoms (AOR=2.61, p = 0.007) or classic ACS symptoms in combination with both pain and stress symptoms (AOR=3.90, p = 0.012) were associated with higher odds of arriving to the ED by EMS compared to classic ACS symptoms alone. Among 260 patients with prehospital delay time available, arriving by EMS decreased median delay time by 68.5 minutes compared to those with other transportation, after accounting for symptom clusters, patient and study characteristics (p = 0.002). Symptom clusters did not predict delay time in adjusted modeling (p = 0.952). Conclusion: While chest pain was the most prevalent symptom of ACS for most (85%), these findings suggest that it is the cluster of classic ACS symptoms with other types of symptom that motivate patients to use EMS. With less than half of patients using EMS, further research is needed to better understand how symptom clusters influence care-seeking behavior.

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Abstract 13173: Unusual Fatigue and Failure to Utilize Emergency Medical Services Are Associated With Prolonged Prehospital Delay for Suspected Acute Coronary Syndrome

Circulation ◽

10.1161/circ.142.suppl_3.13173 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Holli A Devon ◽

Mohamud R Daya ◽

Elizabeth Knight ◽

Mary-Lynn Brecht ◽

Erica Su ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Chest Pain ◽

Delay Time ◽

Failure Time ◽

Secondary Analysis ◽

High Sensitivity ◽

Final Diagnosis ◽

Prehospital Delay ◽

Coronary Syndrome ◽

Risk Patients

Introduction: Rapid reperfusion reduces infarct size and mortality for acute coronary syndrome (ACS) but efficacy is time dependent. Time to presentation in the Emergency Department (ED) remains excessive and patient-controlled prehospital delay may be a modifiable variable for intervention. The aim of the study was to determine if transportation factors and clinical presentation predicted prehospital delay for suspected ACS stratified by final diagnosis (ACS vs. no ACS). Hypothesis: Symptoms other than chest pain would contribute to longer prehospital delay that would vary by final diagnosis. Methods: Secondary analysis of data collected from a multi-center prospective study. A heterogeneous sample of ED patients with symptoms suggestive of ACS were enrolled at five sites in the US. Accelerated failure time (AFT) models were used to specify a direct relationship between delay time and variables to predict prehospital delay by final diagnosis. Results: The sample of 975 adults included 609 (62.5%) men and 366 (37.5%) women who were predominantly Caucasian (69.1%), had a mean age of 60.32 (±14.07) years, and had lower income levels (66.4% ≤$50,000 annually). Median delay time was 6.68 (1.91, 24.94) hours and only 26.2% had a prehospital delay of 2 hours or less. Patients with and without ACS presenting with unusual fatigue (TR=1.71, p=0.002; TR=1.54, p=0.003 , respectively) or self-transporting to the ED experienced significantly longer prehospital delay (TR 1.93, p<0.001; TR 1.71, p<0.001 , respectively). Predictors of shorter delay in patients with ACS were shoulder pain and lightheadedness (TR=0.65, p =0.013 and TR=0.67, p =0.022, respectively). Predictors of shorter delay for patients ruled-out for ACS were the presence of chest pain, sweating (TR=0.071, p =0.025 and TR=0.073, p =0.032, respectively). Conclusion: Patients self-transporting to the ED had prolonged prehospital delays. Encouraging the use of EMS is an important modifiable factor for patients with symptoms concerning for ACS. Calling 911 can be positively framed to at risk patients and the community as having advanced care come to them since EMS diagnostic capabilities include 12-lead ECG acquisition and possibly high sensitivity troponin assays.

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A Randomized Controlled Trial to Reduce Prehospital Delay Time in Patients With Acute Coronary Syndrome (ACS)

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2013.08.114 ◽

2014 ◽

Vol 46 (4) ◽

pp. 495-506 ◽

Cited By ~ 41

Author(s):

Mary Mooney ◽

Gabrielle McKee ◽

Gerard Fealy ◽

Frances O' Brien ◽

Sharon O'Donnell ◽

...

Keyword(s):

Randomized Controlled Trial ◽

Acute Coronary Syndrome ◽

Delay Time ◽

Controlled Trial ◽

Prehospital Delay ◽

Coronary Syndrome ◽

Randomized Controlled

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THE CORRELATION OF HEALTH SEEKING BEHAVIOR AND TRANSPORTATION MODE WITH PREHOSPITAL DELAY TIME IN PATIENTS WITH ACUTE CORONARY SYNDROME AT EMERGENCY DEPARTMENT OF REGIONAL PUBLIC HOSPITAL OF dr. T.C. HILLERS

NurseLine Journal ◽

10.19184/nlj.v2i2.5922 ◽

2017 ◽

Vol 2 (2) ◽

pp. 87

Author(s):

Ode Irman ◽

Sri Poeranto ◽

Tony Suharsono

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Delay Time ◽

Public Hospital ◽

Health Seeking ◽

Transportation Mode ◽

Health Seeking Behavior ◽

Prehospital Delay ◽

Coronary Syndrome ◽

Seeking Behavior

Emergency conditions of the acute coronary syndrome (ACS) requires rapid and precise management. Prehospital delay time can result in deaths attributed to health seeking behavior and transportation mode. This research aimed to analyze the correlation of health seeking behavior and transportation mode with prehospital delay time in patients with Acute Coronary Syndrome at Emergency Department of Regional Public Hospital of dr. T.C. Hillers. The research design was observational analytic with cross sectional approach. The sample was 42 respondents obtained by using consecutive sampling. Data were collected with an interview in April-June 2017, then analyzed with univariate analysis and bivariate (Fisher test). The results showed that the majority of health seeking behavior of ACS patients was delayed to hospital (76.2%) and the mode of transportation used was public transportation (31%). Prehospital delay time most of which arrived late (> 120 min) (61.9%). Result of fisher test show there is correlation of health seeking behavior and transportation mode with prehospital delay time in patients with Acute Coronary Syndrome at Emergency Department of Regional Public Hospital of dr. T.C. Hillers. The results indicate the importance of improving patient referral systems, provide health counseling, provide village ambulances, support and organize Emergency Medical Services.

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Time to Seek Care and Hospital Length of Stay Among Older Adults With Acute Coronary Syndrome During the COVID-19 Pandemic

Clinical Nursing Research ◽

10.1177/10547738211040167 ◽

2021 ◽

pp. 105477382110401

Author(s):

Audai A. Hayajneh ◽

Mohammad Rababa ◽

Sami Al-Rawashedeh

Keyword(s):

Older Adults ◽

Acute Coronary Syndrome ◽

Cross Sectional Study ◽

Abrupt Onset ◽

Hospital Length ◽

Hospital Length Of Stay ◽

Cross Sectional ◽

Convenience Sample ◽

Prehospital Delay ◽

Coronary Syndrome

The prevalence of prehospital delay is high among older adults with acute coronary syndrome (ACS). The current study aimed to examine the associated factors of prehospital delay among patients with ACS during the COVID-19 pandemic. This cross-sectional study was conducted on a convenience sample of 300 older adults with ACS admitted to the emergency department in Jordan. Data were collected from June 1 to September 1, 2020. Bivariate and multivariate analyses were used to explore the predictors of prehospital delay. Being widowed, educational level, pain intensity, the gradual onset of ACS symptoms, symptoms lasting for more than 30 minutes, patients’ feeling anxious about their ACS symptoms, patients’ perceiving their symptoms to be particularly dangerous, history of myocardial infarction (MI), and mode of transportation were associated with the time taken before seeking emergency care. Significant predictors of time to seek help were chief complaint of chest pain or palpitations, abrupt onset of symptoms, the associated symptom of vertigo, and a higher number of chronic illnesses; they explained about 17.9% of the variance in the time to seek care. The average time to seek care among patients with ACS during the COVID-19 pandemic was found to be longer than the average time reported by studies conducted prior the pandemic. Improved understanding of the associations between prehospital delay is crucial for optimal ACS patient outcomes under the impacts of the COVID-19 pandemic.

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