From Suspicion to Recognition—Being a Bystander to a Relative Affected by Acute Coronary Syndrome

2021 ◽  
pp. 104973232110509
Author(s):  
Lene Søndergård Andersen ◽  
Vibeke Lorentzen ◽  
Kirsten Beedholm
Keyword(s):  
Acute Coronary Syndrome ◽  
Thematic Analysis ◽  
Interview Study ◽  
Knowledge Gap ◽  
Negative Direction ◽  
Coronary Syndrome ◽  
Qualitative Thematic Analysis ◽  
Before And After ◽  
Bodily Sensations ◽  
The Individual

Within cardiac research, an overwhelming number of studies have explored factors related to pre-hospital delay. However, there is a knowledge gap in studies that explore the bystander’s experiences or significance when an individual is affected by acute coronary syndrome (ACS). We conducted an interview study with 17 individuals affected by ACS and the bystander(s) involved and performed a qualitative thematic analysis. In the pre-hospital phase, the bystander moved from suspicion of illness to recognition of illness while trying to convince the individual affected by ACS (p-ACS) to respond to bodily sensations. This led to conflicts and dilemmas which affected the bystander both before and after the p-ACS was hospitalized. Bystanders may influence pre-hospital delay in both positive and negative direction depending on their own knowledge, convictions, and the nature of their interaction with the p-ACSs. The bystander’s influence during the pre-hospital delay is more extensive than previously recognized.

scholarly journals Trends of case-fatality rate by acute coronary syndrome in Portugal: Impact of a fast track to the coronary unit

2019 ◽  
Vol 8 ◽  
pp. 204800401985195
Author(s):  
D Abreu ◽  
FJ Pinto ◽  
C Matias-Dias ◽  
P Sousa
Keyword(s):  
Acute Coronary Syndrome ◽  
Fast Track ◽  
Case Fatality ◽  
Interrupted Time Series ◽  
P Value ◽  
Coronary Syndrome ◽  
Health Authorities ◽  
Track System ◽  
Before And After ◽  
The Impact

Introduction Efforts were made to improve management of coronary disease as the fast-track system to the Coronary Unit. We aim to analyse case-fatality rates by acute coronary syndrome in Portugal from 2000 to 2016, mainly the impact of the fast-track system and the proportion of patients that activate the fast-track system. Methods We analysed monthly acute coronary syndrome case-fatality before and after the implementation of the fast-track system in 2007. Impact of the system was assessed through regression models for interrupted time-series. We calculated annual proportion of fast-track system admissions. Results After 2007 case-fatality by acute coronary syndrome decreased (β=−1.27, p-value < 0.01). The estimates obtained for ST Elevation Myocardial Infarction suggest a reduction of nearly 86 monthly deaths prevented after 2007. The highest percentage of patients admitted through the fast-track system was 35%. Conclusions Our results suggest fast-track system may have contributed to a decline in acute coronary syndrome case-fatality. However, more than half of patients were not admitted through the system. This should encourage health authorities to make efforts to ensure compliance.

scholarly journals Prevention after acute coronary syndrome the ‘less is more’ philosophy

2020 ◽  
Vol 22 (Supplement_E) ◽  
pp. E153-E156
Author(s):  
Pier Luigi Temporelli
Keyword(s):  
Acute Coronary Syndrome ◽  
Chronic Phase ◽  
Scientific Basis ◽  
Pharmacological Intervention ◽  
Less Is More ◽  
Coronary Syndrome ◽  
Non Invasive ◽  
The Individual ◽  
Objective Being ◽  
Clinical Problems

Abstract In the cardiology field, in recent years, we have witnessed an exponential increase in the use of both invasive and non-invasive instrument diagnostics. Particularly after an acute coronary syndrome, instrumental examinations, especially non-invasive ones, are often prescribed inappropriately until they almost completely replace the clinical evaluation. Their correct use, on the contrary, would require the choice of a test to be prescribed according to the epidemiological and clinical context of the individual patient. The strategy of early diagnosis, obtainable through instrumental screening and borrowed from oncological pathologies, was transferred ‘tout court’ in the cardiovascular field without any scientific basis, replacing the pharmacological or non-pharmacological intervention, such as the appropriate lifestyle, aimed at reducing cardiovascular risk factors. The guidelines of the main scientific societies define the most appropriate paths in the management of the coronary heart disease patients, both in the immediate post-acute phase and in the chronic phase. Although the guidelines sometimes show an excessive simplification of clinical problems, in an age in which the control of health expenditure has become a priority the correctness of the indications is an indispensable objective, being incontrovertible that a test is indicated only when an instrumental examination is able to modify the diagnostic-therapeutic path and the outcome of the patient.

From Bodily Sensations to Symptoms: Health Care–Seeking Practices Among People Affected by Acute Coronary Syndrome

2019 ◽  
Vol 29 (11) ◽  
pp. 1651-1660
Author(s):  
Kirsten Beedholm ◽  
Lene Søndergaard Andersen ◽  
Vibeke Lorentzen
Keyword(s):  
Health Care ◽  
Acute Coronary Syndrome ◽  
Health Care System ◽  
Medical Anthropology ◽  
Care Seeking ◽  
Coronary Syndrome ◽  
Starting Point ◽  
Depth Analysis ◽  
Bodily Sensations ◽  
Care System

The reduction of prehospital delay for patients with acute coronary syndrome (ACS) is widely discussed within cardiac research. Medically informed literature generally considers patient hesitancy in seeking treatment a significant barrier to accessing timely treatment. With this starting point, we conducted an interview study with people previously hospitalized for ACS and with the bystanders involved in their decision to contact the health care system. The analysis was conducted in two stages: first, a systematic extraction of key information; second, an in-depth analysis informed by medical anthropology. This led us to understand the prehospital period as an interpretation process where bodily sensations appeared as symptoms. Informants vacillated between sensations, knowledge, interpretations, and emotions as they struggled to preserve everyday ordinariness. They were led to contact the health care system by bodily discomfort rather than a rational decision to reduce risk. The paradigmatic implications from medical anthropology proved an important alternative to the medical paradigm.

scholarly journals Sex-specific effects of implementing a high-sensitivity troponin I assay in patients with suspected acute coronary syndrome: results from SWEDEHEART registry

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Dorien M. Kimenai ◽  
Bertil Lindahl ◽  
Tomas Jernberg ◽  
Otto Bekers ◽  
Steven J. R. Meex ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Troponin I ◽  
High Sensitivity ◽  
Major Adverse Cardiovascular Events ◽  
Coronary Syndrome ◽  
Specific Effects ◽  
Before And After ◽  
The Impact ◽  
Multivariable Adjustment ◽  
Observation Period

Abstract Using high-sensitivity cardiac troponin (hs-cTn) assays with sex-specific 99th percentiles may improve management of patients with suspected acute myocardial infarction (AMI). We investigated the impact of transitioning from a conventional troponin I assay to a high-sensitivity assay with sex-specific thresholds, in patients with suspected acute coronary syndrome admitted to Swedish coronary care units. Based on data from SWEDEHEART registry (females, n = 4,819/males, n = 7,670), we compared periods before and after implementation of hs-cTnI assay (Abbott) using sex-specific 99th percentiles. We investigated differences on discharge diagnosis, in-hospital examinations, treatments, and clinical outcome. Upon implementation of the hs-cTnI assay, proportion of patients with troponin levels above diagnostic AMI threshold increased in women and men by 24.3% versus 14.8%, respectively. Similarly, incidence of AMI increased by 11.5% and 9.8%. Diagnostic interventions and treatments increased regardless of sex. However, these associations did not persist following multivariable adjustment, probably due to the effect of temporal management trends during the observation period. Overall, no risk reduction on major adverse cardiovascular events was observed (HR: 0.91 [95% CI 0.80–1.03], P = 0.126). The implementation of hs-cTnI assay together with sex-specific 99th percentiles was associated with an increase in incidence of AMI regardless of sex, but had no major impact on clinical management and prognosis.

scholarly journals Preliminary Data from a Study on Polymorphism RS4244285 of P4502c19 Cytochrome Gene in Patients with Acute Coronary Syndrome, Undergoing Treatment with Dual Antiplatelet Therapy With Clopidogrel and Aspirin

2016 ◽  
Vol 9 (1) ◽  
pp. 65-71
Author(s):  
Katya S. Kovacheva ◽  
Petya A. Nikolova ◽  
Valentin V. Hristov ◽  
Diana I. Pendicheva ◽  
Sotir T. Marchev ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Antiplatelet Therapy ◽  
Preliminary Data ◽  
Dual Antiplatelet Therapy ◽  
Coronary Intervention ◽  
Major Adverse Cardiovascular Events ◽  
Individual Response ◽  
Coronary Syndrome ◽  
High Prevalence ◽  
The Individual

Summary Administration of antiplatelet therapy Aspirin and Clopidogrel (CLP) is a corner stone inpatients with Acute Coronary Syndrome (ACS) undergoing Percutaneous Coronary Intervention (PCI) with/without stent implantation. The CYP2C19*2 allele is the most important genetic variant determining response to CLP. We aim to investigate frequency of CYP2C19*2 polymorphism in patients with ACS and significance for the individual response to CLP therapy. The preliminary data of a study including a total of 120 patients with ACS undergoing PCI with stent placement and treated with dual antiplatelet therapy (CLP and Aspirin) are presented. So far 18 patients (41-81 year age) are tested for CYP2C19*l/*2 polymorphisms. The genotype CYP2C19*1/*1; CYP2C19*l/*2 and CYP2C19*2/*2 is demonstrated in 50%, 33%, 17% respectively, of the patients. The established frequency of CYP2C 19*2 allele (33%) is significantly higher (x2=5.220; p=0.022) than in healthy Bulgarian individuals (16%). In-stent thrombosis have developed 3 (17%) of patients: 2 are C YP2C19* l/*2 carriers, and 1 - homozygous CYP2C19*2/*2. The preliminary data demonstrate high prevalence of CYP2C19*2 polymorphism in patients with ACS and point to significance of the variant for CLP therapy. Further extension of the study with larger samples and monitoring of the patients are required to determine the effects of the polymorphism on the prognosis for major adverse cardiovascular events.

scholarly journals Retrospective analysis of Acute Coronary Syndrome profile before and after Covid-19

2020 ◽  
Vol 72 ◽  
pp. S33-S34
Author(s):  
Akshat Ajay Jain ◽  
Sunil Dattatray Dighe ◽  
Rahul Singla ◽  
Narendra Omprakash Bansal
Keyword(s):  
Acute Coronary Syndrome ◽  
Retrospective Analysis ◽  
Coronary Syndrome ◽  
Before And After

scholarly journals Body mass index and cardiovascular outcomes in patients with acute coronary syndrome by diabetic status: Korean cohort study

2020 ◽  
Author(s):  
Se-Jun Park ◽  
Kyoung Hwa Ha ◽  
Dae Jung Kim
Keyword(s):  
Body Mass Index ◽  
Acute Coronary Syndrome ◽  
Body Mass ◽  
Reference Group ◽  
Obesity Paradox ◽  
Normal Weight ◽  
Baseline Body Mass Index ◽  
Coronary Syndrome ◽  
Obese Class ◽  
The Individual

Abstract Background: The “obesity paradox” has not been elucidated in the long-term outcomes of acute coronary syndrome (ACS). Therefore, we investigated the association between obesity and cardiovascular (CV) outcomes in ACS patients with and without diabetes.Methods: We identified 6,978 patients with ACS aged 40–79 years from the Korean National Health Insurance Service-Health Screening Cohort between 2003 and 2015. Baseline body mass index (BMI) was categorized as underweight (<18.5 kg/m2), normal weight (18.5–22.9 kg/m2), overweight (23.0–24.9 kg/m2), obese class I (25.0–29.9 kg/m2), and obese class II (≥30.0 kg/m2). The primary outcome was major adverse CV events (MACE)—CV death, myocardial infarction (MI), and stroke. The secondary outcomes were the individual components of MACE, hospitalization for heart failure (HHF), and all-cause death. Results: The study included 3,989 patients with and 2,989 without diabetes. Compared to normal-weight patients without diabetes (reference group), those with diabetes had a higher risk of MACE (hazard ratio [HR], 1.29; 95% confidence interval [CI], 1.07–1.56). Obese patients without diabetes had a lower risk of MACE (HR, 0.78; 95% CI, 0.62–0.97) than those with diabetes (HR, 0.95; 95% CI 0.78–1.14). In patients without diabetes, obese BMI decreased the risk of HHF (HR, 0.62; 95% CI, 0.42–0.92) and stroke (HR, 0.61; 95% CI, 0.42–0.88), but not in those with diabetes. Conclusion: Among patients with ACS, obesity had rather protective effect on CV outcomes compared to normal weight, while this was not evident in patients with diabetes.

scholarly journals An observational study assessing the impact of a cardiac arrest centre on patient outcomes after out-of-hospital cardiac arrest (OHCA)

2020 ◽  
Vol 9 (4_suppl) ◽  
pp. S67-S73
Author(s):  
Matthew Kelham ◽  
Timothy N Jones ◽  
Krishnaraj S Rathod ◽  
Oliver Guttmann ◽  
Alastair Proudfoot ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Cardiac Arrest ◽  
Hospital Mortality ◽  
Coronary Intervention ◽  
Stepwise Logistic Regression ◽  
Coronary Syndrome ◽  
Before And After ◽  
The Impact ◽  
Hospital Cardiac Arrest ◽  
Baseline Demographic

Background: Out-of-hospital cardiac arrest (OHCA) is a major cause of death worldwide. Recent guidelines recommend the centralisation of OHCA services in cardiac arrest centres to improve outcomes. In 2015, two major tertiary cardiac centres in London merged to form a large dedicated tertiary cardiac centre. This study aimed to compare the short-term mortality of patients admitted with an OHCA before-and-after the merger of services had taken place and admission criteria were relaxed, which led to managing OHCA in higher volume. Methods: We retrospectively analysed the data of OHCA patients pre- and post-merger. Baseline demographic and medical characteristics were recorded, along with factors relating to the cardiac arrest. The primary endpoint was in-hospital mortality. Results: OHCA patients ( N =728; 267 pre- and 461 post-merger) between 2013 and 2018 were analysed. Patients admitted pre-merger were older (65.0 vs. 62.4 years, p=0.027), otherwise there were similar baseline demographic and peri-arrest characteristics. There was a greater proportion of non-acute coronary syndrome-related OHCA admission post-merger (10.1% vs. 23.4%, p=0.0001) and a corresponding decrease in those admitted with ST-elevation myocardial infarction (80.2% vs. 57.0%, p=0.0001) and those treated with percutaneous coronary intervention (78.8% vs. 54.0%, p=0.0001). Despite this, in-hospital mortality was lower post-merger (63.7% vs. 44.3%, p=0.0001), which persisted after adjustment for demographic and arrest-related characteristics using stepwise logistic regression ( p=0.036) between the groups. Conclusion: Despite an increase in non-acute coronary syndrome-related OHCA cases, the formation of a centralised invasive heart centre was associated with improved survival in OHCA patients. This suggests there may be a benefit of a cardiac arrest centre model of care.

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