Inconsistent measurement of acute coronary syndrome patients’ pre-hospital delay in research: A review of the literature

Background: Patients’ treatment-seeking delay remains a significant barrier to timely initiation of reperfusion therapy. Measurement of treatment-seeking delay is central to the large body of research that has focused on pre-hospital delay (PHD), which is primarily patient-related. This research has aimed to quantify PHD and its effects on morbidity and mortality, identify contributing factors, and evaluate interventions to reduce such delay. A definite time of symptom onset in acute coronary syndrome (ACS) is essential for determining delay, but difficult to establish. This literature review aimed to explore the variety of operational definitions of both PHD and symptom onset in published research. Methods and results: We reviewed the English-language literature from 1998–2013 for operational definitions of PHD and symptom onset. Of 626 papers of possible interest, 175 were deemed relevant. Ninety-seven percent reported a delay time and 84% provided an operational definition of PHD. Three definitions predominated: (a) symptom onset to decision to seek help (18%); (b) symptom onset to hospital arrival (67%), (c) total delay, incorporating two or more intervals (11%). Of those that measured delay, 8% provided a definition of which symptoms triggered the start of timing. Conclusion: We found few and variable operational definitions of PHD, despite American College of Cardiology/American Heart Association recommendations to report specific intervals. Worryingly, definitions of symptom onset, the most elusive component of PHD to establish, are uncommon. We recommend that researchers (a) report two PHD delay intervals (onset to decision to seek care, and decision to seek care to hospital arrival), and (b) develop, validate and use a definition of symptom onset. This will increase clarity and confidence in the conclusions from, and comparisons within and between studies.

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An Integrative Literature Review on the Nomenclature and Definition of Dementia at a Young Age

Journal of Alzheimer s Disease ◽

10.3233/jad-210458 ◽

2021 ◽

pp. 1-26

Author(s):

Dennis van de Veen ◽

Christian Bakker ◽

Kirsten Peetoom ◽

Yolande Pijnenburg ◽

Janne M. Papma ◽

...

Keyword(s):

Symptom Onset ◽

Operational Definition ◽

Young Age ◽

Future Research ◽

International Consensus ◽

Young Onset ◽

Age Related ◽

Young Onset Dementia ◽

Age Limits ◽

Definition Of

Background: There has been growing interest in young people living with dementia. Future research requires consensus on the terminology and operational definition of this group. Objective: The purpose of this integrative review was to explore and include all operational definitions used to define dementia at a young age. Methods: On August 14, 2020, the PubMed, Embase, Cinahl, and PsycInfo databases were searched for empirical and theoretical literature using Google. Various terms to describe and define ‘dementia’ and ‘at a young age’ were used to collect literature concerning terminology; age-related aspects, including cut-off ages and criteria; and etiologies of dementia at a young age. Results: The search yielded 6,891 empirical and 4,660 theoretical publications, resulting in the inclusion of 89 publications, including 36 publications containing an explicit discussion and 53 publications as confirmation. ‘Young-onset dementia’ was the most commonly used term of seven identified terms, in the last two decades. The age of 65 years at symptom onset was used most frequently when considering a total of six upper age limits and four criteria to define a cut-off age. Eight lower age limits and an option for subdivision based on age were included. We identified 251 different etiologies and 27 categories of etiologies. Conclusion: Despite relative consensus on the term young-onset dementia and an age at symptom onset being used as a cut-off criterion, much is still unclear concerning possible etiologies of dementia at a young age. In the current study, controversies were detected for discussion in an international consensus study.

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Abstract P478: Trends in Concurrent Heart Failure and Acute Coronary Syndrome Hospitalizations: A Literature Review

Circulation ◽

10.1161/circ.141.suppl_1.p478 ◽

2020 ◽

Vol 141 (Suppl_1) ◽

Author(s):

Sarah Godfrey ◽

Laura Cohen ◽

Susan Hennessy ◽

Brandon Bellows

Keyword(s):

Heart Failure ◽

Acute Coronary Syndrome ◽

Clinical Practice ◽

Literature Review ◽

Pooled Analysis ◽

Coronary Syndrome ◽

St Elevation ◽

Recent Trends ◽

Definition Of ◽

Over Time

Purpose: Patients who present with concurrent heart failure (HF) and acute coronary syndrome (ACS) have an increased risk of mortality, but changes in clinical practice have improved clinical outcomes. We sought to examine recent trends in concurrent HF and ACS hospitalizations in the United States (US) through review of published literature. Methods: We searched the Medline and PubMed databases for studies published after January 1, 2000 reporting the hospitalizations for HF with concurrent acute coronary syndromes. We included studies performed in the US or with at least 25% US participants, that reported the proportion with concurrent HF and ACS, and used a clinical definition of HF (e.g. Killip Class II or III, NYHA Class, or Framingham Criteria). Studies were reviewed by and data was extracted using a standardized form. We extracted study and patient characteristics, definition of HF, and rates of concurrent HF and ACS hospitalizations. We categorized included studies by ACS type: (1) non-specific myocardial infarction (MI) or ACS, (2) non-ST elevation (NSTE) MI or NSTE-ACS, or (3) ST elevation (STE) MI. We descriptively examined recent trends in hospitalizations for concurrent HF and ACS over time; rates reported for multiple time periods or ACS types were considered separately. Results: We identified 23 observational studies, systematic reviews, and randomized clinical trials. Of these, we excluded 13 due to non-US populations, use of non-clinical definitions of HF (i.e., diagnosis codes), or not reporting rates of concurrent HF and ACS. Of the 10 included studies, 7 reported concurrent HF with non-specific MI or ACS from 1975 through 2005 across multiple registries and literature reviews. Rates ranged from 12.5% to 48.0% with no clear time-related trends. We identified 3 studies reporting concurrent HF with NSTEMI or NSTE-ACS from pooled analysis or the Global Registry of Acute Coronary Events (GRACE) registry from 1994 to 2008. Reported rates ranged from 8.2%-15.7% for studies starting in the 1990s with one study reporting and 6.1% in 2005. We identified 4 studies reporting concurrent HF with STEMI, including a pooled analysis, the GRACE registry, and a clinical trial. Rates of concurrent HF with STEMI appeared to decrease over time from 32.5% in 1990 to 1998, 15.6%-19.5% from 1999 to 2001, and 2.6%-11.0% in 2005. Conclusion: Our literature review found that there may be a decrease in concurrent HF and STEMI hospitalizations in recent decades, but no apparent trends with other types of ACS. This may be related to emphasis on early revascularization strategies, improved primary prevention, and/or earlier time to presentation due to increasing public awareness.. However, there was a dearth of data reporting concurrent HF and ACS hospitalization within the last decade. Further research is needed to understand the impact of multiple changes in clinical practice on secular trends.

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Comparison of platelet reactivity between prasugrel and ticagrelor in patients with acute coronary syndrome: a meta-analysis

BMC Cardiovascular Disorders ◽

10.1186/s12872-020-01603-0 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Mingxiang Wen ◽

Yaqi Li ◽

Xiang Qu ◽

Yanyan Zhu ◽

Lingfang Tian ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Platelet Reactivity ◽

Weighted Mean Difference ◽

Meta Analysis ◽

Reactivity Index ◽

Cochrane Library ◽

Coronary Syndrome ◽

Significant Difference ◽

Definition Of ◽

The Cochrane Library

Abstract Background This meta-analysis aimed to compare the effects of prasugrel and ticagrelor on high (HTPR) and low on-treatment platelet reactivity (LTPR) in patients with acute coronary syndrome (ACS). Methods Eligible studies were retrieved from PubMed, Embase, and the Cochrane Library. HTPR and LTPR were evaluated on the basis of the vasodilator-stimulated phosphoprotein platelet reactivity index (VASP-PRI) and P2Y12 reaction units (PRUs). HTPR and LTPR were analyzed using risk ratios (RRs) and their 95% confidence intervals (CIs). Weighted mean difference (WMD) and 95% CI were used to calculate the pooled effect size of platelet reactivity (PR). Results Fourteen eligible studies were obtained, which included 2629 patients treated with ticagrelor (n = 1340) and prasugrel (n = 1289). The pooled results showed that the prasugrel-treated patients had higher platelet reactivity than the ticagrelor-treated patients (PRU: WMD = − 32.26; 95% CI: − 56.48 to − 8.76; P < 0.01; VASP-PRI: WMD = − 9.61; 95% CI: − 14.63 to − 4.60; P = 0.002). No significant difference in HTPR based on PRU was identified between the ticagrelor and prasugrel groups (P = 0.71), whereas a lower HTPR based on VASP-PRI was found in the ticagrelor-treated patients than in the prasugrel-treated patients (RR = 0.30; 95% CI: 0.12–0.75; P = 0.010). In addition, the results showed a lower LTPR was observed in the prasugrel group than in the ticagrelor group (RR = 1.40; 95% CI: 1.08–1.81; P = 0.01). Conclusions Prasugrel might enable higher platelet reactivity than ticagrelor. Ticagrelor could lead to a decrease in HTPR and increase in LTPR. However, this result was only obtained in pooled observational studies. Several uncertainties such as the nondeterminancy of the effectiveness of ticagrelor estimated using VASP-PRI or the definition of HTPR (a high or modifiable risk factor) might have affected our results.

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The presenting symptoms as a predictor of the hospital arrival time intervals of patients with acute coronary syndrome

Indian Journal of Public Health Research & Development ◽

10.5958/0976-5506.2018.01717.5 ◽

2018 ◽

Vol 9 (11) ◽

pp. 1856

Author(s):

Tony Suharsono ◽

Shynatry Ayu Andhika ◽

Ahmad Hasyim Wibisono ◽

Tina Handayani

Keyword(s):

Acute Coronary Syndrome ◽

Arrival Time ◽

Time Intervals ◽

Hospital Arrival ◽

Presenting Symptoms ◽

Coronary Syndrome

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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

ACC Current Journal Review ◽

10.1016/j.accreview.2005.11.013 ◽

2005 ◽

Vol 14 (12) ◽

pp. 4

Author(s):

M. Thuresson ◽

M. Berglin Jarlöv ◽

B. Lindahl ◽

L. Svensson ◽

C. Zedigh ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Symptom Onset ◽

Coronary Syndrome ◽

History Of ◽

St Elevation

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Acute coronary syndrome: pathogenesis, diagnosis, treatment, rehabilitation (part 1)

Cardiosomatics ◽

10.26442/cs45215 ◽

2016 ◽

Vol 7 (1) ◽

pp. 70-81

Author(s):

N. B Perepech

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Risk Stratification ◽

Unstable Angina ◽

Clinical Manifestation ◽

Laboratory Diagnostics ◽

Coronary Syndrome ◽

Definition Of

The lecture provides a definition of "acute coronary syndrome" and entities that united this term. The mechanisms of the development and clinical manifestation of acute coronary syndrome. The methods of instrumental and laboratory diagnostics, rules formulation diagnosis of myocardial infarction and unstable angina. Provides information on how to assess prognosis and risk stratification in patients with acute coronary syndrome.

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IMPACT OF GENDER ON THE CLINICAL FEATURES, ANGIOGRAPHIC FINDINGS, AND OUTCOMES OF YOUNG PATIENTS PRESENTED WITH ACUTE CORONARY SYNDROME

Pakistan Heart Journal ◽

10.47144/phj.v54i4.2186 ◽

2022 ◽

Vol 54 (4) ◽

pp. 321-327

Author(s):

Kamran Ahmed Khan ◽

Dileep Kumar ◽

Ayaz Hussain Shaikh ◽

Sanam Khowaja ◽

Mehboob Ali ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Coronary Syndrome ◽

Symptom Onset ◽

Young Patients ◽

Cross Sectional ◽

Men And Women ◽

St Segment Elevation ◽

Coronary Syndrome ◽

Significant Difference ◽

Angiographic Findings

Objectives: Acute coronary syndrome (ACS) at a younger age is now becoming a crucial problem. This study determined the effect of gender on the clinical findings and outcomes of young patients (≤ 45 years) with ACS. Methodology: In this descriptive cross sectional study, young patients (≤45 years) who presented with ACS and underwent coronary angiography were recruited. The comparison of clinical profile, angiographic findings, in-hospital, and 90-days mortality between genders were made. Results: A total of 335 young patients with ACS were included, 80.6% of whom were men. A significant difference was found between men and women in terms of mean age: 38±6 vs. 40±5 (p=0.014), hypertension: 37.8% vs. 58.5% (p=0.002), diabetes: 17.4% vs. 35.4% (p=0.001), smoking: 50.4% vs. 6.2% (p≤0.001), use of smokeless tobacco: 14.1% vs. 4.6% (p=0.037), median time from symptom onset to first medical contact: 270 [420–165] minutes vs. 346 [499.5–240] minutes (p=0.047), ST-segment elevation myocardial infarction (STEMI) 89.6% vs. 78.5% (p=0.015), non-ST-elevation myocardial infarction (NSTEMI) 8.5% vs. 18.5% (p=0.019), and three-vessel disease (3VD) 10.7% vs. 21.5% (p=0.019), respectively. In-hospital and 90-day mortality rates were 0.4% vs. 3.1% (p=0.097) and 1.5% vs. 4.6% (p=0.136) for men and women, respectively. Conclusion: Women tended to have a higher age at presentation, more frequent traditional risk factors, late presentation after symptom onset, frequent NSTEMI, and 3VD, whereas men were distinct with frequent STEMI and higher tobacco use. In addition, women trended to have a higher in-hospital as well as short-term mortality than men did.

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Sex differences in presenting symptoms of acute coronary syndrome: the EPIHeart cohort study

BMJ Open ◽

10.1136/bmjopen-2017-018798 ◽

2018 ◽

Vol 8 (2) ◽

pp. e018798 ◽

Cited By ~ 10

Author(s):

Carla Araújo ◽

Olga Laszczyńska ◽

Marta Viana ◽

Filipa Melão ◽

Ana Henriques ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Sex Differences ◽

Cohort Study ◽

Latent Class ◽

Referred Pain ◽

Presenting Symptoms ◽

Coronary Syndrome ◽

Tertiary Hospitals ◽

Pain Knowledge ◽

Definition Of

ObjectivesPrompt diagnosis of acute coronary syndrome (ACS) remains a challenge, with presenting symptoms affecting the diagnosis algorithm and, consequently, management and outcomes. This study aimed to identify sex differences in presenting symptoms of ACS.DesignData were collected within a prospective cohort study (EPIHeart).SettingPatients with confirmed diagnosis of type 1 (primary spontaneous) ACS who were consecutively admitted to the Cardiology Department of two tertiary hospitals in Portugal between August 2013 and December 2014.ParticipantsPresenting symptoms of 873 patients (227 women) were obtained through a face-to-face interview. Outcome measures: Typical pain was defined according to the definition of cardiology societies. Clusters of symptoms other than pain were identified by latent class analysis. Logistic regression was used to quantify differences in presentation of ACS symptoms by sex.ResultsChest pain was reported by 82% of patients, with no differences in frequency or location between sexes. Women were more likely to feel pain with an intensity higher than 8/10 and this association was stronger for patients aged under 65 years (interaction P=0.028). Referred pain was also more likely in women, particularly pain referred to typical and atypical locations simultaneously. The multiple symptoms cluster, which was characterised by a high probability of presenting with all symptoms, was almost fourfold more prevalent in women (3.92, 95% CI 2.21 to 6.98). Presentation with this cluster was associated with a higher 30-day mortality rate adjusted for the GRACE V.2.0 risk score (4.9% vs 0.9% for the two other clusters, P<0.001).ConclusionsWhile there are no significant differences in the frequency or location of pain between sexes, women are more likely to feel pain of higher intensity and to present with referred pain and symptoms other than pain. Knowledge of these ACS presentation profiles is important for health policy decisions and clinical practice.

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