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

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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Abstract 12162: Association of Symptom Clusters With Mode of Transportation to Emergency Department in Patients Diagnosed With Acute Coronary Syndrome

Circulation ◽

10.1161/circ.132.suppl_3.12162 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Leslie L Davis ◽

Thomas P McCoy ◽

Barbara Riegel ◽

Sharon McKinley ◽

Lynn Doering ◽

...

Keyword(s):

Emergency Department ◽

Acute Coronary Syndrome ◽

Chest Pain ◽

Delay Time ◽

Symptom Clusters ◽

Prehospital Delay ◽

Coronary Syndrome ◽

Stress Symptoms ◽

Mode Of Transportation

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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Health-Seeking Behavior of Patients with Acute Coronary Syndrome and Their Family Caregivers

Prehospital and Disaster Medicine ◽

10.1017/s1049023x18001036 ◽

2018 ◽

Vol 33 (6) ◽

pp. 614-620

Author(s):

Kumboyono Kumboyono ◽

Jeki Refialdinata ◽

Titin A Wihastuti ◽

Septi D Rachmawati ◽

Aditya N Aziz

Keyword(s):

Health Care ◽

Acute Coronary Syndrome ◽

Family Caregivers ◽

Prescription Drugs ◽

Health Seeking ◽

Publication Type ◽

Health Seeking Behavior ◽

Coronary Syndrome ◽

Seeking Behavior ◽

The Government

AbstractIntroductionAcute Coronary Syndrome (ACS) is a life-threatening condition. Immediate and proper treatment will decrease mortality rate. Patient awareness on ACS is still lacking and as the consequence, ACS patients do not seek immediate help.ProblemThe patients’ efforts to get rid of ACS symptoms.MethodsThe study was a descriptive, qualitative study in which a semi-structured, in-depth interview became the instrument. The respondents were 34 participants (including 17 ACS patients and 17 family caregivers). Data analysis was done by triangulation of data sources.ResultsThree themes were obtained, namely: (1) prefer traditional and self-treatment, for example (a) traditional medicine, (b) taking non-prescription drugs to overcome ACS symptoms, and (c) spontaneous action; (2) using available health resources and facilities that consisted of (a) getting initial treatment at home by nurses, (b) visiting a health center to take care of the symptoms, and (c) using non-ambulance service to visit the health centers; and (3) expectations on health care services to patients composed by sub-themes such as (a) the expectation to get information that supports the healing, and (b) the caring attitude of the heath professional.Conclusions:The results showed that in the prehospital setting when experiencing ACS symptoms, the patients try to overcome the symptoms independently. However, as the symptoms get worse, they utilize health facilities in different ways. At the time of obtaining health services, patients are satisfied with health professionals who show caring attitudes, explain the results of the examination, and provide health education on health care efforts. Thus, to prevent mortality and morbidity, it is important for a health professional to educate the public about ACS, including topics about ACS healthy lifestyles and potential threats if it is too late to get treatment. Furthermore, it is also important for the government to implement prehospital emergency services nation-wide.KumboyonoK, RefialdinataJ, WihastutiTA, RachmawatiSD, AzizAN. Health-seeking behavior of patients with Acute Coronary Syndrome and their family caregivers. Prehosp Disaster Med. 2018;33(6):614–620.

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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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