Factors associated with longer time to treatment for patients with suspected acute coronary syndromes: a cohort study.
Circ Cardiovasc Qual Outcomes
; 7(1): 86-94, 2014 Jan.
Article
en En
| MEDLINE
| ID: mdl-24425697
ABSTRACT
BACKGROUND:
Rapid treatment of acute coronary syndromes (ACS) is important; causes of delay in emergency medical services care of ACS are poorly understood. METHODS ANDRESULTS:
We performed an analysis of data from IMMEDIATE (Immediate Myocardial Metabolic Enhancement during Initial Assessment and Treatment in Emergency Care), a randomized controlled trial of emergency medical services treatment of people with symptoms suggesting ACS, using hierarchical multiple regression of elapsed time. Out-of-hospital ECGs were performed on 54,230 adults calling 9-1-1; 871 had presumed ACS, 303 of whom had ST-segment elevation myocardial infarction and underwent percutaneous coronary intervention. Women, participants with diabetes mellitus, and participants without previous cardiovascular disease waited longer to call 9-1-1 (by 28 minutes, P<0.01; 10 minutes, P=0.03; and 6 minutes, P=0.02, respectively), compared with their counterparts. Time from emergency medical services arrival to ECG was longer for women (1.5 minutes; P<0.01), older individuals (1.3 minutes; P<0.01), and those without a primary complaint of chest pain (3.5 minutes; P<0.01). On-scene times were longer for women (2 minutes; P<0.01) and older individuals (2 minutes; P<0.01). Older individuals and participants presenting on weekends and nights had longer door-to-balloon times (by 10, 14, and 11 minutes, respectively; P<0.01). Women and older individuals had longer total times (medical contact to balloon inflation 16 minutes, P=0.01, and 9 minutes, P<0.01, respectively; symptom onset to balloon inflation 31.5 minutes for women; P=0.02).CONCLUSIONS:
We found delays throughout ACS care, resulting in substantial differences in total times for women and older individuals. These delays may impact outcomes; a comprehensive approach to reduce delay is needed.Palabras clave
Texto completo:
1
Colección:
01-internacional
Base de datos:
MEDLINE
Asunto principal:
Factores Sexuales
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Factores de Edad
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Electrocardiografía
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Síndrome Coronario Agudo
/
Tiempo de Tratamiento
Tipo de estudio:
Diagnostic_studies
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Etiology_studies
/
Incidence_studies
/
Observational_studies
/
Risk_factors_studies
Límite:
Aged
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Aged80
/
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
Circ Cardiovasc Qual Outcomes
Asunto de la revista:
ANGIOLOGIA
/
CARDIOLOGIA
Año:
2014
Tipo del documento:
Article
País de afiliación:
Marruecos