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ObjectiveTo investigate the influencing factors associated with delayed time in pre-hospital emergency medical care in patients with hypertensive emergency in the main urban area of Chongqing. MethodsA total of 1 246 patients with hypertension in the main urban area of Chongqing from March 2018 to August 2021 were included in this study. The delayed time in the pre-hospital emergency medical care was determined. A multivariate linear regression model was used to analyze the influencing factors. ResultsThe delayed time in the pre-hospital emergency medical care for the patients with hypertensive emergency was concentrated in 0‒12 h， with the average of （5.89±1.96） h. The delayed time differed significantly by gender， age， history of atrial fibrillation， diabetes， educational level， time of onset， mode of transportation， awareness of hypertensive emergency， blood pressure at the onset， and presence of persons at the onset of emergency （P<0.05）. Multivariate linear regression analysis showed that educational level， time of onset， blood pressure at the onset， awareness of hypertensive emergency， presence of persons at the onset were linearly correlated with delayed time in the pre-hospital medical care for hypertensive emergencies （P<0.05）. ConclusionDelay in pre-hospital medical care is prevalent for patients with hypertensive emergency in the main urban area of Chongqing. The delayed time is associated with multiple factors， such as educational level， time of onset， blood pressure at onset， awareness of hypertensive emergency， and presence of persons at onset. It warrants further improvement in the interventions to reduce the delay in the pre-hospital medical care.
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@#Background: Pre-hospital delay is currently a major factor limiting early reperfusion among ST-elevation myocardial infarction (STEMI) patients worldwide. This study aims to determine pre-hospital factors affecting symptom-to-door time among STEMI patients in Malaysia. Methods: This cross-sectional study included 222 STEMI patients admitted to two tertiary hospitals in Malaysia. By determining symptom-to-door time, the study population was categorised into two definitive treatment seeking groups: early (≤ 3 h) and delayed (> 3 h). Data was collected focusing on socio-demographical data, risk factors and comorbidities, clinical presentation, situational factors and action taken by patients. Results: The mean age of our patients was 58.0 (SD = 11.9) years old, and the population consisted of 186 (83.8%) males and 36 (16.2%) females. Our study found that the median symptomto- door time was 130.5 (IQR 240) min, with 64% of subjects arriving early and 36% arriving late. Pre-hospital delays were found to be significant among females (adj OR = 2.42; 95% CI: 1.02, 5.76; P = 0.046), patients with recurrence of similar clinical presentations (adj OR = 2.74; 95% CI: 1.37, 5.46; P = 0.004), patients experiencing atypical symptoms (adj OR = 2.64; 95% CI: 1.11, 6.31; P = 0.029) and patients who chose to have their first medical contact (FMC) for their symptoms with a general practitioner (adj OR = 2.80; 95% CI: 1.20, 6.56; P = 0.018). However, patients with hyperlipidaemia (adj OR = 0.46; 95% CI: 0.23, 0.93; P = 0.030), self-perceived cardiac symptoms (adj OR = 0.36; 95% CI: 0.17, 0.73; P = 0.005) and symptoms that began in public places (adj OR = 0.21; 95% CI: 0.06, 0.69; P = 0.010) tended to seek treatment earlier. Conclusion: The symptom-to-door time among the Malaysian population is shorter in comparison to other developing countries. Nevertheless, identified, modifiable pre-hospital factors can be addressed to further shorten symptom-to-door time among STEMI patients.
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The treatment of stroke relies on early, rapid and effective reperfusion after cerebral ischemia to rescue the ischemic penumbra through cerebral blood flow restoration. However,the thrombolytic rate of stroke patients in China is only 2%. The time delay of treatment is the bottleneck, with pre-hospital delay an important reason and in-hospital delay not optimistic either. The article reviewed the current status and influencing factors of the treatment delay in patients with acute ischemic stroke,aiming to provide a basis for the establishment of an organized and integrated stroke emergency model in the future.
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Objective To describe the current situation of pre-hospital delay and health belief in patients with colorectal cancer and explore the relationship between them. Methods With convenient sampling methods,totally 385 patients with colorectal cancer were recruited from January to June 2016. Patients with colorectal cancer were investigated using a general data survey questionnaire, visit situation questionnaire and the Champion Health Belief Model Scale. Results The median pre-hospital delay time was 3.00 months.The rate of pre-hospital delay was 43.1%(166/385). The score of the overall health belief was (119.52 ± 12.62) points. The two dimensions of"perceived susceptibility and perceived severity" scored lower, and the two dimensions of "health motivation and perceived therapeutic benefits" scored higher. The health belief was negatively correlated with the pre- hospital delay among colorectal cancer patients (r=- 0.737, P<0.01). Conclusions Pre-hospital delay occurred among patients with colorectal cancer is severe. Patients with a higher level of health belief have shorter pre-hospital delay.It′s important to improve the level of health belief of"perceived susceptibility and perceived severity"and reduce the time of pre-hospital delay to improve outcomes in patients with colorectal cancer.
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Objective To investigate the differences of pre-hospital delay time in acute ST-elevation myocardial infarction (STEMI)between the advanced age group(>75 years old)and control group(≤75 years old).Methods Four hundreds patients with STEMI in the cardiology and emergency departments of the First Affiliated Hospital and Affiliated Luoyang Central Hospital of Zhengzhou University from January 2013 to March 2015 were selected and divided into two groups according to the age,the ad-vanced age group (>75 years old)and control group(≤75 years old).The patients′data were inquired and recorded for conducting the statistical analysis.Results The proportion of pre-hospital delay time < 6 h in the advanced age group was significantly lower than that in the control group and the time for conducting coronary angiography was longer than that in the control group,the differences were statistically significant(P <0.05).The mortality rates of intra-hospital,on 30 d and half a year after discharge in the advanced age group were higher than those in the control group,the differences between the two groups were statistically signif-icant (P <0.05).Conclusion The advanced age patients receiving active therapy are relatively less,which is mainly due to the wor-ry on the age related adverse reactions.
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Objective To explore pre-hospital delay factor of coronary reperfusion therapy for ST-elevation acute myocardial infarction (STEAMI) patients presenting with non-chest pains. Methods A retrospective observation was conducted. The clinical data of STEAMI patients underwent emergency percutaneous coronary intervention (PCI) admitted to Luoyang Central Hospital Affiliated to Zhengzhou University from August 2013 to August 2015 were analyzed. The patients were divided into chest pain group and non-chest pain group according to the presence of chest pain or not. Clinical characteristics were compared between the two groups, and incidence of major adverse cardiac events (MACE), door-to-balloon time, door-to-electrocardiograms (ECG) time and ECG-to-balloon time were evaluated. Influencing factors of pre-hospital delay was analyzed by logistic multiple stepwise regression. Results A total of 259 patients with STEAMI were enrolled, including 154 patients with chest pain and 105 presented with non-chest pains. Compared with chest pain group, the patients in the non-chest pain group were older (years: 68.12±8.93 vs. 62.34±7.12, P < 0.05), less female (26.67% vs. 42.20%, P< 0.05), and had a higher past history of angina, stroke and heart failure (27.61% vs. 13.63%, 31.42% vs. 18.83%, 26.67% vs. 11.68%, respectively, all P < 0.05), and higher percentage of Killip ≥ Ⅲ patients (15.24% vs. 6.49%, P < 0.05), the lower ambulance use (26.67% vs. 44.81%, P < 0.01), longer hospitalization time (days: 12.50±2.89 vs. 9.50±2.67, P < 0.05), higher incidence of MACE (19.05% vs. 9.09%, P < 0.05), longer door-to-balloon time and door-to-ECG time (minutes: 159.01±51.21 vs. 115.31±36.74, 53.06±18.17 vs. 30.35±9.93, both P < 0.01). It was shown by logistic multivariate regression analysis that no-chest pain [odds ratio (OR) = 5.14, 95% confidence interval (95%CI) = 2.34-10.81, P < 0.001], age ≥ 65 years old (OR = 1.43, 95%CI = 0.93-2.99, P = 0.022), diabetes (OR = 1.57, 95%CI = 0.66-2.15, P = 0.015) and no-ambulance transport (OR = 1.55, 95%CI = 0.73-2.75, P < 0.001) were risks factors of coronary reperfusion delay ≥ 2 hours. Conclusions STEAMI patients presenting without chest pain showed higher incidences of MACE, longer time of ECG obtained and initial PCI time delay. Clinicians should try to reduce the delay time of the patients in order to improve patient survival rates.
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Objective To clear the coping process of ischemic stroke patients and their families before the onset,explain its response rules and the influence factors,and provide scientific basis for the construction of comprehensive stroke pre-hospital intervention program.Methods A semi-structured interviews were conducted with 10 cases.Data were analyzed using the grounded theory.Results Ischemic stroke patients and their families at the onset process experienced recognition,reaction,alert and action stage.Conclusion Health education should be combined with the whole process of ischemic stroke patients and their families before hospital,building a comprehensive intervention program.
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Objective To evaluate the effect of community health education on pre-hospital delay and clinical outcomes of hospitalization of the patients with acute myocardial infarction.Methods Community health education for the adults living near the Linyi People's Hospital was conducted from July 1st to October 30th,2012.ST-elevation acute myocardial infarction identified 1 year prior to or during the health education program was used as control (n=81) or study group (n=89),respectively.Delay from the onset of ST-elevation acute myocardial infarction symptoms to hospital admission,the rate of reperfusion therapy,the in-hospital malignant complications and the death rate were compared between the two groups.Student's t test,Chi-square test,Fisher's exact probability test and the Wilcoxon rank sum test were used for data analysis.Results Median pre-hospital delay was 80 (47-150) min in the study group,less than 90 (60-255) min of the control group (Wilcoxon W=6 912.00,Z=-2.182,P=0.029).The rate of reperfusion therapy was 54％ in the study group,higher than 38％ of the control group (x2 =4.181,P=0.041).The overall incidence of severe complications during hospitalization was 24％ in the study group,less than 42％ in the control group (x2=6.732,P=0.009).Conclusion Community health education could decrease pre-hospital delay for acute myocardial infarction,improve the rate of reperfusion therapy and decrease the overall incidence of severe complications during hospitalization.
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Introduction: A cardiovascular disease, especially the acute myocardial infarction (AMI), is the most important health problem worldwide. Pre-hospital delay in seeking medical treatment is an effective factor on patients' outcomes. The aim of this study was to identify the patients' reactions to the signs and symptoms of AMI and identifying the factors contributing to the pre-hospital delay in a central hospital in Kashan, Iran. Materials and Methods: In this cross-sectional study, a random sample of 248 patients suffering from AMI was recruited. A questionnaire used, which contained demographic data, the time, and place of experiencing the symptoms, and the manner of responding to the initial symptoms. The SPSS software (version, 19was used for data analysis. Result: 248 patients participated in the study, 183 (73.8%) were males and 65 (26.2%) were females. The mean delay time was 127 174 min. Moreover, 162 patients had arrived at the hospital during the first 60 min after the onset of the symptoms. The variables of being female (P = 0.024), low level of education (P = 0.014), living in urban area (P = 0.01) and referring to the hospital by one's own car instead of using ambulance were accompanied by more pre-hospital delay. 63 patients (25.4%) referred to the hospital by ambulance. Conclusion: Despite having only 25% of the patients referring to this center by ambulance, most patients arrived on time to the hospital.
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Decision Making , Humans , Iran , Myocardial Infarction/drug therapy , Myocardial Infarction/surgery , Myocardial Infarction/therapy , Patient Acceptance of Health Care , Time Factors , Transportation of Patients/methodsABSTRACT
SIGNIFICANCE OF THE STUDY: Acute myocardial infarction (AMI) is a major cause of death in Korea. Delay in seeking treatment may cause unnecessary exacerbation of the disease and early mortality from AMI. Patients' recognition of symptoms of an AMI and response to those symptoms may influence the delay time. Bystanders' role in patients' seeking treatment after AMI has not been studied in previous research. Understanding reasons for delay in seeking treatment is important in developing interventions for reducing these delays and increasing survival rate from AMI. PURPOSE OF THE STUDY: A retrospective survey was conducted with 144 AMI patients to: (1) investigate time from symptom onset to arrival at the first hospital for treatment of AMI; (2) describe patient's and bystander's response to the patient's symptoms; (3)examine whether patient's and bystander's responses affect delay time. RESULTS: The mean of overall pre-hospital delay time was 13.64 (21.86) hours and it consisted of patients' delay of 13.64 (22.32) hours and transportation time of 24.86 (19.41) minutes. People living in rural area delayed longer than people living in urban area. Pre-hospital delay time was associated with the bystander: patients delayed longer when they were with their spouse, family and friends than when with colleagues at work. Calling 119 saved transportation time, but did not reduce overall pre-hospital delay time. CONCLUSION AND SUGGESTIONS: Patients delay longer than the time window for a successful reperfusion therapy when they experience symptoms of AMI; and calling 119 does not diminish this delay. Bystanders' adequate response to the patients' symptom may reduce the delay time in seeking treatment. Findings from this study may suggest that health education and public campaigns are needed to increase people's recognition of symptoms of an AMI and to promote adequate response from bystanders to the AMI symptoms. In addition, public campaigns urging car operators to yield to the emergency vehicle are needed in order to reduce transportation time.
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Humans , Cause of Death , Emergencies , Friends , Health Education , Korea , Mortality , Myocardial Infarction , Reperfusion , Retrospective Studies , Spouses , Survival Rate , TransportationABSTRACT
SIGNIFICANCE OF THE STUDY: Acute myocardial infarction (AMI) is a major cause of death. Most of the deaths from AMI, if diagnosed and treated early enough, can be prevented. Delay in treatment may cause unnecessary exacerbation of the disease and even death in AMI patients. PURPOSE OF THE STUDY: A retrospective survey was conducted to (1) investigate the delay time in AMI patients' seeking treatment from symptom onset to arrival at the first hospital (overall pre-hospital delay), the length of time taken for decision-making (patients' delay) and transport (transportation time); (2) to identify factors associated with delay times; (3) to compare delay times between the group who called 119 and the group who did not. RESULTS: The mean of overall pre-hospital delay time was 17.42 (+/-24.03) hours and it was consisted of patients' delay, 17.07(+/-24.45), and transportation time, .84 (+/-2.34). None of socio-demographic variables such as age, sex, marital status, monthly income, education, and living environment was associated with either the patients' delay or the overall delay time. Living rural area (F=4.483, p=.016), having previous MI (F=35.252, p=.000), and other heart disease (F=69.435, p=.000) decreased transportation time; having previous heart disease decreased overall pre-hospital delay(F=4.489, p=.039); and having angina (F=92.907, p=.000) and CAD (F=9.724, p=.003) increased transportation time. Place of symptom attack, bystander, whether patients or bystander called 119, modes of transportation, intensity of pain, presence of typical chest pain and anxiety perceived by patients were not associated with any of delay times. No significant differences appeared between the group who called 119 and the group who did not in any of delay times. CONCLUSION AND SUGGESTIONS: Although number of patients who arrive at the hospital early enough for treatment tend to be increasing, considerable number of patients still delayed longer than desired when they experienced symptoms of AMI, and calling 119 did not diminish this delay because patients delayed mostly before they decided to call. Living urban area, having previous MI, and heart disease decreased transportation time whereas having previous heart disease decreased the overall pre-hospital delay time and having previous angina and CAD increased transportation time. Further studies to identify reasons for real late arrivals as well as public campaigns to reduce delay time in treatment are needed.