Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome
| Autor: | Jaimi H. Greenslade, John W. Pickering, Emily Dalton, William A. Parsonage, Martin Than, Chris J. Pemberton, Sally Aldous, Rachelle Foreman, Louise Cullen, Louven Menzies, Bianca Crosling, Ashley Leong |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Adult
Male Acute coronary syndrome medicine.medical_specialty Time Factors Endpoint Determination 030204 cardiovascular system & hematology Critical Care and Intensive Care Medicine Chest pain Angina 03 medical and health sciences 0302 clinical medicine Risk Factors Outcome Assessment Health Care medicine Clinical endpoint Humans 030212 general & internal medicine Myocardial infarction Prospective Studies Acute Coronary Syndrome Case report form Aged Aged 80 and over business.industry Unstable angina Australia General Medicine Emergency department Middle Aged medicine.disease Emergency medicine Emergency Medicine Female medicine.symptom business Emergency Service Hospital New Zealand |
| Zdroj: | Emergency medicine journal : EMJ. 33(6) |
| ISSN: | 1472-0213 |
| Popis: | Free to read Abstract Objective To define the association between time taken to present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS) and 1-year outcomes. We also determined whether particular patient characteristics are associated with delays in seeking care after symptom onset. Methods We collected data, which included a customised case report form to record symptom onset, on adult patients presenting with suspected ACS to two EDs in Australia and New Zealand. Such patients were followed up prospectively for 1 year. The composite primary endpoint included death, acute myocardial infarction, unstable angina pectoris treated with revascularisation or readmission with heart failure occurring after discharge but within 12 months after the index presentation. Results ACS was diagnosed at presentation in 420 (16.8%) of 2515 patients recruited. Cox regression was conducted to assess the relationship between presentation time and the rate of primary endpoints after controlling for age, ethnicity, prior angina, prior coronary artery bypass graft and index diagnosis. Middle (2–6 h) and late presenters (>6 h postsymptom onset) developed the primary endpoint at a rate 1.22 (95% CI 0.80 to 1.85) and 1.57 (1.07 to 2.31) times higher than early presenters. Patients with known risk factors and cardiovascular disease were more likely to present late to the ED. Conclusions There is an independent association between time to presentation and 1-year cardiac outcomes following initial chest pain assessment for ED patients with possible cardiac chest pain in the Australian and New Zealand setting. This association occurred irrespective of the eventual diagnosis. Effective public health campaigns and other measures that facilitate early presentation with symptoms for patients with symptoms suggestive of ACS are justified and may improve prognosis. Trial registration number ACTRN12611001069943. |
| Databáze: | OpenAIRE |
| Externí odkaz: |
|