PURPOSE OF THE STUDY: A retrospective and descriptive survey was conducted to investigate the level of anxiety that patients experience in early stage of AMI and to examine whether anxiety independently predict inhospital complications.
SIGNIFICANCE OF THE STUDY: AMI is a major cause of death and disability. Anxiety may contribute to developing complications and mortality. However, the association between anxiety and complications has not been examined.
RESULTS
Data were analyzed for 424 AMI patients enrolled for MICA (Myocardial Infarotion Complication and Anxiety) project. The mean score of the state anxiety inventory (SAI) measured within 72 hours after admission for the whole sample was 39.14 (+/-12.77) and ranged from 18 to 80. Overall, 161 patients (38.0%) experienced at least one episode of in-hospital complication (i.e. VT, VF, reinfarction, recurrent ischemia or cardiac death). Incidence of in-hospital complications was higher in the high anxiety group than in the low anxiety group (45.4% vs. 31.2%). There were significant differences in the incidence of recurrent ischemia between groups with low level of anxiety and high level of anxiety (27.5% vs. 18.9%). According to the Ward criterion from the logistic regression, anxiety reliably predicted the occurrence of in-hospital complications. Anxiety (odds ratio = 1.75, 95% CI 1.01-3.01, p= 0.04) significantly contributed to the model. Patients who were in the high anxiety group were 1.8 times more likely to have in-hospital complications than those who were in the low anxiety group.
CONCLUSION
AND SUGGESTION: This finding confirms that patients experience significant level of anxiety early after AMI, and this anxiety, after controlling other risk factors for the complications, is a reliable predictor of in-hospital complications.
Citations
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.
Citations
PURPOSE: The purpose of this study was to investigate the effects of cardiac rehabilitation teaching program on knowledge level and compliance of health behavior for the patients with myocardial infarction.
METHOD
The subjects were 47 patients 23 were assigned to the experimental group and 24 were for the control. The cardiac rehabilitation teaching program is a individualized teaching program which was delivered to the experimental group during hospitalization period by present researcher. Data were collected through questionnaire surveys for knowledge level and compliance of health behavior from September 15, 1999 to December 31, 2000. The collected data was analyzed by using the SAS program.
RESULTS
1. With regard to the knowledge scores 1) The total knowledge level in the experimental group was significantly higher than in the control group. 2) As to the knowledge domains, nature of disease, risk factors, diet, medication, exercise, and daily activities were significantly higher in score in the experimental group than in the control group. 2. With regard to the compliance of health behavior 1) The average compliance with good health behavior was significantly higher in the experimental group than in the control group. 2) As to the health behavior domains smoking cessation, diet, stress management, regular exercise, and other measures for lifestyle modification were significantly higher in score in the experimental group than in the control group. 3. The pre-treatment knowledge score was positively correlated to the post-treatment knowledge score and post-treatment knowledge score was positively correlated to the post-treatment compliance of health behaviors.
CONCLUSION
The above findings indicate that the cardiac rehabilitation teaching program for the experimental group was effective in increasing level of knowledge and improvement f compliance with good health behavior of patients with myocardial infarction.
Citations
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.
Citations
Many patients of acute myocardial infarction showed delay time before seeking treatment although they needed immediate thrombolytic therapy once they perceived their symptoms. The objectives of this study were to identify the relationship between clinical symptoms and the delay, and to find the time spent before seeking the treatment. This study was a retrospective research. The delay time for the treatment consisted of the length of delay from symptom onset to patients' decision (T1), from patients' decision making to finding transportation (T2), and from taking transportation to the first hospital arrival(T3). The subjects were 89 patients who were admitted in the ICU and Cardiac Ward at Chonnam University Hospital with the first attack of acute myocardial infarction. The data was collected for three months from March 1st to May 31st of 1998 through questionnaires and reviewing patients' charts: The chart information was suppled by two nurses working at the ICU and Cardiac Ward. The data was analyzed by using frequency, mean and ANOVA through the SAS program. The results of study summarized as follows: 1. Sixty two patients (69.7%) were male and twenty seven patients (30.3%) were female, the ratio of male to female was 2.3 : 1. 2. In daily life, the 70.8% of the patients felt chest pain and discomfort fatigue in 67.4%, dyspnea in 57.3%, and pain in arm, neck, and jaw in 52.8%. During the attack, 97.8% of the patients felt chest pain and discomfort dyspnea in 82.1%, pain in arm, neck, jaw in 67.4% and perspiration in 51.7%. 3. The length of time a patient spent seeking time for treatment (T1+T2+T3) was 94.6 minutes, in which the time for patients' decision making for treatment (T1) was 70.3 minutes, time for finding transportation (T2) was 8.2 minutes, and time for the transportation of the patient to the first hospital (T3) was 16.1 minutes. Time for patients' decision making to go to a hospital(T1) was 74.2% of the total time sought for treatment.
Citations
The main purposes of this study were to determine the interval between the onset of symptoms of myocardial infarction and treatment-seeking time and identify the factors related to the interval time. This study used a retrospective design, The sample consisted of 45 patients aged over 30 who were diagnosed with an acute myocardial infarction at two large university affiliated medical center from September 1, 1997 to June 30, 1998. Data was collected by using questionnaires, which included demographic data, premonitory clinical signs and symptoms of myocardial infarction, and a measure of the severity of the signs and symptoms. Also semi-structured interviews and chart reviews were used to obtain information related to treatment seeking time. The results of this study are summarized as follows: 1. The most frequent premonitory clinical symptom was chest pain(92.9%), the second, was perspiration(81.0%), and the next were nausea(40.5%) and dyspnea(38.1%). Thirty two patients reported having more than four premonitory signs and symptoms. Patients described the characteristics of chest pain as "something very heavy pressing down "(26.2%), "felt like my chest would burst"(24.4%), or "sharp pain"(16.7%). Over 95% of the sample reported having chest pain. 2. Twenty two (52.4%) patients reported to have "very severe" premonitory pain. 3. The mean time interval between the onset of signs and symptoms and the arrival at the medical center was 6.39+/-0.80 hours in 42 samples, the mean time from the onset to arrival at a local hospital was 3.27+/-.39 hours and for transfer from a local hospital to the medical center was 4.75+/-.87 hours in patients who had arrived at medical center via local hospital. 4. The severity of premonitory signs and symptoms did not differ significantly according to existence of premonitory signs and symptoms. 5. There was no significant relationship between treatment-seeking time and age, gender, marital status, economic status, occupation, or residence. But education had significant relationship(r=-0.51, p=0.01). Analysis of difference of the time interval according to the premonitory signs and symptoms showed that the time was shorter in patients who experienced nausea or dysnea(U=115.50, p=0.01, U=132.00, p=0.04), however the severity of premonitory signs and symptoms did not have statistical significance.
Citations
1) To identify the time taken from symptom onset to the arrival at the hospital (pre-hospital delay time) and time taken from the arrival at the hospital to the initiation of the major treatment (in-hospital delay time) 2) to examine whether rapid treatment results in lower mortality. 3) to examine whether the pre- and in-hospital delay time can independently predict in-hospital mortality.
A retrospective study with 586 consecutive AMI patients was conducted.
Pre-hospital delay time was 5.25 (SD=10.36), and in-hospital delay time was 1.10 (SD=1.00) hours for the thrombolytic therapy and 50.24 (SD=121.18) hours for the percutaneous transluminal coronary angioplasty(PTCA). In-hospital mortality was the highest when the patients were treated between 4 to 48 hours after symptom onset using PTCA (rho=.02), and when treated between 30 minutes and one hour after hospital arrival using thrombolytics (rho=.01). Using a hierarchical logistic regression model, the pre- and in-hospital delay times did not predict the in-hospital mortality.
Pre- and in-hospital delay times need to be decreased to meet the desirable therapeutic time window. Thrombolytics should be given within 30 minutes after arrival at the hospital, and PTCA should be initiated within 4 hours after symptom onset to minimize in-hospital mortality of AMI patients.
Citations
The purpose of this study was to determine whether a relaxing music was effective in reducing stress response of patients admitted to a coronary care unit with the diagnosis of acute myocardial infarction.
The research design was the chosen convenience sample of a randomized control group pre-posttest quasi- experimental design. Forty patients, 20 for an experimental group and another 20 for control group. The study was to provide the patients three different kinds of relaxing music. The experimental group listened to relaxing music for a 20-minute one time a day for 3days. The control group was just provided with a 20-minute period of rest. Test for hypothesis was done by repeated measured ANOVA.
The experimental group which received relaxing music showed a significantly lower level of electrodermal response, myocardial oxygen consumption and respiration rate, and a higher level of peripheral skin temperature than the control group. The experimental group which received relaxing music showed a significant reduction in state anxiety than the control group.
The results showed that relaxing music is an effective nursing intervention for reducing physiologic and psychologic stress response of the patients with acute myocardial infarction in a critical intensive care unit.
Citations
This research was done to identify the hospital arrival rate and factors related to prehospital delay in arriving at an emergency medical center within the golden time after symptom onset in patients with acute myocardial infarction (AMI).
Data used in the research was from the National Emergency Department Information System of the National Emergency Medical Center which reported that in 2014, 9,611 patients went to emergency medical centers for acute myocardial infarction. Prehospital time is the time from onset to arrival at an emergency medical center and is analyzed by subdividing arrival and delay based on golden time of 2 hour.
After onset of acute myocardial infarction, arrival rate to emergency medical centers within the golden time was 44.0%(4,233), and factors related to prehospital delay were gender, age, region of residence, symptoms, path to hospital visit, and method of transportation.
Results of this study show that in 2014 more than half of AMI patients arrive at emergency medical centers after the golden time for proper treatment of AMI. In order to reduce prehospital delay, new policy that reflects factors influencing prehospital delay should be developed. Especially, public campaigns and education to provide information on AMI initial symptoms and to enhance utilizing EMS to get to the emergency medical center driectly should be implemented for patients and/or caregivers.
Citations
This study was done to identify effects of a smoking cessation program including telephone counseling and text messaging using stages of change for outpatients who have had a myocardial infarction (MI).
This research was a quasi-experimental design with a nonequivalent control group pretest-posttest. The participants were 48 outpatients (experimental group=24, control group=24) recruited from one university hospital. They were randomly assigned to one of two groups: (a) an experimental group with telephone counseling (once a week) and text messaging (five times a week) using stages of change, and (b) a control group with traditional telephone counseling (once a month). Efficacy of the intervention was measured by comparing the two groups on smoking-related variables at 3 weeks and 12 weeks.
At the 3-week and 12-week measurements, there were significant differences between the experimental and control groups on smoking cessation self-efficacy (
The results indicate that the smoking cessation program including telephone counseling and text messaging using stages of change is effective for outpatients after a MI. Further attention should be paid to the intensity of the smoking cessation program and periods for long-term follow-up.
Citations
This study was conducted to examine and compare clinical manifestations and predicting factors for treatment-seeking delay among patients <65 and ≥65 yr with first-time acute coronary syndrome (ACS).
A total of 288 patients who were diagnosed with ACS were individually interviewed at C university hospital in G-city from November 2007 to December 2008.
Median pre-hospital delays for younger and older patients were 5 and 12 hr, respectively. Younger patients were more likely to be current smokers, heavy drinkers, obese, stressed, and have an unhealthy diet and family history, and to complain of chest pain, left shoulder and arm pain, perspiration, and nausea. Older patients were more likely to have hypertension and diabetes, and to complain syncope and dyspnea. Logistic regression analyses showed that after adjustment for age, gender and education, progressive onset of symptom and no attribution to cardiac problem significantly predicted pre-hospital delay >3 hr in both younger and older patients. Low perceived health status was a significant independent predictor in older patients only.
Health care providers should be concerned with different manifestations between younger and older adults, and educate people at risk for heart attack about symptoms and actions to get immediate help.
Citations