| 1. |
- Herlitz, Johan, et al.
(författare)
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A description of the characteristics and outcome of patients hospitalized for acute chest pain in relation to whether they were admitted to the coronary care unit or not in the thrombolytic era
- 2002
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 82:3, s. 279-287
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Tidskriftsartikel (refereegranskat)abstract
- bjectives: To describe the characteristics and outcome of patients hospitalized for acute chest pain in relation to whether they were admitted to the coronary care unit (CCU) or not. Design: Prospective observational study with a follow-up of 2 years. Setting: Sahlgrenska University Hospital in Göteborg, Sweden. Subjects: All patients hospitalized due to acute chest pain during 6 months. Main outcome measures: Mortality, use of medical resources, complications and previous history. Results: In all 1.592 patients were admitted to hospital for chest pain, of whom 1.136 (71%) were not directly admitted to the CCU. These patients differed from those directly admitted to the CCU, being older, including more women, having a higher prevalence of known congestive heart failure and a lower degree of initial suspicion of acute myocardial infarction (AMI). Among all patients with confirmed AMI only 58% were directly admitted to CCU. Overall, the occurrence of complications and the use of medical resources were less frequent in the patients not admitted to the CCU. The mortality during the subsequent 2 years was 16.8% for patients not admitted to the CCU and 18.5% for patients admitted to the CCU. When adjusting for various factors at baseline, patients admitted to the CCU had a relative risk of death during 2 years of follow-up being 1.23 0.87–1.73 (P=0.24) as compared with those not admitted to the CCU. Conclusion: In a Swedish university hospital, more than two thirds of patients hospitalized for acute chest pain were not directly admitted to the CCU. They differed from those admitted to the CCU in several aspects. However, their unadjusted and adjusted mortality during the subsequent 2 years did not significantly differ from those admitted to CCU.
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| 2. |
- Karlson, BW, et al.
(författare)
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Use of medical resources complications and long-term outcome in patients hospitalized with acute chest pain. A comparison between a city university hospital and a county hospital
- 2002
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Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 85:2-3, s. 229-238
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The primary aim was to test the hypothesis that there is a difference in long-term outcome after hospital discharge among patients hospitalized with acute chest pain in a university hospital and a county hospital. Secondary aims were to compare these two hospitals with regard to use of medical resources, occurrence of complications and risk indicators for death. Patients: All patients hospitalized at Sahlgrenska University Hospital in Göteborg (with a catchment population of 706 inhabitants/km2) and Uddevalla County Hospital (with a catchment population of 34 inhabitants/km2) due to symptoms of acute chest pain during a period of 6 months. Results: Complications, use of medical resources and mortality during the subsequent 2 years after discharge were compared among 1592 hospitalizations in a city hospital and 822 in a county hospital due to acute chest pain. Angina pectoris after the first event, congestive heart failure and various arrhythmias were more frequently reported in the county hospital. The use of medical resources differed. Thus, the use of betablockers, heparin, antiarrhythmics, diuretics and nipride was more frequent in the county hospital, whereas the use of nitrates, digitalis, coronary angiography, percutaneous transluminal coronary angioplasty (PTCA) and coronary artery bypass grafting (CABG) was more frequent in the city hospital. Despite these differences, the mortality 2 years after hospital discharge was similar (14.7% in the city hospital and 12.8% in the county hospital, P=0.26). Two factors, intravenous digitalis in hospital and a prescription of insulin at discharge, were significantly more associated with death in the county hospital compared with the city hospital. Conclusions: When comparing a city university hospital with a county hospital with regard to patients admitted with chest pain, major differences in terms of complications and use of medical resources were found. Thus, various complications were reported more frequently in the county hospital. The use of medical resources varied, some being used more frequently in the county hospital, whereas others were used more frequently in the university hospital. Despite these differences the mortality 2 years after hospital discharge was similar in the two cohorts.
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| 3. |
- Herlitz, Johan, et al.
(författare)
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Factors of importance for patients' decision time in acute coronary syndrome
- 2010
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Ingår i: International Journal of Cardiology. - Amsterdam : Elsevier. - 0167-5273 .- 1874-1754. ; 141:3, s. 236-242
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Not much is known about the patients' decision time in acute coronary syndrome (ACS). The aim of the survey was therefore to describe patients' decision time and factors associated with this parameter in ACS. METHODS: We conducted a national survey comprising intensive cardiac care units at 11 hospitals in Sweden in which patients with ACS diagnosis and symptoms onset outside hospital participated. Main outcome measures were patients' decision time and factors associated with patients' decision time. RESULTS: In all, 1939 patients took part in the survey. The major factors associated with a shorter patient decision time were: 1) ST-elevation ACS, 2) associated symptoms such as vertigo or near syncope, 3) interpreting the symptoms as cardiac in origin, 4) pain appearing suddenly and reaching a maximum within minutes, 5) having knowledge of the importance of quickly seeking medical care and 6) experiencing the symptoms as frightening. The following aspects of the disease were associated with a longer decision time: 1) pain was localised in the back and 2) symptom onset at home when alone. CONCLUSION: A number of factors, including the type of ACS, the type and localisation of symptoms, the place where symptoms occurred, patients' interpretation of symptoms and knowledge were all associated with patients' decision time in connection with ACS.
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| 4. |
- Svensson, L., et al.
(författare)
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Are predictors for myocardial infarction the same for women and men when evaluated prior to hospital admission?
- 2006
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Ingår i: Int J Cardiol. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 109:2, s. 241-7
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To describe predictors of myocardial infarction prior to hospital admission in women and men among patients with a suspected acute coronary syndrome without ST-elevation. DESIGN: Prospective observational study in Stockholm and Goteborg, Sweden. RESULTS: Of 433 patients who did fulfill the inclusion criteria 45% were women. Fewer women (17%) than men (26%) developed acute myocardial infarction (AMI) (p=0.054), particularly among patients with initial ST-depression, in whom AMI was developed in 22% of women and 54% of men (p = 0.001). Predictors for infarct development in women were: a history of AMI and advanced age. Among men they were: initial ST-depression or a Q-wave on ECG and elevation of biochemical markers (both recorded on admission of the ambulance crew). There was a significant interaction between gender and the influence of ST-depression on the risk for development of myocardial infarction (p < 0.05). CONCLUSION: Among patients transported with ambulance due to a suspected acute coronary syndrome and no ST-elevation fewer women than men seem to develop AMI particularly among patients with ST-depression. These results suggest that early prediction of myocardial infarction might differ between women and men with acute chest pain.
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| 5. |
- Svensson, L., et al.
(författare)
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Prehospital identification of acute coronary syndrome/myocardial infarction in relation to ST elevation
- 2005
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Ingår i: Int J Cardiol. - : Elsevier BV. - 0167-5273 .- 1874-1754. ; 98:2, s. 237-44
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To evaluate factors that identify patients with an acute coronary syndrome/myocardial infarction prior to hospital admission among patients with a suspected acute coronary syndrome who were transported by ambulance with and without ST elevation on the ambulance electrocardiogram (ECG). METHODS: This was a prospective observational study in the part of Stockholm that is served by South Hospital ambulance organisation and the Municipality of Goteborg. All the patients who called for an ambulance due to acute chest pain or other symptoms raising the suspicion of an acute coronary syndrome took part. Immediately after the arrival of the ambulance, a blood sample was drawn for the analysis of serum myoglobin, creatine kinase (CK) MB and troponin I. A 12-lead ECG was simultaneously recorded. Further factors that were taken into consideration were age, gender, history of cardiovascular disease, symptoms and clinical findings. RESULTS: In patients with ST elevation in prehospital ECG, the likelihood of an acute myocardial infarction increased if there were simultaneous ST depression in other leads (OR 3.94, 95% CL 1.26-12.38). For patients without an ST elevation, the likelihood of an acute myocardial infarction increased if there were: elevation of any biochemical marker OR 2.96, 95% CL 1.32-6.64; ST depression (OR 2.54, 95% CL 1.43-4.51), T-inversion (OR 2.22, 95% CL 1.10-4.48), male gender (OR 2.21, 95% CL 1.24-3.93) and increasing age (OR 1.04, 95% CL 1.01-1.06). CONCLUSION: Among patients with a suspected acute coronary syndrome, factors that increased the likelihood for an ongoing acute myocardial infarction could already be defined prior to hospital admission. For those with an ST elevation, factors were found in ECG pattern. For those without an ST elevation, such factors were found in elevation of biochemical markers, admission ECG, male gender and increasing age.
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