| 1. |
- Ravn-Fischer, A, et al.
(författare)
-
Prehospital ECG signs of acute coronary occlusion are associated with reduced one-year motality
- 2013
-
Ingår i: International Journal of Cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 168:4, s. 3594-3598
-
Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We wanted to evaluate predictors of direct admittance to a coronary care unit (CCU) and predictors of death in patients with suspected acute coronary syndromes (ACS). METHODS: During 2004-2007, all consecutive prehospitally triaged patients with suspected ACS were prospectively included. Prehospital and emergency data were collected at point of care. Data from medical records, ECG-, echocardiography- and laboratory databases was collected retrospectively. RESULTS: In all, 2757 patients were included. Out of these 858 were directly admitted to the CCU or cath/lab. Predictors for direct admittance to the CCU were ST-segment elevation on the initial ECG; odds ratio (OR) 46.11, left bundle branch block; OR 3.30, ongoing symptoms; OR 2.90, current smoking; OR 2.18 and ST-segment depression; OR 2.05. Independent predictors for 1-year mortality were cardiogenic shock; OR 14.40, increasing age OR (per year) 1.08, diabetes; OR 2.09 and chronic heart failure; OR 1.67. ST-segment elevation was associated with a lower 1-year mortality rate; OR 0.52. CONCLUSIONS: Among patients with a suspected ACS, prehospital ECG-signs indicating an acute coronary occlusion were not only a predictor for direct admission to acute coronary care but also a predictor for increased survival. To improve future outcome in acute ischemic heart diseases we must find and treat not only the STEMI's but also the high-risk NSTEMIs that otherwise would have a poor prognosis.
|
|
| 2. |
- Santos, Marco, 1978, et al.
(författare)
-
Is early treatment of ac ute chest pain provided sooner to patients who speak the national language
- 2013
-
Ingår i: International Journal for Quality in Health Care. - : Oxford University Press. - 1353-4505 .- 1464-3677. ; 25:5, s. 582-589
-
Tidskriftsartikel (refereegranskat)abstract
- Objective Identify differences in the early treatment of acute chest pain patients with regard to the language proficiency of patients and thus identify opportunities for improving equity in cardiac care. Design Retrospective cross-sectional study comparing care delivered to Swedish-speaking (SS) and non-Swedish-speaking (NSS) patients. Setting A Swedish university hospital that provides highly specialized care to 1.6 million inhabitants. Participants All patients with acute chest pain or symptoms suggestive of acute coronary syndrome who sought care between mid-September and mid-December 2008 (2588 visits). Missing data on the patient group to which study subjects belonged were 2% (45 visits). NSS represented 8% of the 2543 visits (NSS = 2334; NNSS = 209). Main Outcome Measure(s) Delay times from arrival in hospital to admission to catheterization laboratory or ward (ΔTHOSP-PCI), first physical contact to first electrocardiogram (ΔTCONTACT-ECG), first physical contact to first aspirin (ΔTCONTACT-ASA) and arrival in hospital to coronary angiography (ΔTHOSP-ANGIO). Also included baseline characteristics of patients, diagnosis and findings in hospital and secondary preventive activities. Results The median ΔTHOSP-PCI was longer for NSS by 43 min [254 versus 211, 95% confidence interval (CI), odds ratio (OR) = (1.3; 2.8)]. The median ΔTCONTACT-ECG and ΔTHOSP-ANGIO were longer for NSS by 4 min [17 versus 13, 95% CI, OR = (0.8; 1.8)] and 14 h [44 versus 30, 95% CI, OR = (0.6; 3.6)], respectively. Conversely, the median ΔTCONTACT-ASA was longer for SS by 20 min [81 versus 61, 95% CI, OR = (0.3; 1.6)]. Conclusions Poorer language proficiency was associated with longer delay time from arrival in hospital to admission to catheterization laboratory or ward. No other delay times were found to be statistically significantly different with respect to the language proficiency of patients.
|
|
