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- Herlitz, Johan, et al.
(författare)
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Follow-up of a 1-year media campaign on delay times and ambulance use in suspected acute myocardial infarction
- 1992
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 13:2, s. 171-177
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Tidskriftsartikel (refereegranskat)abstract
- In order to reduce the delay times from onset of symptoms to arrival in hospital, and increase the use of ambulance in patients with suspected acute myocardial infarction (AMI), a media campaign was initiated in an urban area. An initial 3-week intense campaign was followed by a maintenance phase of 1 year. Delay times and ambulance use during the campaign were compared with the previous 21 months. Among patients admitted to a coronary care unit (CCU) due to suspected AMI, the median delay time was reduced from 3 h to 2 h 40 min and the mean delay time was reduced from 11 h 33 min to 7 h 42 min (P <0.001). Among patients with confirmed AMI the median delay time was reduced from 3 h to 2 h 20 min and the mean delay time from 10 h to 6 h 27 min (P <0.001). We conclude that a 1-year media campaign can reduce delay times in suspected AMI, and that this effect appears to continue at 1 year, but ambulance use seems to be more djfficult to influence.
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- Berglin Blohm, Marianne, et al.
(författare)
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A media campaign aiming at reducing delay times and increasing the use of ambulance in AMI.
- 1994
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Ingår i: The American journal of emergency medicine. - : W.B. Saunders Co.. - 0735-6757 .- 1532-8171. ; 12:3, s. 315-8
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Tidskriftsartikel (refereegranskat)abstract
- To improve the prognosis in patients with acute myocardial infarction (AMI) if treatment by early instituting treatment, we initiated a media campaign during 1 year with the intention to reduce delay times and increase ambulance use in patients with acute chest pain. This article describes the outcome during 3 years after the campaign was finished. The median delay time in patients with AMI was reduced from 3 hours 0 min before the campaign to 2 hours 20 minutes during the year of the campaign (P < .001). The median delay time remained at a similar level (2 hours 20 min) during the 3 years after the campaign. Ambulance use was not affected during or after the campaign. It can be concluded that a media campaign resulted in a reduction of delay times not only during the campaign, but also during 3 years after its performance, whereas ambulance use was not affected.
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- Herlitz, Johan, 1949, et al.
(författare)
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Delay time between onset of myocardial infarction and start of thrombolysis in relation to prognosis.
- 1993
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 82:5, s. 347-53
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Tidskriftsartikel (refereegranskat)abstract
- In 292 patients with suspected acute myocardial infarction given thrombolytic agents, we describe the delay time between the onset of pain and the start of thrombolysis and relate the observations to the prognosis. In 3%, treatment was started 1 h or less and in 22% 2 h or less after onset of symptoms. The median delay time between onset of symptoms and arrival in hospital was 1 h 38 min, and the median delay time between the arrival in hospital and start of thrombolysis was 1 h 25 min. A very strong association between delay time to thrombolysis and mortality during 2 weeks and 1 year of follow-up was observed.
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- Herlitz, Johan, 1949, et al.
(författare)
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Impact of early thrombolysis on chest pain score reflecting myocardial ischemia in relation to various markers of ischemic damage. TEAHAT Study Group.
- 1993
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Ingår i: International journal of cardiology. - : Elsevier Ireland Ltd. - 0167-5273 .- 1874-1754. ; 41:2, s. 123-31
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Tidskriftsartikel (refereegranskat)abstract
- We randomized 352 patients with pain suggestive of acute myocardial infarction who were seen less than 3 h after onset of symptoms to either tissue plasminogen activator or placebo. The impact of treatment on chest pain score was assessed during the first 24 h and related to limitation of final myocardial damage as assessed by various indirect markers. The most marked effect of tissue plasminogen activator was observed in the chest pain score being reduced by 43% in the tissue plasminogen activator group as compared with placebo. Limitation of infarct size with tissue plasminogen activator reached the following percentage values when various methods were used: maximum serum lactate dehydrogenase I activity, 32%; vectorcardiography (QRS vector difference), 20%; electrocardiography (Palmeri score), 20%; ejection fraction, 9%. We conclude that early thrombolysis in acute myocardial infarction reduces the severity of chest pain by nearly 50%. The effect on chest pain is much more marked as compared with the effect on various markers of the final ischemic damage.
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- Herlitz, Johan, 1949, et al.
(författare)
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Mortality and morbidity 1 year after early thrombolysis in suspected AMI: results from the TEAHAT Study.
- 1991
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Ingår i: Journal of internal medicine. Supplement. - : Journal of Internal Medicine. - 0955-7873. ; 734:suppl 1, s. 43-51
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Tidskriftsartikel (refereegranskat)abstract
- We randomized 352 patients with suspected acute myocardial infarction (AMI) to treatment with rt-PA (n = 177) or placebo (n = 175). Patients were eligible if evaluated within 2 h and 45 min from onset of chest pain, and if aged less than 75 years. There were no ECG criteria for inclusion. A mobile coronary-care unit with a cardiologist present was used to initiate treatment at home in 29% of cases. During 1 year of follow-up the mortality in patients treated with rt-PA was 10.2%, as compared with 14.3% in patients the initial ECG, the mortality during the first year was 8% in the rt-PA group vs. 18% in the placebo group (P less than 0.05). Among patients without ST-elevation the mortality was 9% for the rt-PA group vs. 12% for the placebo group (NS). Requirement for rehospitalization, symptoms of angina pectoris and congestive heart failure, time of return to work and requirement for various medications did not differ significantly between the two groups, regardless of the initial ECG pattern.
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- Herlitz, Johan, 1949, et al.
(författare)
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Occurrence of hypotension during streptokinase infusion in suspected acute myocardial infarction, and its relation to prognosis and metoprolol therapy.
- 1993
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Ingår i: The American journal of cardiology. - : Elsevier, Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 71:12, s. 1021-4
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Tidskriftsartikel (refereegranskat)abstract
- In all patients who received streptokinase infusion for strongly suspected acute myocardial infarction in 1 hospital during 1989 to 1990, the occurrence of hypotension during infusion is described and related to prognosis. In 54% of patients, the beta blocker metoprolol was simultaneously administered intravenously. The median systolic blood pressure (BP) before infusion was 135 mm Hg, and the median value for the lowest systolic BP recorded during infusion was 100 mm Hg (p < 0.001). A positive correlation between systolic BP before streptokinase and the lowest systolic BP during infusion was found (r = 0.53; p < 0.001). Among patients administered streptokinase and metoprolol, 23% had systolic BP < 90 mm Hg, and 12% had < 80 mm Hg at any time during infusion; corresponding values for patients administered streptokinase only were 47 and 30%, respectively. Patients with the lowest systolic BP < 80 mm Hg during infusion had a mortality during the first 2 weeks of 22 vs 11% for those with between 80 and 100 mm Hg, and 8% for those with > 100 mm Hg (p < 0.001). However, in a multivariate analysis the systolic BP before infusion rather than the lowest systolic BP during infusion was independently associated with death. It is concluded that although patients with low systolic BP during streptokinase infusion have a high mortality, the level of systolic BP before infusion is more strongly associated with the outcome. Simultaneous use of intravenous beta blockade does not increase the occurrence of hypotension during streptokinase infusion.
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