| 1. |
- Thomas, HS, et al.
(författare)
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- 2019
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swepub:Mat__t
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| 6. |
- Blohm, M, et al.
(författare)
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Reaction to a media campaign focusing on delay in acute myocardial infarction
- 1991
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Ingår i: Heart & Lung. - : Elsevier. - 0147-9563 .- 1527-3288. ; 20:6, s. 661-666
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Tidskriftsartikel (refereegranskat)abstract
- A media campaign conducted to reduce delay time and to increase the use of ambulance transport in acute myocardial infarction was performed in an urban area with about half a million inhabitants during 1 year. The main message was that chest pain lasting more than 15 minutes might indicate acute myocardial infarction; dial 90,000 immediately for ambulance transport to the hospital. The target population was the general public. After 6 and 12 months 400 and 610 randomly chosen persons, respectively, were contacted by telephone to evaluate the reaction of the general public to the campaign. Of these, 60% and 71%, respectively, had heard of the campaign, and all parts of the message were spontaneously remembered by 15% and 19%, respectively. The reaction to the campaign was generally positive. Among all patients admitted to the coronary care unit of one of the two city hospitals, 65% were aware of the campaign and 31% of them were of the opinion that they came to the hospital faster because of the campaign. In conclusion, a media campaign aimed at reducing patient delay time in acute myocardial infarction was shown to reach a majority of people in the community and patients with ischemic heart disease. The reaction was positive and about one fifth of interviewed people spontaneously remembered the total message.
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| 7. |
- Herlitz, Johan, et al.
(författare)
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Effect of media campaign on delay times and ambulance use in suspected acut myocardial infarction
- 1989
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Ingår i: American Journal of Cardiology. - : Excerpta Medica, Inc.. - 0002-9149 .- 1879-1913. ; 64:1, s. 90-93
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Tidskriftsartikel (refereegranskat)abstract
- The early phase in suspected acute myocardial infarction (AMI) is particularly critical. More than 50% of deaths from coronary artery disease occur outside the hospital mainly due to ventricular fibrillation.1 Recent experiences strongly indicate that early intervention with thrombolysis2–4 and β blockers5,6 can limit myocardial damage and thereby improve prognosis. Delay times in suspected AMI have remained stable over the years. Therefore, a media campaign was started in the urban area of Göteborg, Sweden, with the intention to shorten delay times and to increase ambulance use in patients with suspected AMI.
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| 8. |
- Herlitz, Johan, et al.
(författare)
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Effects of a media campaign to reduce delay times for acute myocardial infarction on the burden of chest pain patients in the emergency department
- 1991
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 79:2, s. 127-134
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Tidskriftsartikel (refereegranskat)abstract
- We evaluated the effect of a media campaign aimed at reducing delay times in suspected acute myocardial infarction (AMI) on the volume of chest pain patients seen in the emergency department. During the 1st week of the campaign, the mean number of chest pain patients increased from 10.5 per day prior to the start to 25.4. However, the number declined rapidly in subsequent months. The greatest increase was observed in patients with chest pain in whom AMI was not suspected on examination. During the campaign, 4,805 patients with chest pain appeared in the emergency department as compared with 4,407 patients during the same time period prior to its start, an increase of 9%. The number of patients with confirmed AMI increased from 595 to 629 (6%).
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| 9. |
- 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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| 12. |
- Risenfors, M, et al.
(författare)
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Early thrombolytic therapy in suspected acute myocardial infarction : role of the electrocardiogram: results from the TEAHAT Study
- 1991
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 734:suppl 1, s. 19-25
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Tidskriftsartikel (refereegranskat)abstract
- In a placebo-controlled trial in which rt-PA was administered to patients within 2 h and 45 min after the onset of symptoms indicative of acute myocardial infarction (AMI), 352 patients were randomized. Standard 12-lead electrocardiograms (ECGs) were recorded at inclusion and repeatedly during admission and at follow-up after 1 month and 1 year. In patients who presented with ST-segment elevation, the infarction rate was high (88%), whereas in patients without ST-elevation the infarction rate was low (21%), and infarct size, as assessed by serum enzyme activities, was small in this group. There were only minor differences between rt-PA- and placebo-treated patients with regard to ST-segment changes and Q-wave development, whereas the R-wave amplitude was higher after 1 month in patients who were given rt-PA. The infarction rate was not altered by rt-PA, but there was a shift towards a reduction in Q-wave infarction in patients who were treated with rt-PA. When a score system, as suggested by Palmeri et al., intended to reflect the ultimate infarct size, was applied, a significantly lower score was found in infarction patients who were treated with rt-PA as compared to placebo (3.95 +/- 0.35 vs. 2.95 +/- 0.29, P = 0.03), indicating limitation of infarct size. In summary, early treatment with rt-PA resulted in less frequent Q-wave infarction and a reduction in the electrocardiographically estimated infarct size.
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| 13. |
- Risenfors, M, et al.
(författare)
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Effect on early intravenous rt-PA on infarct size estimated from serum enzyme activity : results from the TEAHAT Study
- 1991
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 734:suppl 1, s. 11-18
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Tidskriftsartikel (refereegranskat)abstract
- In 319 patients who participated in a double-blind trial to evaluate the effect of early rt-PA administration compared to placebo in suspected acute myocardial infarction, infarct size was assessed from analyses of serum activity of lactate dehydrogenase isoenzyme 1 (LD 1). Treatment was always started less than 3 h after the onset of symptoms, with one-third of the patients' treatment being initiated outside the hospital. The maximum activity of LD 1 was reduced by 32%, from 13.3 mu kat l-1 in placebo to 9.0 mu kat l-1 in rt-PA treated patients (P = 0.001). A reduction in LD-1 activity after rt-PA treatment was restricted to patients with ST-elevation in the initial electrocardiogram, and was more pronounced in patients with previous ischaemic heart disease, above median age, and in those with a shorter delay in initiation of treatment. We conclude that very early intravenous treatment with rt-PA limits indirect signs of infarct size. The effect appears to be restricted to patients with ST-segment elevation in their initial electrocardiogram.
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| 14. |
- Risenfors, M, et al.
(författare)
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Effects on chest pain of early thrombolytic treatment in suspected acute myocardial infarction : results from the TEAHAT Study
- 1991
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 734:suppl 1, s. 27-34
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Tidskriftsartikel (refereegranskat)abstract
- In a randomized, double-blind study, in which recombinant tissue plasminogen activator (rt-PA) administered at an early stage was compared with placebo in patients with suspected acute myocardial infarction (AMI), the effects on pain were studied in 312 patients. Inclusion criteria were as follows: (a) chest pain of duration less than 2 h and 45 min; and (b) age less than 75 years. Chest pain was estimated subjectively by the patients, using a 10-point numerical rating scale, at hourly intervals for the first 24 h, and by the requirement for narcotic analgesics. Compared with placebo, rt-PA treatment resulted in a 43% reduction in mean total pain score (P less than 0.0001), a 26% reduction in pain duration (P less than 0.01), and a 33% reduction in morphine requirement (P = 0.01). Fifty-seven per cent of all patients developed a confirmed AMI. In these subjects rt-PA reduced the pain score by 46% (P less than 0.001). Among patients without confirmed AMI, a 37% reduction in pain score was observed (P = 0.05). The effect on pain was most marked in patients with ST-elevation on the initial ECG. We conclude that early treatment with rt-PA in suspected AMI reduces chest pain considerably. The effect is most marked in patients with ST-elevation on the initial ECG.
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| 15. |
- Berglin Blohm, M, et al.
(författare)
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An evaluation of the results of media and educational campaigns designed to shorten the time taken by patients with acute myocardial infarction to decide to go to hospital
- 1996
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Ingår i: Heart. - : BMJ Group. - 1355-6037 .- 1468-201X. ; 76:5, s. 430-434
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To describe the benefits and pitfalls of educational campaigns designed to reduce the delay between the onset of acute myocardial infarction (AMI) and its treatment. METHODS: All seven educational campaigns reported between 1982 and 1994 were evaluated. RESULTS: The impact on delay time ranged from a reduction of patient decision time by 35% to no reduction. One study reported a sustained reduction that resulted in the delay time being halved during the three years after the campaign. The use of ambulances did not increase. Only one study reported that survival was unaffected. There was a temporary increase in the numbers of patients admitted to the emergency department with non-cardiac chest pain in the initial phase of educational campaigns. CONCLUSION: The challenge of shortening the delay between the onset of infarction and the start of treatment remains. The campaigns so far have not been proved to be worthwhile and it is not certain that further campaigns will do better. New media campaigns should be run to establish whether a different type of message is more likely to change the behaviour of people in this life-threatening situation.
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| 16. |
- Berglin Blohm, M, et al.
(författare)
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Factors associated with prehospital and in-hospital delay time in acute myocardial infarction : a 6-year experience
- 1998
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 243:3, s. 243-250
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: To explore factors associated with delay time prior to hospital admission and in hospital amongst acute myocardial infarction (AMI) patients with particular emphasis on the delay time to the administration of thrombolytic therapy. METHODS: During a 6-year period we prospectively computerized pre-hospital and in-hospital time intervals for AMI patients admitted to the coronary care unit (CCU) direct from the emergency department (ED) or via paramedics, at Sahlgrenska Hospital, Göteborg, Sweden. RESULTS: Pre-hospital delay: independent predictors of a prolonged delay were increased age (P = 0.0007), female sex (P = 0.02) and a history of hypertension (P = 0.03). For AMI patients who received thrombolytic treatment and the only independent predictor of a prolonged delay was increased age (P = 0.005). In-hospital delay: for all AMI patients independent predictors of a prolonged delay were prolonged pre-hospital delay (P < 0.0001), increased age (P = 0.03) and a history of angina (P = 0.002), hypertension (P = 0.01) and diabetes (P = 0.01). For thrombolytic treated AMI patients independent predictors of a prolonged delay were prolonged pre-hospital delay (P < 0.0001), female sex (P = 0.02) and a history of diabetes (P = 0.02). CONCLUSION: Risk factors for both pre-hospital and hospital delay time could in AMI be defined although slightly different. Two factors appeared for both, i.e. increasing age and a history of hypertension.
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| 19. |
- From Attebring, M, et al.
(författare)
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Has the interest in secondary prevention increased among the physicians after the 4S study?
- 2000
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 34:2, s. 164-167
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Tidskriftsartikel (refereegranskat)abstract
- This study evaluates the occurrence of various risk indicators, with particular emphasis on serum lipids one year after a coronary event (development of acute mycoardial infarction (AMI); exposure to either coronary artery bypass grafting (CABG) or percutaneous transluminal coronary angioplasty (PTCA), prior to and after presentation of the main results from the 4S study. Patients under 70 years of age either hospitalized for AMI or undergoing CABG or PTCA at Sahlgrenska University Hospital in Göteborg were evaluated one year after the event. Patients who had an event during the period January 1, 1993 until December 31, 1993 were evaluated one year later (Period I) and those who had an event during the period September 1, 1995 until August 31, 1996 were evaluated one year thereafter (Period II). In total, 293 patients were evaluated during Period I and 284 during Period II. Mean total serum cholesterol levels fell from 6.2 mmol/l during Period I to 5.3 mmol/l during Period II (p < 0.001). The proportion of patients with serum cholesterol < or =5.0 mmol/l increased from 15% during Period I to 40% during Period II (p < 0.001). The mean low-density lipoprotein (LDL) levels fell from 4.0 mmol/l during Period I to 3.2 mmol/l during Period II (p < 0.001). The proportion of patients with LDL < or =3.5 mmol/l increased from 32% during Period I to 68% during Period II (p < 0.001). The proportion of patients using lipid-lowering drugs increased from 25% during Period I to 57% during Period II (p < 0.001). Among patients with coronary artery disease who had either developed AMI or undergone CABG or PTCA, a marked increase in the use of lipid-lowering drugs has been observed in a university hospital in Sweden after presentation of the results of the 4S study. Parallel to the increased use of lipid-lowering drugs, we observed a substantial lowering of serum lipids.
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| 20. |
- From Attebring, M, et al.
(författare)
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Risk indicators for recurrence among patients with coronary artery disease. Problems associated with their modification.
- 1998
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Ingår i: Scandinavian Cardiovascular Journal. - : Informa Healthcare. - 1401-7431 .- 1651-2006. ; 32:1, s. 9-16
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Tidskriftsartikel (refereegranskat)abstract
- Various risk indicators associated with recurrence of a new ischemic event among patients with coronary artery disease are described and the impact of the implementation of a secondary preventive program on such risk indicators is evaluated. At Sahlgrenska Hospital in Göteborg 293 consecutive patients under the age of 70 years were followed for one to two years after an acute myocardial infarction (AMI), coronary artery bypass grafting (CABG), or percutaneous transluminal coronary angioplasty (PTCA). Enrollment and follow-up began after institution of a secondary preventive program among physicians and nurses at the hospital. A secondary preventive nurse was appointed and guidelines for risk factor modification were provided. The lipid guidelines were rather modest, with hyperlipidemia defined as cholesterol > 6.5 mmol/l or triglycerides > 3.0 mmol/l. The mean value for low density lipoprotein (LDL) cholesterol was 3.96 mmol/l at first screening and 3.94 mmol/l at second screening. Smoking was modestly reduced, from 36% at first screening to 26% at second screening (p < 0.01) It was found that 70% of all the patients had one or more of the following risk indicators at the first screening: s-cholesterol > 6.5 mmol/l (30%), s-triglycerides > 3.0 mmol/l (19%), fasting blood glucose > 6.7 mmol/l (29%), systolic blood pressure > 160 mmHg (9%), diastolic blood pressure > 90 mmHg (8%) or smoking, compared with 67% one to two years later (p > 0.2). This is a clear demonstration of the difficulty in modifying risk indicators in patients, even with the aid of health-care professionals, in order to achieve risk-factor reduction in coronary artery disease.
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| 21. |
- Hartford, M, et al.
(författare)
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Components of delay time in suspected acute myocardinal infarction with particular emphasis on patient delay
- 1990
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Ingår i: Journal of Internal Medicine. - : Wiley-Blackwell Publishing Ltd.. - 0954-6820 .- 1365-2796. ; 228:5, s. 519-523
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Tidskriftsartikel (refereegranskat)abstract
- Two hundred and thirty-four patients admitted to a coronary care unit (CCU) were interviewed a few days after arrival in hospital to determine reasons for patient delay and the various components of total delay time from onset of symptoms to arrival in CCU. Of the three major components of delay, decision time (time from onset of symptoms to decision to go to hospital), and hospital procedure time (time from arrival in hospital to arrival in the CCU), were of the same magnitude, 1 h 15 min and 1 h 30 min (median), whereas the median time for preparation and transportation to hospital was somewhat shorter, being 45 min. Decision time appeared to be similar in patients with confirmed and non-confirmed acute myocardial infarction (AMI) and was not associated with intensity of pain or infarct size. Half of the patients hesitated to go to hospital, which resulted in a prolonged decision delay (3 h). It is concluded that patient indecision to seek medical help is the most important reason for delay in hospital arrival in patients with suspected AMI.
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| 22. |
- Hartford, M, et al.
(författare)
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Symptoms, thoughts and environmental factors in suspected acute myocardial infarction
- 1993
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Ingår i: Heart & Lung. - : Elsevier. - 0147-9563 .- 1527-3288. ; 22:1, s. 64-70
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: To increase our understanding of patients' reactions and behavior at onset of symptoms of myocardial infarction. PROCEDURE: During a 5-month period a questionnaire focusing on symptoms, thoughts, and environmental factors at onset of symptoms was administered to all patients admitted to the coronary care unit at Sahlgrenska Hospital in Göteborg, Sweden, because of suspected acute myocardial infarction. RESULTS: A myocardial infarction developed in 48% of the 226 patients answering the questionnaire. In 81% of the patients, chest pain was the main symptom bringing them to the hospital. Forty-three percent characterized their symptoms as an oppression or uncomfortable feeling. Eighty-five percent suspected that the pain emanated from the heart, and yet 51% hesitated to go to the hospital, mainly because they expected the pain to disappear. Efforts to relieve pain were made by 63%, (mostly with nitroglycerin), which was taken more often by patients who did not subsequently develop a myocardial infarction than by those who did. Only 50% of the patients used an ambulance for transportation to hospital. There was a significant relation between subjective assessment of severity of symptoms and 1-year mortality (p < 0.05) and rehospitalization rate (p < 0.01), respectively. CONCLUSION: The majority of patients seem to interpret the symptoms of a myocardial infarction correctly and also have a correct perception of the severity of symptoms. For only a few is the natural next step to immediately call for an ambulance to get to the hospital.
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| 23. |
- Herlitz, Johan, et al.
(författare)
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Delay time in suspected acute myocardial infarction and the importance of its modification
- 1989
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Ingår i: Clinical Cardiology. - : John Wiley & Sons, Inc.. - 0160-9289 .- 1932-8737. ; 12:7, s. 370-374
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Tidskriftsartikel (refereegranskat)abstract
- This paper summarizes the present knowledge of delay time in suspected acute myocardial infarction. More than 50% of deaths in acute myocardial infarction occur outside of the hospital setting. Recent experiences indicate that early and even late mortality can be dramatically reduced by intervention in the early phase. This points up the importance of bringing patients with suspected acute myocardial infarction to the hospital as early in the course of MI as possible. The predominating cause of delay is the time it takes for the patient to decide to go to hospital regardless of a previous history of cardiovascular disease. Patients arriving in hospital in later stages of MI are at a very high risk of mortality. Therefore one of the most important problems to be resolved is how to reduce delay time in suspected acute myocardial infarction. Such efforts have been surprisingly few. Limited experiences indicate that public education can reduce delay time dramatically.
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| 24. |
- Herlitz, Johan, et al.
(författare)
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Determinants of an impaired quality of life five years after coronary artery bypass surgery
- 1999
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Ingår i: Heart. - : B M J Group. - 1355-6037 .- 1468-201X. ; 81:4, s. 342-346
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE—To identify determinants of an inferior quality of life (QoL) five years after coronary artery bypass grafting (CABG). SETTING—University hospital. PARTICIPANTS—Patients from western Sweden who underwent CABG between 1988 and 1991. MAIN OUTCOME MEASURES—Questionnaires for evaluating QoL before CABG and five years after operation. Three different instruments were used: the Nottingham health profile (NHP), the psychological general wellbeing index (PGWI), and the physical activity score (PAS). RESULTS—2121 patients underwent CABG, of whom 310 died during five years' follow up. Information on QoL after five years was available in 1431 survivors (79%). There were three independent predictors for an inferior QoL with all three instruments: female sex, a history of diabetes mellitus, and a history of chronic obstructive pulmonary disease. Multivariate analysis showed that a poor preoperative QoL was a strong independent predictor for an impaired QoL five years after CABG. An impaired QoL was also predicted by previous disease. CONCLUSIONS—Female sex, an impaired QoL before surgery, and other diseases such as diabetes mellitus are independent predictors for an impaired QoL after CABG in survivors five years after operation.
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| 25. |
- Herlitz, Johan, et al.
(författare)
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Diagnostic accuracy of physicians for identifying patients with acute myocardial infarction without an electrocardiogram. Experiences from the TEAHAT trial
- 1995
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Ingår i: Cardiology. - : S. Karger AG. - 0008-6312 .- 1421-9751. ; 86:1, s. 25-27
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To determine the diagnostic accuracy of physicians for identifying patients with acute myocardial infarction (AMI) without an electrocardiogram (ECG). PATIENTS: All patients in Göteborg with suspected AMI below 75 years of age who called for an ambulance or came directly to one of the two city hospitals with a delay time of less than 2 h 45 min from the start of symptoms. METHODS: As part of the TEAHAT study (comparing rt-PA and placebo in AMI), we asked physicians to judge on a 1-5 scale (1 = no suspicion; 5 = convinced) how strong their suspicion of AMI was prior to interpreting the ECG. RESULTS: Among patients evaluated outside hospital with 4 or 5 on the scale, i.e. either a strong suspicion of AMI or the physician felt convinced about the diagnosis, 45% had ST elevation and 48% developed AMI during the first 3 days in hospital. The corresponding values for patients evaluated in hospital were 67 and 70%, respectively. CONCLUSION: We found that physicians could not accurately distinguish patients with AMI from those without based on clinical criteria without the help of an ECG.
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