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- 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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| 3. |
- 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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| 4. |
- 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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| 7. |
- Luepker, RV, et al.
(författare)
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Differences in the treatment of acute myocardial infarction between regions of countries and the impact on prognosis
- 1999
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Ingår i: Journal of Cardiovascular Risk. - : Sage Publications Ltd.. - 1350-6277 .- 1473-5652. ; 6:2, s. 77-98
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Tidskriftsartikel (refereegranskat)abstract
- Differences in the incidence, prevalence of and mortality from coronary heart disease (CHD) are observed between and within countries. These differences are believed to be related to differing levels of CHD risk factors and medical care. Medical care for acute myocardial infarction has changed significantly in the past decades, with the development of new methods for diagnosis and treatment. Although widely known, these technologies are not consistently applied for reasons of availability and cost, as well as local medical cultures and traditions. The outcomes of medical care for acute myocardial infarction are best measured by case fatality of those hospitalized. Since the early 1960s, case fatality has fallen to less than half that observed previously. This has occurred in the context of widespread use of coronary care unit monitoring, innovative pharmacologic agents and invasive reperfusion treatments. A common debate compares aggressive invasive management with more conservative pharmacologic methods. In this context, studies have produced mixed results with no clear advantage to one approach when both methods are available and effectively applied to appropriately selected patients.
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| 8. |
- Luepker, RV, et al.
(författare)
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Strategies for change : Public education
- 1991
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Ingår i: Proceedings of the National Heart, Lung and Blood Institute Symposium on Rapid Identification and Treatment of Acute Myocardial Infarction: Issues and Answers. - : DIANE Publishing Company. - 0788128256 ; , s. 117-121
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Konferensbidrag (refereegranskat)
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| 9. |
- Smith, LG, et al.
(författare)
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International comparision of treatment and long-term outcomes for acute myocardial infarction in the elederly : Minneapolis/St Paul, MN, USA and Goteborg, Sweden
- 2013
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 34:41, s. 3191-3197
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: International studies provide an opportunity to compare treatment approaches and outcomes. The present study compares elderly hospitalized acute myocardial infarction (AMI) patients in Minneapolis/St. Paul, USA (MSP) and Göteborg, Sweden (GB). METHODS AND RESULTS: A population-based sample of hospitalized AMI (ICD-9 410) patients aged ≥75 in MSP and GB in 2001-02 was abstracted by trained nurses. Mortality was ascertained from medical records and death certificates. Demographics, cardiovascular procedures, and prescription medications were compared using sex-specific generalized linear models. Adjusted hazard ratios (HR) were calculated with Cox regression. In MSP 839 (387 men, 452 women) and in GB 564 (275 men, 289 women) patients were identified. Age was similar (men: MSP 83 ± 7, GB 82 ± 5; women: MSP 84 ± 6, GB 84 ± 6) yet MSP patients had more previous cardiovascular comorbidities and procedures (PCI/CABG). Guideline-based medication use was high in both locations. MSP patients were significantly more likely to undergo PCI (men: MSP 33%, GB 7%; women: MSP 30%, GB 7%). Survival at 7.5 years was 27.8% among MSP patients (men: 26.6%, women: 28.8%) and 17.2% among GB patients (men: 17.5%, women: 17.0%). After adjustment for baseline characteristics and guideline-based therapies, survival was higher among MSP men [HR: 0.66, 95% confidence interval (CI): 0.50-0.88] and women (HR: 0.49, 95% CI: 0.36-0.67) compared with GB. CONCLUSION: In MSP and GB, guideline-based therapy use was high. However, PCI use was markedly higher in MSP. Long-term survival was better among elderly men and women in MSP compared with GB possibly related to greater utilization of PCI.
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