PMC:2652658 / 7679-14356 JSONTXT

{"target":"https://pubannotation.org/docs/sourcedb/PMC/sourceid/2652658","sourcedb":"PMC","sourceid":"2652658","source_url":"https://www.ncbi.nlm.nih.gov/pmc/2652658","text":"3 Results\nPatients were predominantly male with a mean age of 59.0 ± 11.2 years, white European, married and poorly educated (Table 1). Only a quarter of participants initially recognized their symptoms as a heart attack. Most patients were diagnosed with STEMI and more than a third gave high ratings of pain intensity. Most patients experienced additional symptoms as well as chest pain (such as pain in arms, shoulders, jaw, back and non-pain symptoms including breathlessness, nausea/vomiting, sweating, dizziness/fainting). A bystander was present in just over half of cases and most patients were at home rather than somewhere else (such as their workplace, outside, in a car, at a recreational venue) when their symptoms started. Only half of patients contacted the EMS directly with the remainder first accessing the advice of physicians, friends or family.\nThe median total pre-hospital delay was 120 min, ranging from 10 min to 4.3 days, with a mean delay of 6.1 h (± 12.9 h). Decision time constituted 60% of the total pre-hospital delay period, while home-to-hospital delay accounted for 40%. The median patient decision time was 50 min (mean 3.6 h, ± 8.0 h), ranging from 0 to 2.7 days, and patient decision times ≤ 60 min were observed in 60.8% of patients. The median home-to-hospital delay was 58 min (mean 2.4 h ± 8.9 h), and 53.7% had home-to-hospital delays ≤ 60 min.\n\n3.1 Factors associated with short total pre-hospital delays (≤ 120 min)\nMarried patients were more likely than patients who were not married to have a short total pre-hospital delay (p = 0.048). There were no other significant associations between short total pre-hospital delays and sociodemographic or socioeconomic factors, but clinical presentation was important (Table 2). Patients who had an STEMI rather than NSTEMI or UA were more likely to have short total pre-hospital delay (p = 0.028), as were those who experienced a greater number of symptoms (p = 0.007). Patients who experienced 3 or more non-pain symptoms (including breathlessness, nausea/vomiting, dizziness) were also more likely to have short home-to-hospital delays (p = 0.002). Patients who had suffered a previous myocardial infarction (MI) were more likely to have a short total pre-hospital delay (p = 0.023), as were those who attributed symptoms to a heart attack rather than another cause (p = 0.039). There were no significant associations with other cardiac risk factors such as diabetes, hypertension, hypercholesterolemia, smoking, or level of physical activity.\nProximal factors were also important. Patients who were away from home when their symptoms started were more likely to have a short pre-hospital delay than patients who were at home (p = 0.006), as were those who were accompanied by a bystander at symptom onset rather than being alone (p = 0.006). If symptoms began after midday, patients were more likely to have short pre-hospital delays than if symptoms started earlier (p = 0.007). In multivariate logistic regression entering all the factors found to be significant in Table 2, effects remained significant for previous history of MI (p = 0.008), being away from home at symptom onset (p = 0.004) and having a bystander present (p = 0.001).\n\n3.2 Factors associated with short decision times (≤ 60 min)\nThere were no associations between decision time ≤ 60 min and sociodemographic and socioeconomic factors apart from marital status (Table 3); married patients were more likely to have decision times ≤ 60 min than patients who were not married (p = 0.034). Patients who had an STEMI rather than NSTEMI or UA were more likely to have short decision times (p = 0.006), as were those who attributed symptoms to a heart attack rather than some other cause (p = 0.001). Patients whose symptoms started in the presence of a bystander rather than being alone were more likely to have a short decision time (p = 0.006). The variables that were associated with short decision times were not independent of one another, since symptom onset in the presence of a bystander was strongly associated with marital status. Patients who were away from home when their symptoms started had shorter decision times than those who were at home (p = 0.005). In multivariate logistic regression, including all variables found to be significant in Table 3, attribution of symptoms to a heart attack (p \u003c 0.001), presence of a bystander (p = 0.010) and being away from home (p = 0.003) remained significant independent predictors of short decision times.\n\n3.3 Factors associated with short home-to-hospital delays (≤ 60 min)\nYounger patients were more likely to have short home-to-hospital delays. Table 4 shows that 66.4% of the patients who had a short home-to-hospital delay were aged 60 or less, compared with 42.9% of those with longer delays. There were no associations with socioeconomic factors but clinical factors were important. Patients who had an STEMI rather than a NSTEMI/UA were more likely to have home-to-hospital delay of ≤ 60 min (p = 0.002), as were those who experienced a greater number of pain symptoms (p = 0.028), and non-pain symptoms (p = 0.012). Patients who were away from home when symptoms started were also more likely to have a short decision delay (p = 0.049).\n\n3.4 Patients' choice of contact for help following onset of acute symptoms\nFollowing symptom onset, 45% of patients initially decided to call the EMS rather than other sources of help such as their physician, family/friends, or to refer themselves directly to hospital. As predicted, patients who contacted the EMS for help were more likely to have short total pre-hospital delays: 74.0% of patients who contacted the EMS had total pre-hospital delays ≤ 120 min compared with 33.0% of those who contacted another source of help (adjusted OR 5.80, C.I. 2.98 to 11.30). Patients who contacted the EMS also had shorter decision times; 80.3% had a decision time ≤ 60 min compared with 45.7% who contacted another source of help (adjusted OR 4.83, C.I. 2.40 to 9.70). Interestingly, contacting the EMS was not related to the home-to-hospital component of the total pre-hospital delay period but only to decision time.\nWe investigated the correlates of contacting the EMS following symptom onset. It was not related to age, gender, marital status, education, cardiac history, attribution of symptoms, ACS type, or the presence of a bystander. However, patients who contacted the EMS were likely to have more intense chest pain (adjusted OR 2.05, C.I. 1.01 to 4.61, p = 0.047) and more likely to have an ACS at the weekend rather than a weekday (adjusted OR 1.82, C.I. 0.98 to 3.36, p = 0.057) than those who did not.","divisions":[{"label":"label","span":{"begin":0,"end":1}},{"label":"title","span":{"begin":3,"end":10}},{"label":"p","span":{"begin":11,"end":866}},{"label":"p","span":{"begin":867,"end":1387}},{"label":"sec","span":{"begin":1389,"end":3232}},{"label":"label","span":{"begin":1389,"end":1392}},{"label":"title","span":{"begin":1394,"end":1461}},{"label":"p","span":{"begin":1462,"end":2535}},{"label":"p","span":{"begin":2536,"end":3232}},{"label":"sec","span":{"begin":3234,"end":4522}},{"label":"label","span":{"begin":3234,"end":3237}},{"label":"title","span":{"begin":3239,"end":3294}},{"label":"p","span":{"begin":3295,"end":4522}},{"label":"sec","span":{"begin":4524,"end":5264}},{"label":"label","span":{"begin":4524,"end":4527}},{"label":"title","span":{"begin":4529,"end":4593}},{"label":"p","span":{"begin":4594,"end":5264}},{"label":"label","span":{"begin":5266,"end":5269}},{"label":"title","span":{"begin":5271,"end":5341}},{"label":"p","span":{"begin":5342,"end":6179}}],"tracks":[{"project":"testtesttest","denotations":[{"id":"T17","span":{"begin":39,"end":43},"obj":"Body_part"},{"id":"T18","span":{"begin":209,"end":214},"obj":"Body_part"},{"id":"T22","span":{"begin":379,"end":384},"obj":"Body_part"},{"id":"T23","span":{"begin":413,"end":422},"obj":"Body_part"},{"id":"T24","span":{"begin":424,"end":427},"obj":"Body_part"},{"id":"T25","span":{"begin":429,"end":433},"obj":"Body_part"},{"id":"T26","span":{"begin":2319,"end":2324},"obj":"Body_part"},{"id":"T30","span":{"begin":3704,"end":3709},"obj":"Body_part"},{"id":"T34","span":{"begin":4355,"end":4360},"obj":"Body_part"},{"id":"T38","span":{"begin":6477,"end":6482},"obj":"Body_part"}],"attributes":[{"id":"A17","pred":"uberon_id","subj":"T17","obj":"http://purl.obolibrary.org/obo/UBERON_0003101"},{"id":"A18","pred":"uberon_id","subj":"T18","obj":"http://purl.obolibrary.org/obo/UBERON_0000948"},{"id":"A19","pred":"uberon_id","subj":"T18","obj":"http://purl.obolibrary.org/obo/UBERON_0007100"},{"id":"A20","pred":"uberon_id","subj":"T18","obj":"http://purl.obolibrary.org/obo/UBERON_0015228"},{"id":"A21","pred":"uberon_id","subj":"T18","obj":"http://purl.obolibrary.org/obo/UBERON_0015230"},{"id":"A22","pred":"uberon_id","subj":"T22","obj":"http://purl.obolibrary.org/obo/UBERON_0001443"},{"id":"A23","pred":"uberon_id","subj":"T23","obj":"http://purl.obolibrary.org/obo/UBERON_0001467"},{"id":"A24","pred":"uberon_id","subj":"T24","obj":"http://purl.obolibrary.org/obo/UBERON_0001708"},{"id":"A25","pred":"uberon_id","subj":"T25","obj":"http://purl.obolibrary.org/obo/UBERON_0001137"},{"id":"A26","pred":"uberon_id","subj":"T26","obj":"http://purl.obolibrary.org/obo/UBERON_0000948"},{"id":"A27","pred":"uberon_id","subj":"T26","obj":"http://purl.obolibrary.org/obo/UBERON_0007100"},{"id":"A28","pred":"uberon_id","subj":"T26","obj":"http://purl.obolibrary.org/obo/UBERON_0015228"},{"id":"A29","pred":"uberon_id","subj":"T26","obj":"http://purl.obolibrary.org/obo/UBERON_0015230"},{"id":"A30","pred":"uberon_id","subj":"T30","obj":"http://purl.obolibrary.org/obo/UBERON_0000948"},{"id":"A31","pred":"uberon_id","subj":"T30","obj":"http://purl.obolibrary.org/obo/UBERON_0007100"},{"id":"A32","pred":"uberon_id","subj":"T30","obj":"http://purl.obolibrary.org/obo/UBERON_0015228"},{"id":"A33","pred":"uberon_id","subj":"T30","obj":"http://purl.obolibrary.org/obo/UBERON_0015230"},{"id":"A34","pred":"uberon_id","subj":"T34","obj":"http://purl.obolibrary.org/obo/UBERON_0000948"},{"id":"A35","pred":"uberon_id","subj":"T34","obj":"http://purl.obolibrary.org/obo/UBERON_0007100"},{"id":"A36","pred":"uberon_id","subj":"T34","obj":"http://purl.obolibrary.org/obo/UBERON_0015228"},{"id":"A37","pred":"uberon_id","subj":"T34","obj":"http://purl.obolibrary.org/obo/UBERON_0015230"},{"id":"A38","pred":"uberon_id","subj":"T38","obj":"http://purl.obolibrary.org/obo/UBERON_0001443"},{"subj":"T17","pred":"source","obj":"testtesttest"},{"subj":"T18","pred":"source","obj":"testtesttest"},{"subj":"T22","pred":"source","obj":"testtesttest"},{"subj":"T23","pred":"source","obj":"testtesttest"},{"subj":"T24","pred":"source","obj":"testtesttest"},{"subj":"T25","pred":"source","obj":"testtesttest"},{"subj":"T26","pred":"source","obj":"testtesttest"},{"subj":"T30","pred":"source","obj":"testtesttest"},{"subj":"T34","pred":"source","obj":"testtesttest"},{"subj":"T38","pred":"source","obj":"testtesttest"}]}],"config":{"attribute types":[{"pred":"source","value type":"selection","values":[{"id":"testtesttest","color":"#de93ec","default":true}]}]}}