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Patient Delay in Acute Myocardial Infarction – A Long Journey Still Ahead
Session:
Comunicações Orais (Sessão 6) - DAC e Cuidados Intensivos 2 - Vários Tópicos
Speaker:
Catarina Amaral Marques
Congress:
CPC 2022
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
14. Acute Cardiac Care
Subtheme:
14.2 Acute Cardiac Care – Prehospital and Emergency Department Care
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Catarina Amaral Marques; André Cabrita; Paulo Maia Araújo; Tânia Proença; Ricardo Alves Pinto; Miguel Martins de Carvalho; Catarina Martins da Costa; Ana Filipa Amador; João Calvão; Ana Isabel Pinho; Cátia Oliveira; Luís Daniel Santos; Cristina Cruz; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Background: </span></strong><span style="color:black">It is overly known that<strong> </strong>time delays in acute myocardial infarction (AMI) strongly influence its outcomes. Patient delay (PD) is repeatedly pointed out as the longer one in this context, as well as it is the less modifiable one by organizational measures. Therefore, it is crucial to understand the reasons for longer PD in our population, to define proper strategies to improve PD and, ultimately, AMI-outcomes. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="color:black">Methods:</span></strong><span style="color:black"> In this 6-month prospective study of patients (pts) admitted in a tertiary hospital due to type-1 AMI, 196 pts were consecutively enrolled between May and October 2021. Data was based on a pts well-structured interview within 48h after admission and review of medical records. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="color:#000000"><strong><span style="color:black">Results: </span></strong><span style="color:black"><span style="font-family:Calibri,sans-serif">Our work spotted several aspects significantly influencing PD in AMI context (Figure 1). Concerning pts cardiovascular background, a trend towards a shorter PD was found in pts with at least 1 cardiovascular risk factor (CVRF) (p=0,08) and with a previous history of AMI (p=0,08). Regarding clinical presentation, a significantly shorter PD was found in pts presenting with associated symptoms (p=0,02), higher chest pain intensity (chest pain intensity </span><span style="font-family:Symbol">>/=</span></span><span style="color:black; font-family:Calibri,sans-serif">7 vs <7 in a 0-10 scale; p=0,03) and symptoms onset on weekdays rather than weekends (p=0,003). </span></span><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="color:black">Regarding pts knowledge, significant differences were found when pts recognized their symptoms as AMI, presenting a shorter PD in this context (p=0,006). Curiously, pts ability to correctly identify AMI symptoms, when asked, or to acknowledge their CVRF (when present), did not influence PD. </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><span style="color:black">Considering sociodemographic factors, higher incomes (p=0,03) and non-rural residence (p=0,03) significantly translated into shorter PD. No differences were found in PD according to pts age, gender or educational level. </span></span></span></span></p> <p><strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Conclusion: </span></span></span></strong><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:black">Our study clearly points to the need for increasing public awareness and educational measures, mainly in pts with lower socioeconomic status, in order to: 1) Improve pts knowledge about CVRF; 2) Improve pts knowledge about AMI symptoms, clarifying that atypical symptoms can happen; 3) Reinforce the importance of shortening AMI time delays, clearly explaining the concept “time is muscle”. </span></span></span></p>
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