Title |
Time to presentation and 12-month health outcomes in patients presenting to the emergency department with symptoms of possible acute coronary syndrome
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Published in |
Emergency Medicine Journal, January 2016
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DOI | 10.1136/emermed-2015-204978 |
Pubmed ID | |
Authors |
Louise Cullen, Jaimi H Greenslade, Louven Menzies, Ashley Leong, Martin Than, Christopher Pemberton, Sally Aldous, John Pickering, Emily Dalton, Bianca Crosling, Rachelle Foreman, William A Parsonage |
Abstract |
To define the association between time taken to present to the emergency department (ED) with symptoms of possible acute coronary syndrome (ACS) and 1-year outcomes. We also determined whether particular patient characteristics are associated with delays in seeking care after symptom onset. We collected data, which included a customised case report form to record symptom onset, on adult patients presenting with suspected ACS to two EDs in Australia and New Zealand. Such patients were followed up prospectively for 1 year. The composite primary endpoint included death, acute myocardial infarction, unstable angina pectoris treated with revascularisation or readmission with heart failure occurring after discharge but within 12 months after the index presentation. ACS was diagnosed at presentation in 420 (16.8%) of 2515 patients recruited. Cox regression was conducted to assess the relationship between presentation time and the rate of primary endpoints after controlling for age, ethnicity, prior angina, prior coronary artery bypass graft and index diagnosis. Middle (2-6 h) and late presenters (>6 h postsymptom onset) developed the primary endpoint at a rate 1.22 (95% CI 0.80 to 1.85) and 1.57 (1.07 to 2.31) times higher than early presenters. Patients with known risk factors and cardiovascular disease were more likely to present late to the ED. There is an independent association between time to presentation and 1-year cardiac outcomes following initial chest pain assessment for ED patients with possible cardiac chest pain in the Australian and New Zealand setting. This association occurred irrespective of the eventual diagnosis. Effective public health campaigns and other measures that facilitate early presentation with symptoms for patients with symptoms suggestive of ACS are justified and may improve prognosis. ACTRN12611001069943. |
X Demographics
Geographical breakdown
Country | Count | As % |
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New Zealand | 1 | 50% |
Unknown | 1 | 50% |
Demographic breakdown
Type | Count | As % |
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Practitioners (doctors, other healthcare professionals) | 1 | 50% |
Members of the public | 1 | 50% |
Mendeley readers
Geographical breakdown
Country | Count | As % |
---|---|---|
Unknown | 44 | 100% |
Demographic breakdown
Readers by professional status | Count | As % |
---|---|---|
Student > Bachelor | 8 | 18% |
Other | 6 | 14% |
Researcher | 6 | 14% |
Student > Master | 5 | 11% |
Student > Ph. D. Student | 2 | 5% |
Other | 5 | 11% |
Unknown | 12 | 27% |
Readers by discipline | Count | As % |
---|---|---|
Medicine and Dentistry | 14 | 32% |
Nursing and Health Professions | 8 | 18% |
Social Sciences | 2 | 5% |
Mathematics | 1 | 2% |
Unspecified | 1 | 2% |
Other | 3 | 7% |
Unknown | 15 | 34% |