Longer pre-hospital delay in first myocardial infarction among patients with diabetes: an analysis of 4266 patients in the Northern Sweden MONICA Study

BMC Cardiovascular Disorders

Mats Eliasson¹  Ulf Näslund²  Christine Brulin³  Karin Hellström Ängerud⁴ 

[1] Internal Medicine, Sunderbyn, Luleå, and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;Cardiology, Heart Centre and Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden;Department of Nursing, Umeå University, Umeå, Sweden;Cardiology, Heart Centre and Department of Nursing, Umeå University, Umeå, Sweden

关键词: Sex differences;    Pre-hospital delay;    Diabetes mellitus;    Myocardial infarction;   

Others  :  857878
DOI  :  10.1186/1471-2261-13-6

 received in 2012-07-26, accepted in 2013-01-24,  发布年份 2013

【 摘 要 】

Background

Reperfusion therapy reduces both morbidity and mortality in myocardial infarction, but the effectiveness depends on how fast the patient receives treatment. Despite the time-dependent effectiveness of reperfusion therapy, many patients with myocardial infarction have delays in seeking medical care. The aim of this study was to describe pre-hospital delay in a first myocardial infarction among men and women with and without diabetes and to describe the association between pre-hospital delay time and diabetes, sex, age, symptoms and size of residential area as a proxy for distance to hospital.

Methods

This population based study was based on data from 4266 people aged 25–74 years, with a first myocardial infarction registered in the Northern Sweden MONICA myocardial infarction registry between 2000 and 2008.

Results

The proportion of patients with delay times ≥ 2 h was 64% for patients with diabetes and 58% for patients without diabetes. There was no difference in delay time ≥ 2 h between men and women with diabetes. Diabetes, older age and living in a town or rural areas were factors associated with pre-hospital delay times ≥ 2 h. Atypical symptoms were not a predictor for pre-hospital delay times ≥ 2 h, OR 0.59 (0.47; 0.75).

Conclusions

A higher proportion of patients with diabetes have longer pre-hospital delay in myocardial infarction than patients without diabetes. There are no differences in pre-hospital delay between men and women with diabetes. The largest risk difference for pre-hospital delay ≥ 2 h is between women with and without diabetes. Diabetes, older age and living in a town or rural area are predictors for pre-hospital delay ≥ 2 h.

【 授权许可】

   
2013 Ängerud et al.; licensee BioMed Central Ltd.

【 图 表 】

【 参考文献 】

• [1]Huxley R, Barzi F, Woodward M: Excess risk of fatal coronary heart disease associated with diabetes in men and women: meta-analysis of 37 prospective cohort studies. BMJ 2006, 332:73-78.
• [2]Eliasson M, Jansson JH, Lundblad D, Naslund U: The disparity between long-term survival in patients with and without diabetes following a first myocardial infarction did not change between 1989 and 2006: an analysis of 6,776 patients in the Northern Sweden MONICA Study. Diabetologia 2011, 54:2538-2543.
• [3]Norhammar A, Lindback J, Ryden L, Wallentin L, Stenestrand U: Improved but still high short- and long-term mortality rates after myocardial infarction in patients with diabetes mellitus: a time-trend report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission. Heart 2007, 93:1577-1583.
• [4]De Luca G, Suryapranata H, Ottervanger JP, Antman EM: Time delay to treatment and mortality in primary angioplasty for acute myocardial infarction: every minute of delay counts. Circulation 2004, 109:1223-1225.
• [5]Kushner FG, Hand M, Smith SC Jr, King SB 3rd, Anderson JL, Antman EM, et al.: 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2009, 54:2205-2241.
• [6]Isaksson RM, Holmgren L, Lundblad D, Brulin C, Eliasson M: Time trends in symptoms and prehospital delay time in women vs. men with myocardial infarction over a 15-year period. The Northern Sweden MONICA Study. Eur J Cardiovasc Nurs 2008, 7:152-158.
• [7]Saczynski JS, Yarzebski J, Lessard D, Spencer FA, Gurwitz JH, Gore JM, Goldberg RJ: Trends in prehospital delay in patients with acute myocardial infarction (from the Worcester Heart Attack Study). Am J Cardiol 2008, 102:1589-1594.
• [8]Goldberg RJ, Steg PG, Sadiq I, Granger CB, Jackson EA, Budaj A, Brieger D, Avezum A, Goodman S: Extent of, and factors associated with, delay to hospital presentation in patients with acute coronary disease (the GRACE registry). Am J Cardiol 2002, 89:791-796.
• [9]Herlitz J, Thuresson M, Svensson L, Lindqvist J, Lindahl B, Zedigh C: Factors of importance for patients’ decision time in acute coronary syndrome. Int J Cardiol 2010, 141:236-242.
• [10]Dracup K, McKinley SM, Moser DK: Australian patients’ delay in response to heart attack symptoms. Med J Aust 1997, 166:233-236.
• [11]Dracup K, Moser DK: Beyond sociodemographics: factors influencing the decision to seek treatment for symptoms of acute myocardial infarction. Heart Lung 1997, 26:253-262.
• [12]Isaksson RM, Brulin C, Eliasson M, Naslund U, Zingmark K: Prehospital experiences of older men with a first myocardial infarction: a qualitative analysis within the Northern Sweden MONICA Study. Scand J Caring Sci 2011, 25:787-97.
• [13]King KB, McGuire MA: Symptom presentation and time to seek care in women and men with acute myocardial infarction. Heart Lung 2007, 36:235-243.
• [14]Isaksson R-M, Brulin C, Eliasson M, Näslund U, Zingmark K: Older women’s prehospital experiences of their first myocardial infarction: A qualitative analysis from the Northern Sweden MONICA study. J Cardiovasc Nurs 2012. E-pub ahead of print
• [15]Lovlien M, Schei B, Hole T: Prehospital delay, contributing aspects and responses to symptoms among Norwegian women and men with first time acute myocardial infarction. Eur J Cardiovasc Nurs 2007, 6:308-313.
• [16]Ting HH, Bradley EH, Wang Y, Lichtman JH, Nallamothu BK, Sullivan MD, Gersh BJ, Roger VK, Curtis JP, Krumholz HM: Factors associated with longer time from symptom onset to hospital presentation for patients with ST-elevation myocardial infarction. Arch Intern Med 2008, 168:959-968.
• [17]Ting HH, Chen AY, Roe MT, Chan PS, Spertus JA, Nallamothu BK, DeLong ER, Bradley EH, Krumholz h, Peterson ED: Delay from symptom onset to hospital presentation for patients with non-ST-segment elevation myocardial infarction. Arch Intern Med 2010, 170:1834-1841.
• [18]Ottesen MM, Dixen U, Torp-Pedersen C, Kober L: Prehospital delay in acute coronary syndrome–an analysis of the components of delay. Int J Cardiol 2004, 96:97-103.
• [19]Johansson I, Stromberg A, Swahn E: Factors related to delay times in patients with suspected acute myocardial infarction. Heart Lung 2004, 33:291-300.
• [20]Moser DK, McKinley S, Dracup K, Chung ML: Gender differences in reasons patients delay in seeking treatment for acute myocardial infarction symptoms. Patient Educ Couns 2005, 56:45-54.
• [21]Angerud KH, Brulin C, Naslund U, Eliasson M: Patients with diabetes are not more likely to have atypical symptoms when seeking care of a first myocardial infarction. An analysis of 4028 patients in the Northern Sweden MONICA Study. Diabet Med 2012, 29:e82-7.
• [22]Lundblad D, Holmgren L, Jansson JH, Naslund U, Eliasson M: Gender differences in trends of acute myocardial infarction events: the Northern Sweden MONICA study 1985–2004. BMC Cardiovasc Disord 2008, 8:17. BioMed Central Full Text
• [23]Stegmayr B, Lundberg V, Asplund K: The events registration and survey procedures in the Northern Sweden MONICA Project. Scand J Public Health Suppl 2003, 61:9-17.
• [24]WHO MONICA PROJECT: MONICA manual. Part IV: Event registration. Section 1: Coronary event registration data component. http://www.ktl.fi/publications/monica/manual/part4/iv-1.htmHellström webcite
• [25]Goldberg RJ, Mooradd M, Gurwitz JH, Rogers WJ, French WJ, Barron HV, Gore JM: Impact of time to treatment with tissue plasminogen activator on morbidity and mortality following acute myocardial infarction (The second National Registry of Myocardial Infarction). Am J Cardiol 1998, 82:259-264.
• [26]Dean AG, Sullivan KM, SOE MM: OpenEpi: Open Source Epidemiologic Statistics for Public Health, Version 2.3.1. http://www.openepi.com webcite] updated 2011/23/06 edn updated 2011/23/06, accessed 2012/10/29
• [27]McKinley S, Aitken LM, Marshall AP, Buckley T, Baker H, Davidson PM, Dracup K: Delays in presentation with acute coronary syndrome in people with coronary artery disease in Australia and New Zealand. Emerg Med Australas 2011, 23:153-161.
• [28]Thuresson M, Jarlov MB, Lindahl B, Svensson L, Zedigh C, Herlitz J: Thoughts, actions, and factors associated with prehospital delay in patients with acute coronary syndrome. Heart Lung 2007, 36:398-409.
• [29]Prohaska TR, Keller ML, Leventhal EA, Leventhal H: Impact of symptoms and aging attribution on emotions and coping. Health Psychol 1987, 6:495-514.
• [30]Hwang SY, Jeong MH: Cognitive factors that influence delayed decision to seek treatment among older patients with acute myocardial infarction in Korea. Eur J Cardiovasc Nurs 2012, 11:154-9.
• [31]Bulpitt CJ, Palmer AJ, Battersby C, Fletcher AE: Association of symptoms of type 2 diabetic patients with severity of disease, obesity, and blood pressure. Diabetes Care 1998, 21:111-115.
• [32]Mayer DD, Rosenfeld A: Symptom interpretation in women with diabetes and myocardial infarction: a qualitative study. Diabetes Educ 2006, 32:918-924.
• [33]Kentsch M, Rodemerk U, Muller-Esch G, Schnoor U, Munzel T, Ittel TH, Mitusch R: Emotional attitudes toward symptoms and inadequate coping strategies are major determinants of patient delay in acute myocardial infarction. Z Kardiol 2002, 91:147-155.
• [34]Nymark C, Mattiasson AC, Henriksson P, Kiessling A: The turning point: from self-regulative illness behaviour to care-seeking in patients with an acute myocardial infarction. J Clin Nurs 2009, 18:3358-3365.
• [35]Pattenden J, Watt I, Lewin RJ, Stanford N: Decision making processes in people with symptoms of acute myocardial infarction: qualitative study. BMJ 2002, 324:1006-1009.
• [36]Fukuoka Y, Dracup K, Ohno M, Kobayashi F, Hirayama H: Symptom severity as a predictor of reported differences of prehospital delay between medical records and structured interviews among patients with AMI. Eur J Cardiovasc Nurs 2005, 4:171-176.
• [37]Hwang SY, Zerwic JJ, Jeong MH: Impact of prodromal symptoms on prehospital delay in patients with first-time acute myocardial infarction in Korea. J Cardiovasc Nurs 2011, 26:194-201.