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Identifying predictors of patient delay for reperfusion in myocardial infarction: Does it matter?
Identificar preditores de demora do doente para a reperfusão no enfarte do miocárdio: Algum valor?
Jorge Ferreira
Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal
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"<span class="elsevierStyleTextfn">Original Article</span>" "titulo" => "Factors influencing patient delay before primary percutaneous coronary intervention in ST-segment elevation myocardial infarction: The Stent for life initiative in Portugal" "tienePdf" => "en" "tieneTextoCompleto" => "en" "tieneResumen" => array:2 [ 0 => "en" 1 => "pt" ] "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "409" "paginaFinal" => "421" ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Fatores que influenciam o atraso do doente até à angioplastia primária no enfarte agudo do miocárdio com supradesnivelamento de ST (STEMI): a iniciativa <span class="elsevierStyleItalic">Stent for Life</span> em Portugal" ] ] "contieneResumen" => array:2 [ "en" => true "pt" => true ] "contieneTextoCompleto" => array:1 [ "en" => true ] "contienePdf" => array:1 [ "en" => true ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0005" "etiqueta" => "Figure 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 3253 "Ancho" => 2497 "Tamanyo" => 349453 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Variables that impact patient delay. (A) Age; (B) symptom onset between 0:00 and 8:00 a.m.; (C) calling 112; (D) EMS transport to the pPCI facility; (E) primary care unit before FMC. Results are presented as median and interquartile range. 112: national medical emergency number; EMS: emergency medical services; FMC: first medical contact; pPCI: primary percutaneous coronary intervention.</p>" ] ] ] "autores" => array:1 [ 0 => array:2 [ "autoresLista" => "Hélder Pereira, Rita Calé, Fausto J. Pinto, Ernesto Pereira, Daniel Caldeira, Sofia Mello, Sílvia Vitorino, Manuel de Sousa Almeida, Jorge Mimoso" "autores" => array:10 [ 0 => array:2 [ "nombre" => "Hélder" "apellidos" => "Pereira" ] 1 => array:2 [ "nombre" => "Rita" "apellidos" => "Calé" ] 2 => array:2 [ "nombre" => "Fausto J." "apellidos" => "Pinto" ] 3 => array:2 [ "nombre" => "Ernesto" "apellidos" => "Pereira" ] 4 => array:2 [ "nombre" => "Daniel" "apellidos" => "Caldeira" ] 5 => array:2 [ "nombre" => "Sofia" "apellidos" => "Mello" ] 6 => array:2 [ "nombre" => "Sílvia" "apellidos" => "Vitorino" ] 7 => array:2 [ "nombre" => "Manuel de Sousa" "apellidos" => "Almeida" ] 8 => array:2 [ "nombre" => "Jorge" "apellidos" => "Mimoso" ] 9 => array:1 [ "colaborador" => "on behalf of the centers participating in the Stent for Life Initiative Portugal" ] ] ] ] ] "idiomaDefecto" => "en" "Traduccion" => array:1 [ "en" => array:9 [ "pii" => "S0870255117300811" "doi" => "10.1016/j.repc.2017.07.014" "estado" => "S300" "subdocumento" => "" "abierto" => array:3 [ "ES" => true "ES2" => true "LATM" => true ] "gratuito" => true "lecturas" => array:1 [ "total" => 0 ] "idiomaDefecto" => "en" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S0870255117300811?idApp=UINPBA00004E" ] ] "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2174204918301661?idApp=UINPBA00004E" "url" => "/21742049/0000003700000005/v1_201806100418/S2174204918301661/v1_201806100418/en/main.assets" ] "en" => array:13 [ "idiomaDefecto" => true "cabecera" => "<span class="elsevierStyleTextfn">Editorial comment</span>" "titulo" => "Identifying predictors of patient delay for reperfusion in myocardial infarction: Does it matter?" "tieneTextoCompleto" => true "paginas" => array:1 [ 0 => array:2 [ "paginaInicial" => "423" "paginaFinal" => "424" ] ] "autores" => array:1 [ 0 => array:3 [ "autoresLista" => "Jorge Ferreira" "autores" => array:1 [ 0 => array:3 [ "nombre" => "Jorge" "apellidos" => "Ferreira" "email" => array:1 [ 0 => "jorge_ferreira@netcabo.pt" ] ] ] "afiliaciones" => array:1 [ 0 => array:2 [ "entidad" => "Serviço de Cardiologia, Hospital de Santa Cruz, CHLO, Carnaxide, Portugal" "identificador" => "aff0005" ] ] ] ] "titulosAlternativos" => array:1 [ "pt" => array:1 [ "titulo" => "Identificar preditores de demora do doente para a reperfusão no enfarte do miocárdio: Algum valor?" ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The guidelines recommend that reperfusion therapy be performed expeditiously in patients with ST-elevation myocardial infarction (STEMI), and that primary percutaneous coronary intervention (PCI) is the preferred strategy.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> In addition to limiting infarct size and increasing survival, early primary PCI reduces hospitalizations for heart failure,<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">2</span></a> which account for high consumption of healthcare resources.<a class="elsevierStyleCrossRefs" href="#bib0070"><span class="elsevierStyleSup">3,4</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">Recording time to reperfusion, including patient delay and system delay, is recommended by the guidelines and is essential for monitoring these important quality indicators in the management of STEMI patients.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">1</span></a> System delay, measured from first medical contact to reperfusion, has been the subject of organizational measures in Portugal, although they have had little impact.<a class="elsevierStyleCrossRefs" href="#bib0080"><span class="elsevierStyleSup">5,6</span></a> On the other hand, although patient delay, measured from onset of symptoms to first medical contact, has generally been considered less amenable to organizational improvements, median patient delay in Portugal improved from 182 min in 2002 to 157 min in 2007.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The factors associated with patient delay can be grouped into four categories: sociodemographic (older age, female gender and low socioeconomic status or educational level), behavioral (delay in seeking help or not calling the emergency services), clinical (history of heart disease, diabetes, and atypical or mild symptoms), and contextual (symptom onset at home or in the early morning).<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7–10</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">In this issue of the <span class="elsevierStyleItalic">Journal</span>, Pereira et al. analyze predictors of patient delay for primary PCI in nearly 1000 STEMI patients included in the Stent for Life initiative at 18 Portuguese centers between 2011 and 2015.<a class="elsevierStyleCrossRef" href="#bib0110"><span class="elsevierStyleSup">11</span></a> The study showed that time to primary PCI in Portugal is still very high (median 250 min), of which patient delay accounts for approximately 45%. Although the change in patient delay between 2011 and 2015 was not statistically significant, the absolute value of the median delay (108 min) decreased by 40% compared to 2002.</p><p id="par0025" class="elsevierStylePara elsevierViewall">The authors identified age ≥75 years, symptom onset between midnight and 8:00 a.m., and first medical contact at a non-PCI center as independent predictors of patient delay, while calling 112 (the national emergency number) and transportation by the emergency medical services to a PCI center were independent predictors of shorter patient delay.</p><p id="par0030" class="elsevierStylePara elsevierViewall">The positive association between age and longer patient delay has been reported in various studies,<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7,8</span></a> and a linear relationship between the two has been described.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">9</span></a> This association may be due to the increased prevalence of atypical symptoms associated with age, or it may reflect decreased access to healthcare services or limited family and social support.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a> Symptom onset in the early morning and use of primary healthcare services have also been associated with longer patient delay.<a class="elsevierStyleCrossRefs" href="#bib0090"><span class="elsevierStyleSup">7–9</span></a> On the other hand, activation of and transportation by the emergency services have been associated with significant reductions in patient delay.<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">10</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">In terms of relative importance, the factor that most affected patient delay was first medical contact being at a non-PCI center, associated with a 76-min longer delay, but this only occurred in 10% of cases. Age ≥75 years was associated with a 42-min increase (19% of patients), and symptom onset between midnight and 8:00 a.m. resulted in a 17-min increase (27%). Calling 112 (39% of patients) and transportation by the emergency medical services to a PCI center (15% of patients) were associated with reductions in patient delay of 48 and 55 min, respectively.</p><p id="par0040" class="elsevierStylePara elsevierViewall">The main limitation of the study is that it is not fully representative of the overall situation in Portugal, given that the Central, Alentejo and Algarve regions accounted for around 19% of the patients but contain 35% of the Portuguese population. However, all of the predictors of patient delay identified by the authors have also been identified in previous studies in other populations, which confirms the reproducibility of the results.</p><p id="par0045" class="elsevierStylePara elsevierViewall">Identifying predictors of patient delay is important and can be used to develop interventions aimed to reduce it, thereby helping to enhance the benefit of reperfusion therapy. By taking into account the factors identified in this study, a strategy can be designed that is aimed at raising awareness of the symptoms of STEMI, especially in the elderly. This could be carried out at health centers with the slogan “Heart attack symptoms? Don’t go to your health center. Call 112 at any time.”</p><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle" id="sect0005">Conflicts of interest</span><p id="par0050" class="elsevierStylePara elsevierViewall">The author has no conflicts of interest to declare.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:2 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Conflicts of interest" ] 1 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Ferreira J. Identificar preditores de demora do doente para a reperfusão no enfarte do miocárdio: Algum valor? Rev Port Cardiol. 2018;37:423–424.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:11 [ 0 => array:3 [ "identificador" => "bib0060" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "2017 ESC Guidelines for the Management of acute myocardial infarction in patients presenting with ST-segment elevation: the Task Force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC)" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:3 [ 0 => "B. Ibanez" 1 => "S. James" 2 => "S. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 5 | 4 | 9 |
| 2024 October | 45 | 40 | 85 |
| 2024 September | 50 | 23 | 73 |
| 2024 August | 71 | 48 | 119 |
| 2024 July | 36 | 44 | 80 |
| 2024 June | 28 | 39 | 67 |
| 2024 May | 30 | 44 | 74 |
| 2024 April | 31 | 45 | 76 |
| 2024 March | 30 | 48 | 78 |
| 2024 February | 30 | 41 | 71 |
| 2024 January | 24 | 41 | 65 |
| 2023 December | 18 | 54 | 72 |
| 2023 November | 30 | 42 | 72 |
| 2023 October | 17 | 35 | 52 |
| 2023 September | 18 | 52 | 70 |
| 2023 August | 24 | 48 | 72 |
| 2023 July | 13 | 26 | 39 |
| 2023 June | 22 | 35 | 57 |
| 2023 May | 34 | 45 | 79 |
| 2023 April | 20 | 25 | 45 |
| 2023 March | 25 | 45 | 70 |
| 2023 February | 26 | 37 | 63 |
| 2023 January | 21 | 31 | 52 |
| 2022 December | 35 | 54 | 89 |
| 2022 November | 40 | 37 | 77 |
| 2022 October | 31 | 38 | 69 |
| 2022 September | 23 | 32 | 55 |
| 2022 August | 17 | 24 | 41 |
| 2022 July | 26 | 42 | 68 |
| 2022 June | 20 | 26 | 46 |
| 2022 May | 17 | 30 | 47 |
| 2022 April | 26 | 34 | 60 |
| 2022 March | 24 | 47 | 71 |
| 2022 February | 28 | 32 | 60 |
| 2022 January | 24 | 30 | 54 |
| 2021 December | 19 | 35 | 54 |
| 2021 November | 26 | 43 | 69 |
| 2021 October | 27 | 33 | 60 |
| 2021 September | 19 | 27 | 46 |
| 2021 August | 18 | 26 | 44 |
| 2021 July | 16 | 20 | 36 |
| 2021 June | 15 | 21 | 36 |
| 2021 May | 27 | 40 | 67 |
| 2021 April | 38 | 78 | 116 |
| 2021 March | 45 | 23 | 68 |
| 2021 February | 33 | 23 | 56 |
| 2021 January | 21 | 12 | 33 |
| 2020 December | 29 | 11 | 40 |
| 2020 November | 20 | 18 | 38 |
| 2020 October | 25 | 16 | 41 |
| 2020 September | 50 | 10 | 60 |
| 2020 August | 12 | 9 | 21 |
| 2020 July | 44 | 14 | 58 |
| 2020 June | 37 | 17 | 54 |
| 2020 May | 32 | 4 | 36 |
| 2020 April | 35 | 8 | 43 |
| 2020 March | 53 | 15 | 68 |
| 2020 February | 28 | 23 | 51 |
| 2020 January | 40 | 5 | 45 |
| 2019 December | 24 | 5 | 29 |
| 2019 November | 20 | 11 | 31 |
| 2019 October | 30 | 6 | 36 |
| 2019 September | 10 | 7 | 17 |
| 2019 August | 27 | 2 | 29 |
| 2019 July | 55 | 6 | 61 |
| 2019 June | 22 | 21 | 43 |
| 2019 May | 45 | 13 | 58 |
| 2019 April | 19 | 16 | 35 |
| 2019 March | 23 | 10 | 33 |
| 2019 February | 46 | 9 | 55 |
| 2019 January | 19 | 6 | 25 |
| 2018 December | 33 | 10 | 43 |
| 2018 November | 59 | 12 | 71 |
| 2018 October | 101 | 16 | 117 |
| 2018 September | 55 | 15 | 70 |
| 2018 August | 36 | 8 | 44 |
| 2018 July | 28 | 7 | 35 |
| 2018 June | 74 | 23 | 97 |
| 2018 May | 17 | 9 | 26 |
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