Many patients having heart attacks still wait more than two hours to go to the hospital

ScienceDaily (Nov. 8, 2010) ? Long delays between developing symptoms and going to the hospital are common among patients with a certain type of heart attack, according to a report in the November 8 issue of Archives of Internal Medicine, one of the JAMA/Archives journals.

Professional guidelines recommend that patients call 9-1-1 if symptoms suggestive of a heart attack do not improve within five minutes, according to background information in the article. Medical treatment is most urgent in patients with ST-segment elevation myocardial infarction (STEMI; a certain pattern on an electrocardiogram during a heart attack). However, patients cannot tell whether their symptoms indicate a STEMI or non-STEMI, so getting to the hospital quickly is critical no matter which type of heart attack they are experiencing.

"For patients with STEMI, studies have documented that the average delay time from symptom onset to hospital presentation is two hours and has not decreased substantially despite multiple public education campaigns," the authors write. "While delays from symptom onset to hospital presentation have been linked to worse outcomes in patients with STEMI, the impact of such delays in patients with non-STEMI is unknown."

Henry H. Ting, M.D., M.B.A., of Mayo Clinic, Rochester, Minn., and colleagues studied 104,622 patients with non-STEMI from 568 hospitals between 2001 and 2006. The hospitals were all participating in a national study (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines, or CRUSADE) for which they collected data on patient demographic and clinical information, physician and hospital characteristics, medication histories and treatment regimens and outcomes.

The delay in arriving to the hospital after symptoms remained stable between 2001 and 2006, with a median (midpoint) delay of 2.6 hours. About 60 percent of patients had delay times longer than two hours, and 11 percent of patients arrived at the hospital more than 12 hours after experiencing symptoms. Delay times were not consistently or strongly associated with patients' risk of dying in the hospital.

Patients who were older, female, a race other than white, had diabetes or currently smoked were more likely to have longer delays. "However, the magnitude of effect (less than 10 percent) on delay time from each factor was overshadowed by the overall duration of delay (median delay time, 2.6 hours)," the authors write. "Therefore, interventions aimed at improving patient awareness of symptoms and responsiveness to seek care will likely need to target all patients at risk for myocardial infarction [heart attack], and not just those who have individual risk factors (age, sex or diabetes) for longer delay time."

In addition, patients who arrived at the hospital during weekday and weekend nights (between 12 a.m. and 8 a.m.) had 25-percent shorter delay times than those who arrived between 8 a.m. and 4 p.m. on weekdays. "While we cannot determine why patients decided to seek care more quickly at night, potential hypotheses include heightened fear during the night when patients may be alone at home, higher tolerance of symptoms during the daytime when a patient is active or at work or a perception of shorter waiting times and less crowding in emergency departments during the night."

"Novel strategies to improve patient responsiveness to seek care are critical and important for both patients with STEMI or non-STEMI," they conclude.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by JAMA and Archives Journals.

Journal Reference:

H. H. Ting, A. Y. Chen, M. T. Roe, P. S. Chan, J. A. Spertus, B. K. Nallamothu, M. D. Sullivan, E. R. DeLong, E. H. Bradley, H. M. Krumholz, E. D. Peterson. Delay From Symptom Onset to Hospital Presentation for Patients With Non-ST-Segment Elevation Myocardial Infarction. Archives of Internal Medicine, 2010; 170 (20): 1834 DOI: 10.1001/archinternmed.2010.385

Note: If no author is given, the source is cited instead.

View the original article here

Women with diabetes having more C-sections and fetal complications, study finds

ScienceDaily (Sep. 17, 2010) ? Nearly half of women with diabetes prior to pregnancy have a potentially-avoidable C-section and their babies are twice as likely to die as those born to women without diabetes, according to the POWER study.

Researchers from St. Michael's Hospital, the Institute for Clinical Evaluative Sciences (ICES) and Women's College Hospital say rates of diabetes in Ontario have doubled in the last 12 years. Nearly one in 10 Ontario adults has been diagnosed with diabetes, including more women than ever before.

As women develop type 2 diabetes (adult onset) during childbearing age, complications during pregnancy are becoming increasingly common.

"We are seeing more younger women living with diabetes. In fact, while older men still have higher rates than older women, women under 45 are getting diagnosed at the same rate as men in that age group," says Dr. Lorraine Lipscombe, a scientist at the Women's College Research Institute at Women's College Hospital and ICES. "This trend is having increasing implications for younger women. With more women having babies later in life, we are seeing a greater number of women getting pregnant with diabetes. The POWER Study found that having diabetes before pregnancy significantly increases the risk of pregnancy and fetal complications."

The POWER (Project for an Ontario Women's Health Evidence-Based Report) Study -- a joint study from St. Michael's Hospital and ICES -- is the first in the province to provide a comprehensive overview of women's health in relation to income, education, ethnicity and geography. The findings are detailed in the report titled Diabetes-the ninth chapter to be released as part of the study. Findings can be used by policymakers and health-care providers to improve access, quality and outcomes of care for Ontario women. The POWER Study was funded by Echo: Improving Women's Health in Ontario, an agency of the Ontario Ministry of Health and Long-Term Care.

"By identifying the provincial variations in diabetes care, the Local Health Integration Networks can now use this data for priority setting, planning and quality improvement activities," says Pat Campbell, CEO, Echo. "By implementing interventions at the policy, population health and practice levels we can reduce these regional inequities and improve the health of both men and women with diabetes."

The POWER study, released Sept. 17, examined the impact of diabetes on Ontarians. Key findings include:

45 per cent of women with pre-gestational diabetes are having C-sections compared with 37 per cent of women with gestational diabetes and 27 percent of women without diabetes.Babies born to women with pre-pregnancy diabetes have twice as many fetal complications as those born to women without diabetes.The rate of stillbirth/in-hospital mortality in women with pre-pregnancy diabetes is twice the rate in women with diabetes (5.2 per 1,000 vs 2.5 per 1,000) than women without diabetes.Rates of major and minor congenital anomalies were 60 per cent higher among women with pre-pregnancy diabetes than women without diabetes.More than 50 per cent of people who don't yet have diabetes have risk factors for the disease.One in four adults aged 65 and older have been diagnosed with diabetes.

"Infants born to women with diabetes are at much higher risk for serious complications -which can be prevented by controlling glucose and blood pressure levels at the time of conception and during pregnancy," says Dr. Gillian Booth, scientist at St. Michael's Hospital and scientist at ICES. "This reflects a need for more targeted pre-pregnancy counselling and better pregnancy care for this group of women."

"Diabetes is quickly becoming a worldwide epidemic, owing to a dramatic rise in type 2 diabetes -- but most diabetes can be prevented," says Arlene Bierman, a physician at St. Michael's Hospital and principal investigator of the study. "We need to focus on preventing or reducing rates of diabetes among young women, one of the most vulnerable groups, and ensure that women who have diabetes get effective treatment," adds Dr. Bierman, also an ICES investigator.

For more information on the POWER Study and its partners, visit www.powerstudy.ca. Other findings from the study will be released later this year.

Editor's Note: This article is not intended to provide medical advice, diagnosis or treatment.

Story Source:

The above story is reprinted (with editorial adaptations by ScienceDaily staff) from materials provided by St. Michael's Hospital, via EurekAlert!, a service of AAAS.

Note: If no author is given, the source is cited instead.

View the original article here