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      Time to hospital arrival among patients with acute myocardial infarction in China: a report from China PEACE prospective study

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          Abstract

          Aims

          Few contemporary studies have reported the time between acute myocardial infarction (AMI) symptoms onset and hospital arrival, associated factors, and patient perceptions of AMI symptoms and care seeking. We sought to study these issues using data from China, where AMI hospitalizations are increasing.

          Methods and results

          We used data from the China PEACE prospective AMI study of 53 hospitals across 21 provinces in China. Patients were interviewed during index hospitalization for information of symptom onset, and perceived barriers to accessing care. Regression analyses were conducted to explore factors associated with the time between symptom onset and hospital arrival. The final sample included 3434 patients (mean age 61 years). The median time from symptom onset to hospital arrival was 4 h (interquartile range 2–7.5 h). While 94% of patients reported chest pain or chest discomfort, only 43% perceived symptoms as heart-related. In multivariable analyses, time to hospital arrival was longer by 14% and 39% for patients failing to recognize symptoms as cardiac and those with rural medical insurance, respectively (both P < 0.001). Compared with patients with household income over 100 000 RMB, those with income of 10 000–50 000 RMB, and <10 000 RMB had 16% and 23% longer times, respectively (both P = 0.03).

          Conclusion

          We reported an average time to hospital arrival of 4 h for AMI in China, with longer time associated with rural medical insurance, failing to recognize symptoms as cardiac, and low household income. Strategies to improve the timeliness of presentation may be essential to improving outcomes for AMI in China.

          Clinical trial registration

          https://clinicaltrials.gov/ct2/show/NCT01624909.

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          Most cited references24

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          EuroQol: the current state of play.

          R. Brooks (1996)
          The EuroQol Group first met in 1987 to test the feasibility of jointly developing a standardised non-disease-specific instrument for describing and valuing health-related quality of life. From the outset the Group has been multi-country, multi-centre, and multi-disciplinary. The EuroQol instrument is intended to complement other forms of quality of life measures, and it has been purposefully developed to generate a cardinal index of health, thus giving it considerable potential for use in economic evaluation. Considerable effort has been invested by the Group in the development and valuation aspects of health status measurement. Earlier work was reported upon in 1990; this paper is a second 'corporate' effort detailing subsequent developments. The concepts underlying the EuroQol framework are explored with particular reference to the generic nature of the instrument. The valuation task is reviewed and some evidence on the methodological requirements for measurement is presented. A number of special issues of considerable interest and concern to the Group are discussed: the modelling of data, the duration of health states and the problems surrounding the state 'dead'. An outline of some of the applications of the EuroQol instrument is presented and a brief commentary on the Group's ongoing programme of work concludes the paper.
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            Depressive symptoms and health-related quality of life: the Heart and Soul Study.

            Bernice Ruo, M A Hlatky, John S Rumsfeld … (2003)
            Little is known regarding the extent to which patient-reported health status, including symptom burden, physical limitation, and quality of life, is determined by psychosocial vs physiological factors among patients with chronic disease. To compare the contributions of depressive symptoms and measures of cardiac function to the health status of patients with coronary artery disease. Cross-sectional study of 1024 adults with stable coronary artery disease recruited from outpatient clinics in the San Francisco Bay Area between September 2000 and December 2002. Main Measures Measurement of depressive symptoms using the Patient Health Questionnaire (PHQ); assessment of cardiac function by measuring left ventricular ejection fraction on echocardiography, exercise capacity on treadmill testing, and ischemia on stress echocardiography; and measurement of a range of health status outcomes, including symptom burden, physical limitation, and quality of life, using the Seattle Angina Questionnaire. Participants were also asked to rate their overall health as excellent, very good, good, fair, or poor. Of the 1024 participants, 201 (20%) had depressive symptoms (PHQ score > or =10). Participants with depressive symptoms were more likely than those without depressive symptoms to report at least mild symptom burden (60% vs 33%; P<.001), mild physical limitation (73% vs 40%; P<.001), mildly diminished quality of life (67% vs 31%; P<.001), and fair or poor overall health (66% vs 30%; P<.001). In multivariate analyses adjusting for measures of cardiac function and other patient characteristics, depressive symptoms were strongly associated with greater symptom burden (odds ratio [OR], 1.8; 95% confidence interval [CI], 1.3-2.7; P =.002), greater physical limitation (OR, 3.1; 95% CI, 2.1-4.6; P<.001), worse quality of life (OR, 3.1; 95% CI, 2.2-4.6; P<.001), and worse overall health (OR, 2.0; 95% CI, 1.3-2.9; P<.001). Although decreased exercise capacity was associated with worse health status, left ventricular ejection fraction and ischemia were not. Among patients with coronary disease, depressive symptoms are strongly associated with patient-reported health status, including symptom burden, physical limitation, quality of life, and overall health. Conversely, 2 traditional measures of cardiac function-ejection fraction and ischemia-are not. Efforts to improve health status should include assessment and treatment of depressive symptoms.
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              Relationship between delay in performing direct coronary angioplasty and early clinical outcome in patients with acute myocardial infarction: results from the global use of strategies to open occluded arteries in Acute Coronary Syndromes (GUSTO-IIb) trial.

              Peter B Berger, Stephen G Ellis, David Holmes … (1999)
              Time to treatment with thrombolytic therapy is a critical determinant of mortality in acute myocardial infarction. Little is known about the relationship between the time to treatment with direct coronary angioplasty and clinical outcome. The objectives of this study were to determine both the time required to perform direct coronary angioplasty in the Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) trial and its relationship to clinical outcome. Patients randomized to direct coronary angioplasty (n=565) were divided into groups based on the time between study enrollment and first balloon inflation. Patients randomized to angioplasty who did not undergo the procedure were also analyzed. The median time from study enrollment to first balloon inflation was 76 minutes; 19% of patients assigned to angioplasty did not undergo an angioplasty procedure. The 30-day mortality rate of patients who underwent balloon inflation /=91 minutes after enrollment, 6.4%. The mortality rate of patients assigned to angioplasty who never underwent the procedure was 14.1% (P=0.001). Logistic regression analysis revealed that the time from enrollment to first balloon inflation was a significant predictor of mortality within 30 days; after adjustment for differences in baseline characteristics, the odds of death increased 1.6 times (P=0.008) for a movement from each time interval to the next. The time to treatment with direct PTCA, as with thrombolytic therapy, is a critical determinant of mortality.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Eur Heart J Qual Care Clin Outcomes
                Journal ID (iso-abbrev): Eur Heart J Qual Care Clin Outcomes
                Journal ID (publisher-id): ehjqcco
                Title: European Heart Journal. Quality of Care & Clinical Outcomes
                Publisher: Oxford University Press
                ISSN (Print): 2058-5225
                ISSN (Electronic): 2058-1742
                Publication date (Print): January 2019
                Publication date (Electronic): 24 June 2018
                Publication date PMC-release: 24 June 2018
                Volume: 5
                Issue: 1
                Pages: 63-71
                Affiliations
                [1 ]National Clinical Research Center of Cardiovascular Diseases, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Road, Beijing, China
                [2 ]Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, USA
                [3 ]Department of Emergency Medicine, Yale University School of Medicine, 464 Congress Ave, Ste 260, New Haven, CT, USA
                [4 ]Department of Pharmaceutical & Health Economics, School of Pharmacy, University of Southern California, 635 Downey Way, Los Angeles, California, USA
                [5 ]Division of Cardiology, University of Colorado Anschutz Medical Campus, Campus Box B132, 12401 East 17th Avenue, Room 522, Aurora, CO, USA
                [6 ]Saint Luke’s Mid America Heart Institute/University of Missouri Kansas City, 4401 Wornall Road, Kansas City, MO, USA
                [7 ]Department of Health Policy and Management, Yale University School of Public Health, 60 College Street, New Haven, CT, USA
                [8 ]Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, 333 Cedar Street, SHM I-456, New Haven, CT, USA
                Author notes
                Corresponding author. Tel: +86 10 8839 6203, Fax: +86 10 8836 5201, Email: jiangl@ 123456fwoxford.org

                Wenchi Guan and Arjun K. Venkatesh two authors are joint first authors.

                Harlan M. Krumholz and Lixin Jiang two authors are joint senior authors.

                Article
                Publisher ID: qcy022
                DOI: 10.1093/ehjqcco/qcy022
                PMC ID: 6307335
                PubMed ID: 29878087
                SO-VID: 95029d50-b667-4d37-af64-674e17e1043c
                Copyright © © The Author(s) 2018. Published by Oxford University Press on behalf of the European Society of Cardiology
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                Date received : 19 March 2018
                Date revision received : 10 May 2018
                Date accepted : 24 May 2018
                Page count
                Pages: 9
                Funding
                Funded by: Research Special Fund for Public Welfare Industry of Health
                Award ID: 201502009
                Funded by: National Health and Family Planning Commission of China
                Funded by: National Key Technology R&D Program
                Award ID: 2015BAI12B01
                Award ID: 2015BAI12B02
                Funded by: Ministry of Science and Technology of China
                Award ID: B16005
                Categories
                Subject: Original Articles

                Keywords: time to hospital arrival,acute myocardial infarction,access to care
                Data availability:
                Keywords: time to hospital arrival, acute myocardial infarction, access to care

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