Andersson Per O, Lawesson Sofia Sederholm, Karlsson Jan-Erik, Nilsson Staffan, Thylén Ingela
Primary Health Care and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden.
Ljungsbro Health Care Centre, Evastigen 9, 590 71 Ljungsbro, Ljungsbro, Sweden.
BMC Fam Pract. 2018 Oct 10;19(1):167. doi: 10.1186/s12875-018-0849-8.
The characteristics of patients with on-going myocardial infarction (MI) contacting the primary healthcare (PHC) centre before hospitalisation are not well known. Prompt diagnosis is crucial in patients with MI, but many patients delay seeking medical care. The aims of this study was to 1) describe background characteristics, symptoms, actions and delay times in patients contacting the PHC before hospitalisation when falling ill with an acute MI, 2) compare those patients with acute MI patients not contacting the PHC, and 3) explore factors associated with a PHC contact in acute MI patients.
This was a cross-sectional multicentre study, enrolling consecutive patients with MI within 24 hours of admission to hospital from Nov 2012 until Feb 2014.
A total of 688 patients with MI, 519 men and 169 women, were included; the mean age was 66±11 years. One in five people contacted PHC instead of the recommended emergency medical services (EMS), and 94% of these patients experienced cardinal symptoms of an acute MI; i.e., chest pain, and/or radiating pain in the arms, and/or cold sweat. Median delay time from symptom-onset-to-decision-to-seek-care was 2:15 hours in PHC patients and 0:40 hours in non-PHC patients (p<0.01). The probability of utilising the PHC before hospitalisation was associated with fluctuating symptoms (OR 1.74), pain intensity (OR 0.90) symptoms during off-hours (OR 0.42), study hospital (OR 3.49 and 2.52, respectively, for two of the county hospitals) and a final STEMI diagnosis (OR 0.58).
Ambulance services are still underutilized in acute MI patients. A substantial part of the patients contacts their primary healthcare centre before they are diagnosed with MI, although experiencing cardinal symptoms such as chest pain. There is need for better knowledge in the population about symptoms of MI and adequate pathways to qualified care. Knowledge and awareness amongst primary healthcare professionals on the occurrence of MI patients is imperative.
目前尚不清楚在住院前联系基层医疗保健（PHC）中心的急性心肌梗死（MI）患者的特征。对MI患者进行及时诊断至关重要，但许多患者延迟就医。本研究的目的是：1）描述急性MI发病时在住院前联系PHC的患者的背景特征、症状、行为和延迟时间；2）将这些患者与未联系PHC的急性MI患者进行比较；3）探讨急性MI患者联系PHC的相关因素。
这是一项横断面多中心研究，纳入了2012年11月至2014年2月期间入院24小时内连续的MI患者。
共纳入688例MI患者，其中男性519例，女性169例；平均年龄为66±11岁。五分之一的人联系了PHC而非推荐的紧急医疗服务（EMS），这些患者中有94%出现了急性MI的主要症状，即胸痛、和/或手臂放射性疼痛、和/或冷汗。PHC患者从症状发作到决定就医的中位延迟时间为2小时15分钟，非PHC患者为0小时4分钟（p<0.01）。住院前使用PHC的概率与症状波动（比值比[OR]1.74）、疼痛强度（OR 0.90）、非工作时间的症状（OR 0.42）、研究医院（两家县级医院的OR分别为3.49和2.52）以及最终的ST段抬高型心肌梗死（STEMI）诊断（OR 0.58）有关。
急性MI患者对救护车服务的利用率仍然较低。相当一部分患者在被诊断为MI之前就联系了他们的基层医疗保健中心，尽管出现了胸痛等主要症状。有必要让公众更好地了解MI的症状以及获得合格医疗服务的适当途径。基层医疗保健专业人员对MI患者发病情况的了解和认识至关重要。
