The Decision to Seek Care and Time to Treatment During Acute Coronary Syndromes

2.50
Hdl Handle:
http://hdl.handle.net/10755/157713
Type:
Presentation
Title:
The Decision to Seek Care and Time to Treatment During Acute Coronary Syndromes
Abstract:
The Decision to Seek Care and Time to Treatment During Acute Coronary Syndromes
Conference Sponsor:Western Institute of Nursing
Conference Year:2009
Author:DeVon, Holli A., PhD, RN
P.I. Institution Name:Loyola University Chicago, Niehoff School of Nursing
Title:Associate Professor
Contact Address:2160 S. First Ave., Bldg. 105; Room 2875, Maywood, IL, 60153, USA
Contact Telephone:847-503-8464
Co-Authors:Nancy Hogan, PhD, RN, FAAN, Distinguished Professor; Amy L. Ochs, RN, MSN, Nurse Practitioner; Moshe Shapiro, MS, Biostatistician
Purpose/Aims: The objectives of this study were to explore factors associated with a decision to seek care in the emergency department for symptoms of acute coronary syndromes (ACS) and to describe patient characteristics associated with time to treatment in the emergency department (ED). Rationale/Background: Multiple sociodemographic and environmental factors have been associated with urgent treatment seeking behaviors for patients experiencing ACS. However, which variables directly affect the decision to seek care in the emergency department have been less well defined. Methods: A mixed methods, cross-sectional, descriptive design was used. The non-probability sample included 112 women and 144 men. The study was conducted on cardiac step-down units at two large urban medical centers. Reasons for seeking care and decision-making descriptions were elicited during semi-structured interviews in the patient's room. Decision-making factors and other patient characteristics were treated as predictor variables in an analysis of time from symptom onset to arrival in the ED using Cox Proportional Hazards model. Results: Five categories of decision-making were identified through content analyses. They were new onset of chest pain, ongoing evaluation of symptom severity, symptoms other than chest pain that worsened or were unrelieved, others making decisions for the patient, and help-seeking orientation. There was no significant difference in median time from symptom onset to arrival in the emergency department for women and men (9.5 hours vs. 6 hours (log-rank test, p=.63). Patients who experienced constant pain vs. intermittent pain (Hazard Ratio= 1.44, p=.01) and those with ST segment elevation myocardial infarction vs. unstable angina (Hazard Ratio=1.59, p=.004) sought treatment significantly sooner. Older patients were more likely to seek treatment later (Hazard Ratio=.99, p=.02). Constant pain was the only variable identified by patients that was a significant predictor of reduced time to treatment. Implications: Women, older patients, and patients who experience intermittent pain should be encouraged to seek emergent treatment for symptoms that may represent ACS. New evidence of patients' decision-making processes and response to symptoms during ACS provide additional information nurses need to counsel patients about the potentially life-saving benefits of seeking emergent care for symptoms of ACS.
Repository Posting Date:
26-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Western Institute of Nursing

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleThe Decision to Seek Care and Time to Treatment During Acute Coronary Syndromesen_GB
dc.identifier.urihttp://hdl.handle.net/10755/157713-
dc.description.abstract<table><tr><td colspan="2" class="item-title">The Decision to Seek Care and Time to Treatment During Acute Coronary Syndromes</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Western Institute of Nursing</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">2009</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">DeVon, Holli A., PhD, RN</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Loyola University Chicago, Niehoff School of Nursing</td></tr><tr class="item-author-title"><td class="label">Title:</td><td class="value">Associate Professor</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">2160 S. First Ave., Bldg. 105; Room 2875, Maywood, IL, 60153, USA</td></tr><tr class="item-phone"><td class="label">Contact Telephone:</td><td class="value">847-503-8464</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">hdevon@luc.edu, holli.devon@ucsf.edu</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Nancy Hogan, PhD, RN, FAAN, Distinguished Professor; Amy L. Ochs, RN, MSN, Nurse Practitioner; Moshe Shapiro, MS, Biostatistician</td></tr><tr><td colspan="2" class="item-abstract">Purpose/Aims: The objectives of this study were to explore factors associated with a decision to seek care in the emergency department for symptoms of acute coronary syndromes (ACS) and to describe patient characteristics associated with time to treatment in the emergency department (ED). Rationale/Background: Multiple sociodemographic and environmental factors have been associated with urgent treatment seeking behaviors for patients experiencing ACS. However, which variables directly affect the decision to seek care in the emergency department have been less well defined. Methods: A mixed methods, cross-sectional, descriptive design was used. The non-probability sample included 112 women and 144 men. The study was conducted on cardiac step-down units at two large urban medical centers. Reasons for seeking care and decision-making descriptions were elicited during semi-structured interviews in the patient's room. Decision-making factors and other patient characteristics were treated as predictor variables in an analysis of time from symptom onset to arrival in the ED using Cox Proportional Hazards model. Results: Five categories of decision-making were identified through content analyses. They were new onset of chest pain, ongoing evaluation of symptom severity, symptoms other than chest pain that worsened or were unrelieved, others making decisions for the patient, and help-seeking orientation. There was no significant difference in median time from symptom onset to arrival in the emergency department for women and men (9.5 hours vs. 6 hours (log-rank test, p=.63). Patients who experienced constant pain vs. intermittent pain (Hazard Ratio= 1.44, p=.01) and those with ST segment elevation myocardial infarction vs. unstable angina (Hazard Ratio=1.59, p=.004) sought treatment significantly sooner. Older patients were more likely to seek treatment later (Hazard Ratio=.99, p=.02). Constant pain was the only variable identified by patients that was a significant predictor of reduced time to treatment. Implications: Women, older patients, and patients who experience intermittent pain should be encouraged to seek emergent treatment for symptoms that may represent ACS. New evidence of patients' decision-making processes and response to symptoms during ACS provide additional information nurses need to counsel patients about the potentially life-saving benefits of seeking emergent care for symptoms of ACS.</td></tr></table>en_GB
dc.date.available2011-10-26T20:08:01Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-26T20:08:01Z-
dc.description.sponsorshipWestern Institute of Nursingen_GB
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