title: [Instruction of patients and a delay of treatment in myocardial infarction and unstable angina in the Krakow Program of Secondary Prevention of Ischaemic Heart Disease (IHD)].
abstract: Shortening the time between the onset of pain and start of the efficacious treatment is an important mean to lower case-fatality in myocardial infarction (MI). The goal of this publication was to assess: 1) current time between the onset of pain and: a) calling medical service by the patient b) first examination by a doctor, and c) first administration of intravenous treatment, 2) reasons of the delay in calling medical service by the patient, 3) whether patients with a diagnosis of ischaemic heart disease (IHD) prior to hospitalization were instructed how to behave in case of chest pain, and 4) whether instructing how to behave in case of chest pain was related with a time between the onset of pain and calling medical service by the patient. Studied group were 515 patients hospitalised in 6 in-patient clinics of cardiology with MI or unstable angina (UA) or hospitalised for first PTCA or CABG, 427 (83%) agreed to participate, out of whom 184 had MI or UA including 110 patients having typical chest pain. In hospitalized patients with MI or UA with typical chest pain 62% received intravenous treatment within first 4 hours after the pain onset. 35% patients received first intravenous treatment later than 6 hours after the onset of pain and out of them 2/3 after 12 hours. The main component of the delay was the long time between the onset of pain and the call for medical service. 46% patients called for medical service later than 1 hour after the onset and in 80% of them the reason was lack of knowledge on the risk and how to behave in case of chest pain. Patients who earlier received instruction had four times higher chance to call medical service within the first hour after the onset of pain (Odds Ratio = 4.11, 95% confidence interval 1.13-15.0). Only half of all patients hospitalised due to acute episode of IHD or for revascularization procedures received intensive instructions from a doctor. Adopting a detailed instruction on how to behave in case of chest pain as a standard procedure for patients with IHD may be an important mean to lower case-fatality in MI.
authors.affiliation: Zakład Epidemiologii i Badań Populacyjnych, Instytut Zdrowia Publicznego Collegium Medicum, Uniwersytet Jagielloński, 31-501 Kraków, ul. Kopernika 15.
authors.forename: A
authors.initials: A
authors.lastname: Pajak
authors.forename: P
authors.initials: P
authors.lastname: Jankowski
authors.forename: E
authors.initials: E
authors.lastname: Dojka
authors.forename: K
authors.initials: K
authors.lastname: Kawecka-Jaszcz
mesh_terms: D000328:Adult; D000368:Aged; D000789:Angina, Unstable / Q000150:complications* / Q000453:epidemiology; D015906:Angioplasty, Balloon, Coronary; D002637:Chest Pain / Q000150:complications; D001026:Coronary Artery Bypass; D004632:Emergency Medical Services; D005260:Female; D006297:Health Services Accessibility; D006760:Hospitalization; D006779:Hospitals, Public; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D016017:Odds Ratio; D010353:Patient Education as Topic; D011044:Poland / Q000453:epidemiology; D012306:Risk; D013997:Time Factors