Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities.
BACKGROUND
The two major complications of atherosclerosis are acute myocardial infarction (AMI) and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase.


METHODS
A literature search was performed on the PubMed, Embase (Ovid SP) and Cochrane Library databases.


RESULTS
In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women).With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS) there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke.


CONCLUSIONS
Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between pre-hospital and in-hospital care might be fruitful.
Herlitz
Johan
J
Institute of Medicine, Department of Molecular and Clinical Medicine, Sahlgrenska University Hospital, SE-413 45 Göteborg, Sweden. johan.herlitz@gu.se
Wireklintsundström
Birgitta
B
Bång
Angela
A
Berglund
Annika
A
Svensson
Leif
L
Blomstrand
Christian
C
D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D020521:Stroke / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D013997:Time Factors
J Neurol. 2005 Dec;252(12):1500-3
16021352
Stroke. 2004 Mar;35(3):700-4
14963279
JAMA. 2000 Jun 28;283(24):3223-9
10866870
J Cardiovasc Nurs. 2004 Jan-Feb;19(1):5-12
14994777
J Prev Med Public Health. 2007 Mar;40(2):130-6
17426424
Neurology. 1998 Aug;51(2):427-32
9710014
Int J Cardiol. 2005 Aug 18;103(2):150-5
16080973
Clin Neurol Neurosurg. 2008 May;110(5):451-4
18353532
J Electrocardiol. 2005 Oct;38(4 Suppl):187-92
16226099
Emerg Med J. 2008 Jun;25(6):340-5
18499815
Stroke. 2000 Nov;31(11):2591-6
11062280
Int J Cardiol. 2005 Aug 18;103(2):120-7
16080968
Stroke. 2003 May;34(5):1230-4
12702836
Kaohsiung J Med Sci. 2007 Nov;23(11):552-9
18055303
Acute Card Care. 2008;10(4):197-204
18781448
Heart. 1996 Aug;76(2):150-5
8795479
Heart. 1997 Nov;78(5):462-4
9415004
Am Heart J. 1990 Oct;120(4):773-80
2220531
Am J Cardiol. 1969 Nov;24(5):651-8
5347938
Arch Intern Med. 2009 Sep 14;169(16):1484-90
19752406
Emerg Med J. 2003 May;20(3):270-3
12748152
J Adv Nurs. 2008 Jul;63(2):148-54
18547371
Stroke. 2010 Jan;41(1):e18-24
19910552
Ann Emerg Med. 1999 Jan;33(1):3-8
9867880
Ann Emerg Med. 2009 Jun;53(6):736-45
19157653
Stroke. 2009 Jul;40(7):2635-60
19423851
Neurol Res. 2007 Jul;29(5):476-9
17535554
Ann Emerg Med. 2004 Nov;44(5):476-83
15520707
Neuroepidemiology. 2006;26(3):168-75
16493205
Stroke. 2009 Dec;40(12):3845-50
19797697
Ann Emerg Med. 1993 Oct;22(10):1597-601
8214844
J Emerg Nurs. 2008 Dec;34(6):509-15
19022072
Int J Cardiol. 2008 Oct 13;129(3):325-32
17997494
Stroke. 2009 Mar;40(3):902-8
19023095
Acad Emerg Med. 2006 Aug;13(8):867-72
16801632
Coron Artery Dis. 2003 May;14(3):225-31
12702926
Lancet. 1986 Feb 22;1(8478):397-402
2868337
Acad Emerg Med. 2006 Jan;13(1):84-9
16365334
Heart Lung. 2007 Nov-Dec;36(6):398-409
18005801
Med Princ Pract. 2005 Nov-Dec;14(6):408-12
16220014
Presse Med. 2008 Mar;37(3 Pt 1):401-5
18082355
Stroke. 2000 Nov;31(11):2585-90
11062279
Eur J Cardiovasc Nurs. 2007 Dec;6(4):280-6
17478122
Am J Cardiol. 2008 Apr 1;101(7):941-6
18359312
Acad Emerg Med. 2000 Aug;7(8):862-72
10958125
Cerebrovasc Dis. 2005;19(2):96-101
15608433
Heart. 1997 Nov;78(5):456-61
9415003
Int J Cardiol. 2009 Jun 12;135(1):86-92
18845348
Eur Heart J. 1996 Mar;17(3):429-37
8737218
Stroke. 1994 Oct;25(10):1920-3
8091434
Br Heart J. 1989 Apr;61(4):322-5
2713188
Patient Educ Couns. 2005 Jan;56(1):45-54
15590222
Eur Heart J. 1997 Feb;18(2):248-53
9043841
Heart Lung. 1998 Mar-Apr;27(2):75-81
9548063
Emerg Med Australas. 2005 Jun;17(3):218-23
15953222
Crit Pathw Cardiol. 2009 Sep;8(3):119-21
19726931
J Clin Neurosci. 2001 Jul;8(4):311-4
11437568
Neuroepidemiology. 1999;18(5):255-64
10461051
Arch Intern Med. 1997 Dec 8-22;157(22):2577-82
9531226
Heart. 2000 Aug;84(2):137-41
10908246
Heart Lung. 2007 Sep-Oct;36(5):307-18
17845877
Eur J Emerg Med. 1999 Jun;6(2):95-103
10461550
N Z Med J. 2006 Apr 21;119(1232):U1927
16633386
J Telemed Telecare. 2009;15(5):260-3
19590033
JAMA. 2000 May 24-31;283(20):2686-92
10819952
Eur Heart J. 1995 Dec;16(12):1789-94
8682008
Eur J Cardiovasc Nurs. 2007 Dec;6(4):308-13
17452019
Am Heart J. 2009 Nov;158(5):829-35
19853705
BMJ. 1992 Jan 11;304(6819):83-7
1737145
Stroke. 1999 Jan;30(1):40-8
9880386
Prog Cardiovasc Nurs. 2006 Winter;21(1):20-7
16522965
Circulation. 2000 Oct 3;102(14):1651-6
11015343
J Stroke Cerebrovasc Dis. 2009 May-Jun;18(3):229-31
19426895
Acad Emerg Med. 2000 Jan;7(1):93-6
10894250
Am J Cardiol. 2007 May 15;99(10):1360-3
17493460
J Stroke Cerebrovasc Dis. 2001 Nov-Dec;10(6):274-8
17903838
J Stroke Cerebrovasc Dis. 2006 May-Jun;15(3):81-7
17904057
Am J Emerg Med. 2006 Jan;24(1):1-7
16338501
Am J Cardiol. 1992 Jul 1;70(1):10-3
1615847
Circulation. 1998 Dec 15;98(24):2649-51
9851947
Am Heart J. 2005 Sep;150(3):392-400
16169313
Int J Cardiol. 2004 Jul;96(1):97-103
15203267
Ethn Dis. 2002 Winter;12(1):38-44
11913607
Cerebrovasc Dis. 2004;18(1):47-56
15178987
Aust Crit Care. 2001 Nov;14(4):139-45
11806510
BMC Neurol. 2008 May 13;8:15
18477393
Stroke. 2001 Jan;32(1):63-9
11136916
Stroke. 2007 Feb;38(2):361-6
17204685
Stroke. 1997 Oct;28(10):1871-5
9341687
Prehosp Emerg Care. 2001 Oct-Dec;5(4):335-9
11642581
Ital J Neurol Sci. 1996 Dec;17(6):401-7
8978446
Stroke. 2006 Jun;37(6):1508-13
16690898
Prev Med. 2005 Jul;41(1):226-31
15917015
Conn Med. 2003 Mar;67(3):145-8
12687788
Circ Cardiovasc Qual Outcomes. 2009 Nov;2(6):524-32
20031889
Eur Neurol. 2004;51(1):35-7
14685017
BMJ. 2002 May 4;324(7345):1065-8
11991910
Ann Emerg Med. 1996 Jan;27(1):8-15
8572455
J R Soc Med. 1993 Nov;86(11):642-4
8258799
Crit Pathw Cardiol. 2006 Mar;5(1):29-33
18340215
Eur J Emerg Med. 2000 Mar;7(1):15-24
10839374
Tech Vasc Interv Radiol. 2005 Jun;8(2):74-80
16194754
Acad Emerg Med. 2009 Apr;16(4):333-42
19456296
Am J Emerg Med. 2000 May;18(3):257-60
10830678
J Transcult Nurs. 2006 Oct;17(4):341-8
16946116
Stroke. 2006 May;37(5):1248-53
16556885
Eur Heart J. 1995 Mar;16(3):325-32
7789374
MMWR Morb Mortal Wkly Rep. 2007 May 18;56(19):474-8
17510611
Rev Neurol. 2006 Jan 16-31;42(2):68-72
16450319
Eur Heart J. 2005 Apr;26(8):770-7
15684279
Ann Intern Med. 1999 Feb 16;130(4 Pt 1):328
10068395
J Epidemiol Community Health. 1999 Aug;53(8):459-64
10562863
Neurocrit Care. 2007;7(1):31-5
17622492
Arq Neuropsiquiatr. 2002 Jun;60(2-A):185-91
12068343
Am Heart J. 2008 Jul;156(1):170-6
18585513
Stroke. 2006 Apr;37(4):963-6
16514096
Neuroepidemiology. 1998;17(3):161-6
9648122
Cerebrovasc Dis. 2007;23(4):289-93
17199086
Int J Cardiol. 2009 Aug 14;136(2):213-4
18639944
Circulation. 2003 Oct 14;108(15):1809-14
14530206
BMJ. 2002 Jul 6;325(7354):17
12098723
Intern Med. 2006;45(7):447-51
16679699
Arch Intern Med. 1993 Nov 22;153(22):2558-61
7598755
Stroke. 2004 May;35(5):e106-8
15017009
Eur J Neurol. 2008 Apr;15(4):329-35
18312404
Am Heart J. 2006 Jun;151(6):1255.e1-5
16781231
Acad Emerg Med. 1999 Mar;6(3):218-23
10192674
Soc Sci Med. 1986;22(12):1297-311
3738555
Prehosp Emerg Care. 2000 Oct-Dec;4(4):290-3
11045405
Arch Intern Med. 1995 Jul 24;155(14):1481-8
7605149
Eur J Neurol. 2006 Mar;13(3):225-32
16618337
J Intern Med. 2002 Nov;252(5):412-20
12528759
Eur Heart J. 1992 Feb;13(2):171-7
1555612
Lancet. 2002 Nov 2;360(9343):1398
12423992
J Nurs Scholarsh. 2003;35(4):317-23
14735673
Ann Intern Med. 1997 Apr 15;126(8):593-9
9103125
Ital Heart J. 2001 Oct;2(10):766-71
11721721
Arch Intern Med. 1998 Nov 23;158(21):2329-38
9827784
J Formos Med Assoc. 2000 Jul;99(7):532-7
10925562
J Stroke Cerebrovasc Dis. 2004 Jan-Feb;13(1):1-11
17903943
Int J Cardiol. 2007 Jul 31;119(3):355-8
17084467
Circulation. 2002 Dec 10;106(24):3018-23
12473545
Gend Med. 2006 Dec;3(4):270-8
17582368
Heart. 2000 Apr;83(4):388-93
10722534
N Engl J Med. 1995 Dec 14;333(24):1581-7
7477192
N Z Med J. 1995 Jun 28;108(1002):253-4
7617332
Heart. 2006 Oct;92(10):1378-83
16914481
JAMA. 2000 Jul 5;284(1):60-7
10872014
Eur J Emerg Med. 2006 Oct;13(5):290-4
16969235
Stroke. 2007 Dec;38(12):3213-7
17962593
Stroke. 2003 Jan;34(1):71-6
12511753
Stroke. 2005 Apr;36(4):809-14
15731476
J Pak Med Assoc. 2008 Apr;58(4):178-82
18655425
Am Heart J. 2005 Aug;150(2):234-42
16086924
J Am Coll Cardiol. 1997 Mar 1;29(3):498-505
9060884
Stroke. 2002 Jan;33(1):153-9
11779905
Neurology. 2006 Feb 14;66(3):306-12
16476927
Intern Med J. 2010 Feb;40(2):112-6
19383057
Stroke. 2007 Nov;38(11):2972-8
17885255
Br Heart J. 1994 May;71(5):440-5
8011407
Cerebrovasc Dis. 2003;16(1):21-6
12766357
J Emerg Med. 2006 Oct;31(3):241-5
16982353
Emerg Med J. 2008 Nov;25(11):735-9
18955606
J Am Coll Cardiol. 1996 Jun;27(7):1646-55
8636549
Eur J Cardiovasc Nurs. 2009 Mar;8(1):26-33
18635400
Age Ageing. 2010 Jan;39(1):11-22
19897540
Eur J Neurol. 2009 Dec;16(12):1331-5
19832903
Am Heart J. 1994 Aug;128(2):255-63
8037091
Chang Gung Med J. 2002 Jul;25(7):458-63
12350032
J Cardiovasc Nurs. 2009 Sep-Oct;24(5):390-7
19707099
Stroke. 1997 May;28(5):916-21
9158625
Heart. 2008 Mar;94(3):354-9
17591647
Int J Cardiol. 2010 Jun 11;141(3):236-42
19136167
Rev Neurol. 2005 May 1-15;40(9):531-6
15898013
Am Heart J. 2006 Oct;152(4):661-7
16996830
Neurology. 2001 Apr 24;56(8):1015-20
11320171
JAMA. 1998 Apr 22-29;279(16):1288-92
9565010
Swiss Med Wkly. 2009 Jul 11;139(27-28):393-9
19629767
J Cardiovasc Nurs. 2003 Jul-Aug;18(3):184-96
12837009
J Clin Neurosci. 2007 Sep;14(9):831-4
17588762
Heart. 1996 Nov;76(5):430-4
8944590
Am J Emerg Med. 2006 Nov;24(7):775-81
17098096
Heart Lung. 1993 Jan-Feb;22(1):64-70
8420858
Scand Cardiovasc J. 2003 Sep;37(4):183-6
12944204
Stroke. 2005 Jul;36(7):1512-8
15961712
Am Heart J. 1992 Apr;123(4 Pt 1):835-40
1549989
Neurology. 2006 Jul 25;67(2):334-6
16864834
Prehosp Emerg Care. 2008 Jul-Sep;12(3):366-71
18584506
Heart Lung. 2007 Jan-Feb;36(1):25-34
17234474
Circulation. 1977 Nov;56(5):786-94
912839
Ann Acad Med Singap. 2007 Apr;36(4):244-6
17483852
JAMA. 2009 Jul 1;302(1):20-1
19567427
Ann Intern Med. 1998 Aug 1;129(3):190-6
9696726
Stroke. 2009 Apr;40(4):1114-20
19211483
JAMA. 2003 Jan 15;289(3):343-6
12525235
Med J Aust. 2008 Oct 20;189(8):429-33
18928434
Am J Crit Care. 1995 Jan;4(1):29-35
7894552
Ann Acad Med Singap. 2002 May;31(3):387-92
12061302
Circ Cardiovasc Qual Outcomes. 2009 May;2(3):148-54
20031831
Neurology. 2005 Jun 28;64(12):2115-20
15985583
J Clin Neurosci. 2009 Jan;16(1):21-5
19008103
BMJ. 1998 Apr 4;316(7137):1060-4
9552909
Stroke. 2003 Apr;34(4):994-8
12624218
Ann Emerg Med. 2004 Dec;44(6):577-85
15573032
Stroke. 1992 Mar;23(3):352-6
1542895
J Am Coll Cardiol. 2006 Apr 18;47(8):1544-52
16630989
Cerebrovasc Dis. 2004;17(4):346
15103185
Circulation. 1971 Jan;43(1):67-82
5540853
Adv Ther. 2006 Mar-Apr;23(2):244-55
16751157
Stroke. 2000 Aug;31(8):1925-8
10926958
Intern Med. 2009;48(19):1739-44
19797829
Prehosp Emerg Care. 1999 Jul-Sep;3(3):211-6
10424858
Arch Intern Med. 2003 Oct 13;163(18):2198-202
14557217
Med Clin North Am. 2007 Jul;91(4):553-72; ix
17640536
Ugeskr Laeger. 2003 Jan 13;165(3):225-8
12555704
Eur Neurol. 2007;58(3):159-65
17622722
Heart Lung. 2004 Sep-Oct;33(5):291-300
15454908
Int J Cardiol. 2011 Mar 3;147(2):224-7
19853936
Stroke. 2007 Oct;38(10):2765-70
17717317
Eur Heart J. 2002 Apr;23(7):550-7
11922645
QJM. 1998 Sep;91(9):635-40
10024918