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Associations between treatment-seeking delay and clinical course of patients with suspected acute coronary syndrome at initial emergency department encounter

Tolassi, Alexandra (2022) Associations between treatment-seeking delay and clinical course of patients with suspected acute coronary syndrome at initial emergency department encounter. Undergraduate Thesis, University of Pittsburgh. (Unpublished)

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Background: Acute coronary syndrome (ACS) is a high-risk clinical condition that requires reperfusion within 12 hours of symptom onset. Treatment-seeking delay prolongs ischemic time and may lead to adverse outcomes. Being aware of potential adverse events at triage may improve patient outcomes.

Purpose: We sought to determine the prevalence of delay greater than 12 hours in patients with suspected ACS and patient characteristics associated with delay. Then, we sought to determine if there was a link between delay and adverse clinical outcomes, as defined by major adverse cardiovascular events (MACE), hospital utilization, and 30-day readmissions.

Methods: This was a secondary analysis of a retrospective study of emergency department (ED) patients with suspected ACS. Descriptive statistics were used to investigate patient characteristics, including demographics, past medical history, vital signs, chief complaints, electrocardiogram results, and delay time, as measured from symptom onset to ED arrival or initial EMS contact. Clinical outcomes of interest include MACE, hospital utilization, and 30-day readmission. MACE was defined as the presence of confirmed ACS diagnosis, death, new onset/worsening heart failure, fatal ventricular dysrhythmia, or cardiogenic shock. Hospital utilization outcomes included: admission, ICU transfer, coronary revascularization, IABP insertion, CABG surgery, or pacemaker or ICD placement. Chi-square or Mann Whitney U tests were used to determine if there were differences in patient characteristics in early (< 12 hours) versus late (≥ 12 hours) presenters. Chi-square was used to find differences in early versus late delay groups for each outcome. Univariable and multivariable binary logistic regressions were used to determine patient factors associated with MACE and hospital utilization in early versus late presenters.

Results: The sample included 1201 patients. Over half (55%, n = 655) presented greater than 12 hours after symptom onset, and 546, (45%) presented before 12 hours. There was no difference in MACE or readmission between delay groups. Early presenters had higher rates of hospital utilization than late presenters.

Conclusion: Nurses should consider patient characteristics at initial ED presentation associated with increased MACE and hospital utilization to better risk stratify those patients. Maximizing reperfusion treatment for patients with delay should be initiated at initial ED assessment.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Tolassi, Alexandraant127@pitt.eduant127
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Committee ChairFrisch, Stephanie O.sof9@pitt.edusof9
Committee CoChairAl-Zaiti, Salahssa33@pitt.edussa33
Committee MemberScott, Paulpws5@pitt.edupws5
Committee MemberDeVon,
Date: 26 April 2022
Date Type: Publication
Defense Date: 13 April 2022
Approval Date: 26 April 2022
Submission Date: 21 April 2022
Access Restriction: 1 year -- Restrict access to University of Pittsburgh for a period of 1 year.
Number of Pages: 70
Institution: University of Pittsburgh
Schools and Programs: David C. Frederick Honors College
School of Nursing > Nursing
Degree: BSN - Bachelor of Science in Nursing
Thesis Type: Undergraduate Thesis
Refereed: Yes
Uncontrolled Keywords: Emergency Department, delay, prehospital, treatment seeking, acute coronary syndrome, MACE, hospital utilization, readmission
Date Deposited: 26 Apr 2022 14:11
Last Modified: 26 Apr 2023 05:15


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