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Ängerud, K. H., Sederholm Lawesson, S., Isaksson, R.-M., Thylén, I. & Swahn, E. (2019). Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction. European heart journal. Acute cardiovascular care., 8(3), 201-207
Open this publication in new window or tab >>Differences in symptoms, first medical contact and pre-hospital delay times between patients with ST- and non-ST-elevation myocardial infarction
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2019 (English)In: European heart journal. Acute cardiovascular care., ISSN 2048-8726, Vol. 8, no 3, p. 201-207Article in journal (Refereed) Published
Abstract [en]

AIM: In ST-elevation myocardial infarction, time to reperfusion is crucial for the prognosis. Symptom presentation in myocardial infarction influences pre-hospital delay times but studies about differences in symptoms between patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction are sparse and inconclusive. The aim was to compare symptoms, first medical contact and pre-hospital delay times in patients with ST-elevation myocardial infarction and non-ST-elevation myocardial infarction.

METHODS AND RESULTS: This multicentre, observational study included 694 myocardial infarction patients from five hospitals. The patients filled in a questionnaire about their pre-hospital experiences within 24 h of hospital admittance. Chest pain was the most common symptom in ST-elevation myocardial infarction and non-ST-elevation myocardial infarction (88.7 vs 87.0%, p=0.56). Patients with cold sweat (odds ratio 3.61, 95% confidence interval 2.29-5.70), jaw pain (odds ratio 2.41, 95% confidence interval 1.04-5.58), and nausea (odds ratio 1.70, 95% confidence interval 1.01-2.87) were more likely to present with ST-elevation myocardial infarction, whereas the opposite was true for symptoms that come and go (odds ratio 0.58, 95% confidence interval 0.38-0.90) or anxiety (odds ratio 0.52, 95% confidence interval 0.29-0.92). Use of emergency medical services was higher among patients admitted with ST-elevation myocardial infarction. The pre-hospital delay time from symptom onset to first medical contact was significantly longer in non-ST-elevation myocardial infarction (2:05 h vs 1:10 h, p=0.001).

CONCLUSION: Patients with ST-elevation myocardial infarction differed from those with non-ST-elevation myocardial infarction regarding symptom presentation, ambulance utilisation and pre-hospital delay times. This knowledge is important to be aware of for all healthcare personnel and the general public especially in order to recognise symptoms suggestive of ST-elevation myocardial infarction and when to decide if there is a need for an ambulance.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
Myocardial infarction, ST-elevation myocardial infarction, care seeking, first medical contact, non-ST-elevation myocardial infarction, prehospital delay, symptoms
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-144358 (URN)10.1177/2048872617741734 (DOI)000464034100002 ()29111768 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden (FORSS) [161061]; Faculty of Medicine, Umea University, Sweden; Swedish Heart and Lung Foundation; Swedish Diabetes Foundation; County Councils of Vasterbotten, Sweden; Heart Foundation of Northern Sweden

Available from: 2018-01-16 Created: 2018-01-16 Last updated: 2019-06-12Bibliographically approved
Isaksson, R.-M., Sederholm Lawesson, S., Thylén, I., Swahn, E., Hellström Ängerud, K. & Karlsson, J.-E. (2019). Geographical Diversities in Symptoms, Actions and Prehospital Delay Times in Swedish ST-Elevation Myocardial Infarction(STEMI) Patients: A Descriptive Multicenter Cross-Sectional Survey Study. Insights of Cardiology Open Access, Article ID 100001.
Open this publication in new window or tab >>Geographical Diversities in Symptoms, Actions and Prehospital Delay Times in Swedish ST-Elevation Myocardial Infarction(STEMI) Patients: A Descriptive Multicenter Cross-Sectional Survey Study
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2019 (English)In: Insights of Cardiology Open Access, article id 100001Article in journal (Refereed) Published
Abstract [en]

Background: Geographical variations in cardiovascular mortality have been reported in Sweden as well as in other countries. Littleattention has been given to possible variations in symptoms, actions and pre-hospital delay times in ST-elevation myocardial infarction (STEMI) patients, as a reason for this diversity. We aimed to study whether STEMI patients from the northern and southern partsof Sweden differ in symptoms and actions that may affect the pre-hospital delay times.

Methods: SymTime was a multicentre cross-sectional survey study where STEMI patients admitted to the coronary care unit completed a validated questionnaire within 24 hours after admission. In total, 531 patients were included, 357 in the southern and 174 inthe northern part of Sweden.

Results: There were no significant differences in age. However, patients in the north had more often hypertension (52 vs 42%, p=0.02)or other concomitant comorbidities (24 vs 14%, p=0.01). Patients in the south experienced more anxiety (14 vs. 7%, p=0.01) and fear(23 vs. 14%, p=0.02) and more often contacted the emergency medical services (EMS) as first medical contact (FMC) (54 vs 44%,p=0.05). There were no differences in other main or associated symptoms or in pre-hospital delay times.

Conclusions: Patients with STEMI in the southern vs. the northern part of Sweden had more anxiety and fear, despite that they wereless often alone at onset of symptoms. There were no differences in pre-hospital delay times. Although patients from the southernregion contacted EMS as their FMC more frequently, it is still worrying that too few patients utilize the EMS.

Place, publisher, year, edition, pages
GRF Publishers, 2019
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-164903 (URN)
Funder
Medical Research Council of Southeast Sweden (FORSS), 161061Norrbotten County CouncilLinköpings universitet
Available from: 2020-03-31 Created: 2020-03-31 Last updated: 2020-03-31
Verheijden Klompstra, L., Johansson Östbring, M., Jaarsma, T., Ågren, S., Fridlund, B., Hjelm, C., . . . Strömberg, A. (2019). The Appropriateness and Presentation of Commonly Available Cardiovascular Web Pages Providing Information About Cardiovascular Diseases.. Computers, Informatics, Nursing, 37(10), 493-497
Open this publication in new window or tab >>The Appropriateness and Presentation of Commonly Available Cardiovascular Web Pages Providing Information About Cardiovascular Diseases.
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2019 (English)In: Computers, Informatics, Nursing, ISSN 1538-2931, E-ISSN 1538-9774, Vol. 37, no 10, p. 493-497Article in journal (Refereed) Published
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-161240 (URN)10.1097/CIN.0000000000000595 (DOI)31633511 (PubMedID)
Available from: 2019-10-24 Created: 2019-10-24 Last updated: 2020-02-03
Lundgren, O., Garvin, P., Kristenson, M., Jonasson, L. & Thylén, I. (2018). A journey through chaos and calmness: experiences of mindfulness training in patients with depressive symptoms after a recent coronary event - a qualitative diary content analysis.. BMC Psychology, 6(1), Article ID 46.
Open this publication in new window or tab >>A journey through chaos and calmness: experiences of mindfulness training in patients with depressive symptoms after a recent coronary event - a qualitative diary content analysis.
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2018 (English)In: BMC Psychology, E-ISSN 2050-7283, Vol. 6, no 1, article id 46Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Psychological distress with symptoms of depression and anxiety is common and unrecognized in patients with coronary artery disease (CAD). Efforts have been made to treat psychological distress in CAD with both conventional methods, such as antidepressant drugs and psychotherapy, and non-conventional methods, such as stress management courses. However, studies focusing on the experiences of mindfulness training in this population are still scarce. Therefore, the aim of this study was to explore immediate experiences of mindfulness practice among CAD patients with depressive symptoms.

METHODS: A qualitative content analysis of diary entries, written immediately after practice sessions and continuously during an 8-week long Mindfulness Based Stress Reduction course (MBSR), was applied.

RESULTS: Twelve respondents participated in the study. The main category: a journey through chaos and calmness captured the participants' concurrent experiences of challenges and rewards over time. This journey appears to reflect a progressive development culminating in the harvesting of the fruits of practice at the end of the mindfulness training. Descriptions of various challenging facets of mindfulness practice - both physical and psychological - commonly occurred during the whole course, although distressing experiences were more predominant during the first half. Furthermore, the diary entries showed a wide variety of ways of dealing with these struggles, including both constructive and less constructive strategies of facing difficult experiences. As the weeks passed, participants more frequently described an enhanced ability to concentrate, relax and deal with distractions. They also developed their capacity to observe the content of their mind and described how the practice began to yield rewards in the form of well-being and a sense of mastery.

CONCLUSIONS: Introducing MBSR in the aftermath of a cardiac event, when depressive symptoms are present, is a complex and delicate challenge in clinical practice. More nuanced information about what to expect as well as the addition of motivational support and skillful guidance during the course should be given in accordance with the participants' experiences and needs.

TRIAL REGISTRATION: The trial was retrospectively registered in clinicaltrials.gov (registration number: NCT03340948 ).

Place, publisher, year, edition, pages
BioMed Central, 2018
Keywords
Depressive symptoms, Mindfulness based stress reduction, Myocardial infarction, Qualitative content analysis, Unstable angina pectoris
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:liu:diva-153226 (URN)10.1186/s40359-018-0252-1 (DOI)30213276 (PubMedID)2-s2.0-85053272711 (Scopus ID)
Available from: 2018-12-03 Created: 2018-12-03 Last updated: 2019-05-01Bibliographically approved
Allemann, H., Strömberg, A. & Thylén, I. (2018). Perceived Social Support in Persons With Heart Failure Living With an Implantable Cardioverter Defibrillator: A Cross-sectional Explorative Study. Journal of Cardiovascular Nursing, 33(6), E1-E8
Open this publication in new window or tab >>Perceived Social Support in Persons With Heart Failure Living With an Implantable Cardioverter Defibrillator: A Cross-sectional Explorative Study
2018 (English)In: Journal of Cardiovascular Nursing, ISSN 0889-4655, E-ISSN 1550-5049, Vol. 33, no 6, p. E1-E8Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The links between chronic illness, psychological well-being, and social support have previously been established. Social isolation and loneliness have shown an increased mortality risk for those with heart failure (HF). Increasingly more people with HF are living with an implantable cardioverter defibrillator (ICD), but only a few small-scale studies have focused on social support in this population.

OBJECTIVE: The aim of this study was to explore factors related to perceived social support in a large cohort of individuals with HF living with an ICD.

METHODS: All eligible adult ICD recipients in the Swedish ICD registry were invited to participate in this cross-sectional study. For this analysis, those with HF and complete data on perceived social support were included (N = 1550; age, 67.3 (SD, 9.8) years; 19.5% female).

RESULTS: Most reported a high level of social support, but 18% did not. In logistic regression, living alone was the greatest predictor of low/medium support. Lower social support for those living alone was associated with poorer perceived health status, having symptoms of depression, and experiencing low perceived control. For those living with someone, lower support was associated with female gender, symptoms of depression and anxiety, and less control. Heart failure status and perceived symptom severity were not related to the outcome.

CONCLUSION: One in five participants reported low/medium social support. Our study underlines the complex relationships between perceived social support, psychological well-being and perceived control over the heart condition. Multiple aspects need to be taken into account when developing interventions to provide psychosocial support and optimize outcomes in this patient group.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2018
National Category
Nursing
Identifiers
urn:nbn:se:liu:diva-154035 (URN)10.1097/JCN.0000000000000523 (DOI)000457866800001 ()30063538 (PubMedID)
Available from: 2019-01-24 Created: 2019-01-24 Last updated: 2019-03-18
Ingadottir, B., Blondal, K., Thue, D., Zoega, S., Thylén, I. & Jaarsma, T. (2017). Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study.. JMIR Serious Games, 5(2), Article ID e10.
Open this publication in new window or tab >>Development, Usability, and Efficacy of a Serious Game to Help Patients Learn About Pain Management After Surgery: An Evaluation Study.
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2017 (English)In: JMIR Serious Games, E-ISSN 2291-9279, Vol. 5, no 2, article id e10Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Postoperative pain is a persistent problem after surgery and can delay recovery and develop into chronic pain. Better patient education has been proposed to improve pain management of patients. Serious games have not been previously developed to help patients to learn how to manage their postoperative pain.

OBJECTIVE: The aim of this study was to describe the development of a computer-based game for surgical patients to learn about postoperative pain management and to evaluate the usability, user experience, and efficacy of the game.

METHODS: A computer game was developed by an interdisciplinary team following a structured approach. The usability, user experience, and efficacy of the game were evaluated using self-reported questionnaires (AttrakDiff2, Postoperative Pain Management Game Survey, Patient Knowledge About Postoperative Pain Management questionnaire), semi-structured interviews, and direct observation in one session with 20 participants recruited from the general public via Facebook (mean age 48 [SD 14]; 11 women). Adjusted Barriers Questionnaire II and 3 questions on health literacy were used to collect background information.

RESULTS: Theories of self-care and adult learning, evidence for the educational needs of patients about pain management, and principles of gamification were used to develop the computer game. Ease of use and usefulness received a median score between 2.00 (IQR 1.00) and 5.00 (IQR 2.00) (possible scores 0-5; IQR, interquartile range), and ease of use was further confirmed by observation. Participants expressed satisfaction with this novel method of learning, despite some technological challenges. The attributes of the game, measured with AttrakDiff2, received a median score above 0 in all dimensions; highest for attraction (median 1.43, IQR 0.93) followed by pragmatic quality (median 1.31, IQR 1.04), hedonic quality interaction (median 1.00, IQR 1.04), and hedonic quality stimulation (median 0.57, IQR 0.68). Knowledge of pain medication and pain management strategies improved after playing the game (P=.001).

CONCLUSIONS: A computer game can be an efficient method of learning about pain management; it has the potential to improve knowledge and is appreciated by users. To assess the game's usability and efficacy in the context of preparation for surgery, an evaluation with a larger sample, including surgical patients and older people, is required.

Place, publisher, year, edition, pages
J M I R Publications, Inc., 2017
Keywords
evaluation studies, knowledge, pain management, patient education, self care, surgical procedures, operative, video games
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-139107 (URN)10.2196/games.6894 (DOI)28490419 (PubMedID)
Available from: 2017-07-01 Created: 2017-07-01 Last updated: 2019-06-27Bibliographically approved
Thylén, I., Moser, D. K., Strömberg, A., Dekker, R. A. & Chung, M. L. (2016). Concerns about implantable cardioverter-defibrillator shocks mediate the relationship between actual shocks and psychological distress.. Europace, 18(6), 828-835
Open this publication in new window or tab >>Concerns about implantable cardioverter-defibrillator shocks mediate the relationship between actual shocks and psychological distress.
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2016 (English)In: Europace, ISSN 1099-5129, E-ISSN 1532-2092, Vol. 18, no 6, p. 828-835Article in journal (Refereed) Published
Abstract [en]

AIMS: Although most implantable cardioverter-defibrillator (ICD) patients cope well, fears about receiving ICD shocks have been identified as a major determinant of psychological distress. The relationships among ICD-related concerns, receipt of defibrillating shocks, and symptoms of anxiety and depression have not yet been investigated. Our objective was to examine whether the relationship between receipt of defibrillating shocks and psychological distress was mediated by patients' concerns related to their ICD.

METHODS AND RESULTS: All Swedish ICD-recipients were invited to this cross-sectional correlational study; 3067 completing the survey (55% response rate). Their mean age was 66 ± 11 years, and 80% were male. One-third (35%) had received defibrillating shocks, and 26% had high ICD-related concerns. Regression analyses demonstrated that having received at least one shock significantly predicted symptoms of anxiety and depression [odds ratio (OR) 1.58 and OR 3.04, respectively]. The association between receipt of shocks and psychologically distress was mediated by high ICD-related concerns which explained 68% of the relationship between shocks and symptoms of anxiety, and 54% of the relationship between shocks and symptoms of depression.

CONCLUSION: Implantable cardioverter-defibrillator-related concerns have a bigger impact on psychological distress than receipt of an actual shock. Assessing ICD-related concerns in clinical practice can identify patients at risk for psychological distress. Further research on assessment of, and interventions targeting, ICD-related concerns is warranted.

Place, publisher, year, edition, pages
Oxford University Press, 2016
Keywords
Implantable cardioverter-defibrillator; ICD-related concerns; ICD shocks; Mediators; Psychological distress
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-124321 (URN)10.1093/europace/euv220 (DOI)000379742500009 ()26324839 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden (FORSS); Swedish Heart and Lung Association

Available from: 2016-01-26 Created: 2016-01-26 Last updated: 2017-11-30Bibliographically approved
Miller, J. L., Thylén, I. & Moser, D. K. (2016). Gender Disparities in Symptoms of Anxiety, Depression, and Quality of Life in Defibrillator Recipients.. Pacing and Clinical Electrophysiology, 39(2), 149-159
Open this publication in new window or tab >>Gender Disparities in Symptoms of Anxiety, Depression, and Quality of Life in Defibrillator Recipients.
2016 (English)In: Pacing and Clinical Electrophysiology, ISSN 0147-8389, E-ISSN 1540-8159, Vol. 39, no 2, p. 149-159Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Most patients cope well with an implantable cardioverter defibrillator (ICD), but psychological distress and ICD-related concerns have been reported in about 20% of ICD recipients. Many previous studies have not distinguished between genders.

METHODS: In this nationwide study we compared quality of life, anxiety, and depression symptoms between the genders in ICD recipients, and determined predictors of each of these variables in men and women. All adult Swedish ICD recipients were invited by mail to participate and 2,771 patients (66 ± 12 years) completed standardized measures of quality of life, symptoms of anxiety, and depression. Time since implantation ranged from 1 year to 23 years with a mean of 4.7 ± 3.9.

RESULTS: Women reported worse quality of life (mean index 0.790 vs 0.825) and higher prevalence of anxiety (20.5% vs 14.7%) than did men (P < 0.001 for both comparisons), while there were no differences in symptoms of depression (8.8% vs 8.2%).

CONCLUSIONS: Most ICD recipients report a good quality of life, without emotional distress, but among the minority with distress, women fare worse than men.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2016
Keywords
gender; implantable cardioverter defibrillator; psychological distress
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-125070 (URN)10.1111/pace.12786 (DOI)000370139200006 ()26856629 (PubMedID)
Available from: 2016-02-12 Created: 2016-02-12 Last updated: 2017-11-30
Hellström Angerud, K., Thylén, I., Lawesson, S., Eliasson, M., Näslund, U. & Brulin, C. (2016). Symptoms and delay times during myocardial infarction in 694 patients with and without diabetes; an explorative cross-sectional study. BMC Cardiovascular Disorders, 16(108), Article ID 108.
Open this publication in new window or tab >>Symptoms and delay times during myocardial infarction in 694 patients with and without diabetes; an explorative cross-sectional study
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2016 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 16, no 108, article id 108Article in journal (Refereed) Published
Abstract [en]

Background: In myocardial infarction (MI) a short pre-hospital delay, prompt diagnosis and timely reperfusion treatment can improve the prognosis. Despite the importance of timely care seeking, many patients with MI symptoms delay seeking medical care. Previous research is inconclusive about differences in symptom presentation and pre-hospital delay between patients with and without diabetes during MI. The aim of this study was to describe symptoms and patient delay during MI in patients with and without diabetes. Methods: Swedish cross-sectional multicentre survey study enrolling MI patients in 5 centres within 24 h from admittance. Results: Chest pain was common in patients both with and without diabetes and did not differ after adjustment for age and sex. Patients with diabetes had higher risk for shoulder pain/discomfort, shortness of breath, and tiredness, but lower risk for cold sweat. The three most common symptoms reported by patients with diabetes were chest pain, pain in arms/hands and tiredness. In patients without diabetes the most common symptoms were chest pain, cold sweat and pain in arms/hands. Median patient delay time was 2 h, 24 min for patients with diabetes and 1 h, 15 min for patients without diabetes (p = 0.024). Conclusion: Chest pain was common both in patients with and without diabetes. There were more similarities than differences in MI symptoms between patients with and without diabetes but patients with diabetes had considerably longer delay. This knowledge is important not only for health care personnel meeting patients with suspected MI, but also for the education of people with diabetes.

Place, publisher, year, edition, pages
BIOMED CENTRAL LTD, 2016
Keywords
Myocardial infarction; Diabetes mellitus; Symptoms; Patient delay
National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-130841 (URN)10.1186/s12872-016-0282-7 (DOI)000380228500001 ()27386934 (PubMedID)
Note

Funding Agencies|Swedish Heart and Lung Foundation; Swedish Diabetes Foundation; County Councils of Vasterbotten; Heart Foundation of Northern Sweden

Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2017-05-02Bibliographically approved
Thylén, I., Ericsson, M., Hellstrom Angerud, K., Isaksson, R.-M. & Lawesson, S. (2015). First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study. BMJ Open, 5(4), e007059
Open this publication in new window or tab >>First medical contact in patients with STEMI and its impact on time to diagnosis; an explorative cross-sectional study
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2015 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 5, no 4, p. e007059-Article in journal (Refereed) Published
Abstract [en]

Objective: It is unknown into what extent patients with ST-elevation myocardial infarction (STEMI) utilise a joint service number (Swedish Healthcare Direct, SHD) as first medical contact (FMC) instead of Emergency Medical Services (EMS) and how this impact time to diagnosis. We aimed to (1) describe patients FMC; (2) find explanatory factors influencing their FMC (ie, EMS and SHD) and (3) explore the time interval from symptom onset to diagnosis. Setting: Multicentred study, Sweden. Methods: Cross-sectional, enrolling patients with consecutive STEMI admitted within 24 h from admission. Results: We included 109 women and 336 men (mean age 66 +/- 11 years). Although 83% arrived by ambulance to the hospital, just half of the patients (51%) called EMS as their FMC. Other utilised SHD (21%), contacted their primary healthcare centre (14%), or went directly to the emergency room (14%). Reasons for not contacting EMS were predominantly; (1) my transport mode was faster (40%), (2) did not consider myself sick enough (30%), and (3) it was easier to be driven or taking a taxi (25%). Predictors associated with contacting SHD as FMC were female gender (OR 1.92), higher education (OR 2.40), history of diabetes (OR 2.10), pain in throat/neck (OR 2.24) and pain intensity (OR 0.85). Predictors associated with contacting EMS as FMC were history of MI (OR 2.18), atrial fibrillation (OR 3.81), abdominal pain (OR 0.35) and believing the symptoms originating from the heart (OR 1.60). Symptom onset to diagnosis time was significantly longer when turning to the SHD instead of the EMS as FMC (1: 59 vs 1: 21 h, pless than0.001). Conclusions: Using other forms of contacts than EMS, significantly prolong delay times, and could adversely affect patient prognosis. Nevertheless, having the opportunity to call the SHD might also, in some instances, lower the threshold for taking contact with the healthcare system, and thus lowers the number that would otherwise have delayed even longer.

Place, publisher, year, edition, pages
BMJ Publishing Group: Open Access / BMJ Journals, 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-119268 (URN)10.1136/bmjopen-2014-007059 (DOI)000354705000054 ()25900460 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden (FORSS) [161061]

Available from: 2015-06-12 Created: 2015-06-12 Last updated: 2017-12-04
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-7097-392X

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