Background
Reference | Zhang B et al. 2016 [15] | Peny YG et al. 2014 [10] | Wang X and Hsu L 2013 [13] | Gao Y and Zhang HJ 2013 [9] | Qian L et al. 2013 [11] | Song L et al. 2010 [12] | Zhang S et al. 2009 [16] | Wu Y et al. 2004 [14] |
---|---|---|---|---|---|---|---|---|
Title | Gender and Age Differences Associated with Prehospital Delay in Chinese Patients presenting with ST-Elevation Myocardial Infarction | Factors associated with prehospital delay in patients with ST-segment elevation acute myocardial infarction | Treatment-seeking delays in patients with acute myocardial infarction and use of the emergency medical service | The effect of symptoms on prehospital delay time in patients with acute myocardial infarction | Factors associated with decision time for patients with ST-segment elevation acute myocardial infarction | Impact of patients’ symptom interpretation on care-seeking behaviors of patients with acute myocardial infarction | Use of Emergency Medical Services in Patients with Acute Myocardial Infarction in China | Factors associated with the extent of care-seeking delay for patients with acute myocardial infarction in Beijing |
Setting/ No. of hospitals | Liaoning Province/ 20 | Beijing/ 1 | Shanghai/ 3 | Jinzhou/ 1 | Whenzhou/ 1 | Beijing/ 19 | Beijing/ 21 | Beijing/ 8 |
Study | prospective, cross-sectional, multi-center | cross-sectional | cross-sectional, multi-center | cross-sectional | cross-sectional | cross-sectional, multi-center | prospective, cross-sectional, multi-center | cross-sectional, multi-center |
Sample size, diagnosis | n = 1429, STEMI | n = 1088, STEMI | n = 250, AMI | n = 116, AMI | n = 100, AMI | n = 799, STEMI | n = 803, AMI | n = 102. AMI |
Reported results | ||||||||
Sex |
27.2% female
|
24.9% female
|
36.4% female
|
27.6% female
|
26% female
|
21.1% female
|
22.0% female
|
23.5% female
|
Mean age (+/− SD) |
–
|
60.94 yrs (+/−12.8)
|
63.5 yrs
|
64.1 yrs (+/− 13.9)
|
65.7 yrs (+/− 12.7)
|
61 yrs (+/− 13)
|
–
|
62 yrs (+/− 12)
|
Years of education | 65.7% (> 6 yrs) | 47.2% (> 9 yrs) |
78.0% (> 6 yrs)
| – | 38% (> 6 yrs) | 16.3% (≥12 yrs) | 57.2% (> 6 yrs) | 75.5% (> 9 yrs) |
Insurance |
58.1%
|
–
|
88.8%
|
–
|
89.0%
|
76.2%
|
73.7%
|
–
|
Reinfarction |
7.3%
|
24%
|
10.8%
|
33.6%
|
–
|
9.5%
|
9.5%
|
11.8%
|
Chest pain |
73.8%
|
84.7%
|
–
|
68.1%
|
–
|
82.1%
|
87.6%
|
87.3%
|
Angina | 28.4% |
–
|
–
|
–
|
24.0%
|
–
|
25.9%
|
33.3%
|
EMS-use |
–
|
59%
|
30.8%
|
–
|
–
|
33.0%
|
39.5%
|
14.7%
|
Median delay time | 150 min | 130 min | 130min* Median patient decision time | 132 min | – | 140 min | – | – |
Delay > 2 h | 53.7% | 51.4% | – | 66.7% | – | 55.4% | – | 63% |
Methods
Study design
Study setting
Clinical setting and organization
Data sources
Information from the interview
Information from the self-administered questionnaire
Affective disorders | Stress and Somatic symptom burden | Social support | ||||
Instrument | Major Depression Inventory | General Anxiety Disorder Scale | INTER-HEART Stress | High Symptom Somatic Scale | Perceived Stress Scale | Social Support Rating Scale |
Abbreviation | MDI | GAD-7 | IHS | SSS-8 | PSS-4 | SSRS |
Authors, year | Bech P., Rasmussen N.A., Noerholm V., Abildgaard W. (2001) [41] | Spitzer R. L., Kroenke K., Williams J.B. (2006) [42] | Rosengren A. et al. (2004) [43] | Narrow W. et al. (2013) Gierck B. et al. (2014) [44] | Cohen S., Kamarck T Mermelstein R. (1983) [45] | Shuiyuan X. (1994) [46] |
Measures | Depressed mood severity, major depressive disorder according to DSM-IV and ICD-10 | Anxiety | Stress from the workplace, at home and financial problems | Somatic Symptom Burden | Global measure of perceived stress | Social support in Chinese patients |
Domains | Measures 10 (3 core; 7 accompanying) symptoms of depression | 1 domain | 3 domains: stress in the family, at work or due to financial problems | Somatic, anxiety and depressive symptoms | 2 domains | 3 domains: subjective support, objective support and support usage |
Items (n) | 10 | 7 | 3 | 8 | 4 | 10 |
Range/score | 0–50 | 0–21 | 3-12 | 0–32 | 0–16 | 12–66 |
Reference describing the use on a Chinese population | Sociodemographic Correlates of Unipolar Major Depression among the Chinese Elderly in Klang Valley, Malaysia: An Epidemiological Study Verma et al. (2014) [47] | Reliability and validity of a generalized anxiety disorder scale in general hospital outpatients He X. et al. (2010)* [48] | Marital Status, Education, and Risk of Acute Myocardial Infarction in Mainland China: The INTER-HEART Study Hu et al. (2012) [49] | Application of Patient Health Questionnaire somatic symptom scale in the General Hospital Outpatients Qian J. et al. (2014)* [50] | Three versions of Perceived Stress Scale: validation in a sample of Chinese cardiac patients who smoke Leung et al. (2010) [51] | The Theoretical Basis and Research and Application of “Social Support Rating Scale” Shuiyuan X. et al. (1994)* [46] |
Locus of control | Well-being | Cardiac denial | Resilience | Personality disorders | ||
Instrument | Mental Health locus of control scale | Well-Being Index | The cardiac denial of impact scale | Resilience Scale 5 | Type D Scale-14 | Framingham Type A personality scale |
Abbreviation | MHLC | WHO-5 | CDIS | RS-5 | DS-14 | FRAS |
Authors, year | Wallston K.A., Wallston B.S., DeVellis R. (1978) [52] | Bech P., Olsen L.R., Kjoller M., Rasmussen N.K. (2003) [53] | Denollet (2005) [58] | Haynes et al. (1980) [59] | ||
Measures | Degree to which health is considered to be determined by own behaviour | Well-being according to the WHO definition | Impact of denial among cardiac patients | Psychosocial stress resistance | Negative affectivity, social inhibition, type D personality | Traits, qualities in character and reaction to work or housework |
Domains | Self-responsibility, self-blame, powerful others | Happiness, energy, motivation, interest in daily life. | Denial of impact | Personal competence and acceptance of self and life | Negative affectivity and social inhibition | 2 domains |
Items (n) | 12 | 5 | 8 | 5 | 14 (7 per domain) | 10 |
Range/score | 1–5 (per item) | 0–100 | 8–40 | 5-35 | 0–28 (per domain) | 0–1 |
Reference describing the use on a Chinese population | Clinical application study on multidimensional health locus of control scales Chen S.J., Wang W.L., Pan Q. (2014)* [60] | Reliability and validity of the World Health Organization Five-item Well-being Index for detecting depressive disorders in senior middle school students Wang Z., Bian Q. (2011)* [61] | – | – | Development of type D personality scale and its reliability and validity in Chinese adolescents and children with emotion disorders. Zhang Y. et al. (2006)* [62] | Short communication: Personal and organizational outcomes related to job stress and Type-A behavior: a study of Canadian and Chinese employees Jamal M. (2005) [63] |
Information from the hospital chart
Data entry
Sample size calculation
Data analysis
Results
Sample size and dropout-analysis
Patient characteristics
Percentage (n) | total (n) | |
---|---|---|
Baseline patient characteristics | ||
Sex | ||
Male | 81.4% (241) | 296 |
Female | 18.6% (55) | |
Age | ||
Older age (≥60 years) | 60.8% (180) | 296 |
Younger age (< 60 years) | 39.2% (116) | |
Years of education | ||
6 years (elementary school) | 9.8% (29) | 296 |
9 years (middle school) | 38.5% (114) | |
12 years (senior high-school) | 31.4% (93) | |
Over 12 years (university degree) | 15.5% (46) | |
Less than 6 years or none | 4.7% (14) | |
Medical insurance | ||
Insured | 80.5% (236) | 293 |
Not-insured | 19.5% (57) | |
Clinical patient characteristics | ||
AMI-history | ||
First infarction | 91.9% (272) | 296 |
Reinfarction | 8.1% (24) | |
Prodromal chest pain | ||
Chest pain | 60.1% (178) | 296 |
No chest pain | 39.9% (118) | |
Psychological patients characteristics | ||
Anxiety (Score ≥ 10) | 11.7% (31) | 265 |
Depression (Score > 25) | 12.4% (33) | 267 |
Cardiac denial (Score ≥ 25) | 53.2% (141) | 265 |
Factors surrounding symptom-onset
Percentage (n) | total (n) | |
---|---|---|
Onset of acute myocardial infarction | ||
In the acute situation | ||
Chest pain and radiation | 40.9% (121) | 296 |
Only chest pain | 46.6% (138) | |
No chest pain | 12.5% (37) | |
Symptom appraisal at symptom-onset | ||
Symptom attribution | ||
Cardiac (> 3) | 61.0% (166) | 272 |
Non-cardiac (≤3) | 39.0% (106) | |
Symptom expectation | ||
As expected (> 3) | 30.3% (87) | 287 |
Not as expected (≤3) | 69.7% (200) | |
Context variables of symptom-onset | ||
Transport | ||
Self-transported (walking/ driving) | 17.3% (51) | 294 |
Driven by others (private/ public) | 59.9% (176) | |
Via ambulance | 22.8% (67) |