Circ Cardiovasc Qual
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Circ Cardiovasc Qual · Jan 2009
Multicenter StudyElapsed time in emergency medical services for patients with cardiac complaints: are some patients at greater risk for delay?
In patients with a major cardiac event, the first priority is to minimize time to treatment. For many patients, first contact with the health system is through emergency medical services (EMS). We set out to identify patient-level and neighborhood-level factors that were associated with elapsed time in EMS. ⋯ Compared with otherwise similar men, women have 50% greater odds of being delayed in the EMS setting. The determinants of delay should be a special focus of EMS studies in which time to treatment is a priority.
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Circ Cardiovasc Qual · Jan 2009
Multicenter StudyImpact of age and medical comorbidity on the effectiveness of implantable cardioverter-defibrillators for primary prevention.
Although implantable cardioverter-defibrillators (ICDs) reduce mortality in primary prevention patients with left ventricular systolic dysfunction, recent studies have questioned their overall role in clinical practice, especially in older patients and those with major comorbid conditions. ⋯ Routine use of ICDs in primary prevention patients with left ventricular systolic dysfunction was associated with lower all-cause mortality, even among older patients and those with major comorbid conditions. Although their use needs to be individualized, our findings suggest that these groups should not be routinely excluded from ICD treatment.